By: Jane M. Orient, M.D.
If you’d like a preview of what your medical care might look like after 2014, when the Patient Protection and Affordable Care Act (PPACA) is fully implemented, take a look at schools in Wisconsin: they’re closed.
The teachers, members of a public employees union, are not exactly on strike, as that would be illegal. Instead they are at the state capitol, obstructing government as well as education. They might still be getting paid because they are taking sick false leave. True, they are able to stand outside in the cold for hours, holding signs, but they do have a doctor’s excuse. They are “stressed,” or “sick of Governor Walker,” or “anxious” about their future taxpayer-funded benefits, or “depressed” about pending legislation. This has been coded and documented in appropriate medical terminology by a credentialed provider, on a properly executed form.
Under PPACA, doctors and other medical workers (now all lumped together as “providers”) are likely to be unionized too. They’ll have to follow work rules, or the equivalent, in any case. These rules are designed to prevent too much work. If doctors join the new type of collective practice, called an accountable care organization, they’ll be punished if too much money is spent providing too much care. Or if there are “disparities” because patients belonging to a “majority” (non-disadvantaged) ethnic or racial group got more than their fair share of the resources.
In addition to studying complex rules and performing administrative busywork, providers will spend a lot of their time writing work excuses, a high-priority function in a socialized economy. In England, for example, absenteeism nearly doubled in the first year of the National Health Service.
Union benefits will be protected by government, as the government is protected by unions. Waivers from onerous provisions of PPACA are generously granted to unions, which generously contribute to friendly politicians from the dues extracted from workers. If the majority (“We won”) party should lose that status in an election, because of taxpayer concerns about the impending bankruptcy of the state, it can still win by hiding out in a luxury hotel in another state. By making it impossible to obtain a quorum, they can keep the legislature from voting to diminish taxpayer-funded union benefits. This maneuver is not a boycott or a strike—when used by the union’s friends.
Once the PPACA passed, it seemingly became immune to repeal, like unsustainable union pensions—as long as its chief advocate (for whom PPACA is often called “ObamaCare”) rules over the executive branch and has the power to veto repeal.
Administrative agencies can redistribute the benefits to friends, and the burdens to enemies—a great way to increase the number of supporters and neutralize opponents. The executive branch is also in charge of the police, the prosecutors, and the prisons.
They enforce the very punitive laws against violating ambiguous and enormously complex rules. Phony work excuses for union members get a wink and a nod and a pass—and a paycheck. A wrong code or an extra service to an ineligible patient gets the doctor an “F” for “fail”—and possibly a fine and a prison term for “fraud.”
The courts are a weak barrier against overreaching by the executive. Judge Vinson, in a case brought by a majority of the states, ruled PPACA unconstitutional. The Obama Administration is forging ahead unhindered. On the other hand, if the legislature passes a law it doesn’t like, the Administration can decide on its own, without benefit of a court, that the law is unconstitutional and refuse to enforce it. (That kind of law seems to involve restrictions on gay marriage or abortion.) PPACA will go to the Supreme Court. But one wonders whether the question once asked about the Pope will be asked in another context: How many divisions does the Supreme Court have?
The “community organizers” who support unions and “reform” can mobilize thousands. Organizing for America, which uses the Obama “O” as its logo, is bussing protestors to Wisconsin. It is also raising money to fight the repeal of PPACA.
“The people are speaking” in the street here, though not as violently as in Egypt. Governor Walker is being portrayed as a Hitler or a Stalin. Signs say “Don’t Retreat, Reload; Repeal Walker,” and show Walker’s face in the crosshairs. Such a graphic on a map of congressional districts got Sarah Palin accused of instigating the shooting of Congresswoman Giffords. But venomous, hate-filled rhetoric is apparently okay when used by unions and their friends.
Education and medicine are key targets in the progressive agenda to “fundamentally transform” America. Government schools are already in its grip. By their actions in Wisconsin, unionized teachers are setting an example of cheating and lying. Is that what their students are learning? The union defines right and wrong, sickness and health, truth and falsehood—to suit its purposes. Some doctors are already collaborating with this agenda. In Wisconsin’s government schools, more than half of the students don’t learn to read well. What will happen to patients in medical facilities run on the same principles? Many may get nothing more than a work excuse.
Wisconsin is showing us the face of progressive reform. We need to study it, and learn.
Jane M. Orient, M.D., On Air contributor speaking on Healthcare Reform. Dr. Orient has appeared on some of the largest TV and Radio Networks in the country and her op-eds have been printed in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and The New York Times.
Doctor Orient is the Executive Director of Association of American Physicians and Surgeons and has been in solo practice of general internal medicine since 1981. She is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.
