Friday, November 29, 2013

The Elephant In The Room: Partying Like It's 1986

Boys and girls, let's flash back to those thrilling days of yesteryear.
To 1986, to be specific.

Our beloved federal representatives, in the spirit of Satan Santa Claus, bestowed upon our republic (and to a great degree, most of the medical professions) two acts of public munificence scarcely to be imagined (at least by anyone who can balance a checkbook).

I refer to the Immigration Reform and Control Act, and the Emergency Medical Treatment and Active Labor Act, whose passage the same year was anything but coincidental.

EMTALA was, in almost every way, the prequel to Obamacare. It mandated (without anyone anywhere paying for it) that all hospitals with emergency services had to provide them to anyone and everyone who walked in, regardless of ability to pay, citizenship status, or any other wee considerations.

Imagine, if you will, McDonald's mandated to give away free cheeseburgers to everyone who demanded one under the same (lack of) restrictions, and then come up with your best guess as to how long before they'd go bankrupt and close forever.

Except that, as a rule, hospitals are full of people who don't want to close, because they're genuinely concerned with finding a way to help people rather than shutting down forever. Because unlike a fast food restaurant, when hospitals close, people don't just miss lunch; they die.

Nonetheless, skyrocketing unreimbursed expenses under EMTALA have driven hundreds of hospitals, especially the smaller community hospitals you may remember if you're over 30, right off the financial cliff and out of business forever, along with no small number of larger facilities as well, due to the crushing burden of unreimbursed care to the indigent and illegal. (CA has lost something like 80 hospitals in the last 15 years, when last I looked, and chiefly for exactly this reason.)

Many others (Kaiser, I'm looking at you) simply curtailed or eliminated emergency services, thus ducking the law (legally). Which then made the wait for you or I to be seen at the hospital ERs remaining climb from minutes, to hours, to even days now at some inner city locations.

The huge hospitals and health care chains that remained had to find a way to make ends meet and buffer the enormous financial losses, so they began padding their bills. Your aspirin, for example, now costs $20. Mind you, it's still bought at $0.02@, but the cost to the insured helps subsidize the 999 other ones given out free (or at least unreimbursed by the recepients, or anyone else) to homeless, indigent, poor, uninsured, and illegal aliens, all by the trainload daily at every hospital impacted by the new law. Nothing in the new law gave these folks any incentive to make better life choices, nor any likelihood they'll ever have to pay for all the "free" health care that Tip O'Neill and Congress started handing out to them, as they have for almost 30 years now. After helpfully inviting 3 million folks to partake of American citizenship with IRCA the same year.

Flash forward, and let's see how those two genius moves have worked out:
Hospital emergency care impacted.
Health care cost rocketing to Jupiter.
Wait times to the moon.
Another 10-20 million folks thronging here illegally, and partaking of all the benefits of "free" health care, among other things.

So, in order to wipe out the scourge of uninsured patients and rampant runaway costs, we get EMTALA on steroids: Obamacare! (Because as we all know, if smashing your thumb with a hammer hurts, the best cure is to take a sledgehammer to your entire hand!)

By forcing millions of young healthy people who could formerly choose to do without it to get health insurance under Obamacare (under pain of IRS enforcement and hefty fines), the government, in collusion with the insurance companies, and against the interests of everyone, not least of them those millions of young healthy folks, has found a new way to pay for care for the unemployed, indigent, insane, and illegal patients, and now everyone else gets to pay for it all, forever! It's a Health Care Miracle!! (Well, except for that whole crashing 1/6th of the American economy like it were the LZ Hindenburg thing. FWIW, the hospital I formerly worked out has laid off 40% of staff across the board, in the fear certainty that reimbursement schemes will bankrupt them. Which put 1200 formerly insured and gainfully employed folks, and their families, in the unemployment line to buy...wait for care from Obamacare! Genius, no?)

And more doctors leave the profession forever (25% of our ED doctors group retired last December, most of them years early, and the group has no plans to replace them anytime soon), most of the rest curtail or cease entirely accepting Medicare or any other government insurance, more hospitals close, the wait gets longer at the ones which remain, and the billing price of everything, like that $20 aspirin, is worse than gasoline: rising indefinitely, with no end in sight.

Meanwhile, your employers cancel (or will shortly) your policies, cut your hours to less than 29@week, or just lay you off outright. And the insurance companies sit back, as their willing shark-smiling minions at the IRS shovel you one and all into their maw, by the government's requirements that everyone buy insurance they don't need - like mandatory mammogram and maternity coverage for men - at prices they can't afford.
Cue government single payer in 3, 2,...

Next up: Let's bring that whole Amnesty Thing up for discussion again, so we can "solve" that problem like we "solved" the health care "crisis".

The biggest problem isn't that the Obamacare sign-up website is broken. It's that someday, it's going to work exactly as designed.

Grab your wallets, and run for your lives.

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