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A Doctor's Prognosis for Obamacare -- The Four Essential Problems With the Patient

This week Dr. Howard Dean, an internist by training and the former head of the Democratic National Committee, went on the record in an appearance on cable TV and predicted that the mandate in the new health care law that requires everyone to carry health insurance would be dropped, either because it will be ruled unconstitutional or because people are just uncomfortable being told what to do. 

As a practicing physician, I couldn't agree more. The mandate is one essential problem with the health care reform law. 

A second problem is the lack of attention to the growing doctor shortage. Many of us who are practicing medicine in the current climate are not happy with third party payers of any kind, public or private, and we are dropping out of insurance, and beginning to band together to protest.  

A third mistake is perpetuating the myth that hospital emergency rooms will no longer carry as large a burden when everyone has insurance

A fourth oversight is not considering how advancing technologies, which are expensive, targeted, and personalized, are going to be covered by a one-size-fits all insurance model that has no disincentive for overuse and so can only control premiums by denying services.

The biggest problem with Obamacare is that it is not about health care, it is all about health insurance. 

Dean is right when he says that people are balking at the concept of being forced to carry health insurance, which doesn't guarantee you health care. 

Lawsuits are underway in Virginia, Florida, and several other states that will test the constitutionality of the new law. 

Last week, 71% of voters in Missouri supported Proposition C, which would establish a state law that people wouldn't be compelled to pay a penalty if they failed to have health insurance. Similar resolutions are expected soon in Arizona and Oklahoma.

Focusing on whether the new health reform law is actually constitutional or not is not as central from a medical point of view as the question of what constitutes health care itself. Obamacare doesn't address that crucial question. 

If, for example, the U.S. government demonstrates an obligation to protect American society by mandating a certain vaccine and then providing it, I and other doctors would have less of an objection than if it insists that all my patients buy an insurance that doesn't guarantee them access to health care. Why should patients be obligated to buy insurance by a federal government that won't even mandate that insurance must be portable across state lines? Portability of insurance would have helped my patients more than a law that mandates that we all carry an insurance which must be purchased at the state exchanges.

If the U.S. government feels a responsibility to provide a rudimentary form of health care for all, the only honest way to do that would be to train and hire the doctors to administer the care and build sufficient facilities for it to be delivered in. Anything else is a cheat on the American people.

Mandating health insurance is not only questionable legally, it is also questionable medically. It sets up an unsustainable tautology that assumes willing participation on the part of doctors. But many of the doctors I know will drop out, even if their patients can't.

Marc Siegel M.D. is an associate professor of medicine at NYU Langone Medical Center and a Fox News Medical contributor.

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