Health care

ObamaCare -- now what?

Brad and Dallas Woodhouse debate


My patients were confused before and they are confused now. All they ever cared about (can you blame them) is being taken care of if they are sick and being able to afford that care.

They don’t like (nor do I) all the excess paperwork at the doctors’ office these days and all the time I have to spend documenting things in the computer. Nothing’s easy anymore. All my patients understand that when they have to wait it’s not because I’m on the golf course, but rather that I’m stuck documenting or ordering things on patients I saw before them. Of course, knowing this doesn’t make it easier and I can’t blame my patients for feeling uneasy.

But I can promise you that the politicians in Washington, D.C., are not envisioning what it’s like to seek care in an actual doctor’s office. That was the problem before, and it’s the problem now. No patient would ever confuse health insurance and health care the way the politicians have. Patients understand that insurance promises care but doesn’t always deliver it, especially if you have a $12,000 deductible to overcome first or your doctor’s schedule is full.

None of my patients (even those with Attention Deficit Disorder) would ever try to accomplish several different things at once in their job, and none of them would try to push their agenda down other peoples’ throats at work exactly the same way it had been done to them seven years before.

Most of my patients -- including the lawyers -- understand compromise and co-operation, negotiation and arbitration. Few would have recommended attaching Medicaid reform to Planned Parenthood defunding and lumping it all together with a scalping of taxes and deregulations and establishing a national marketplace and cutting so-called essential benefits and supposedly playing it out over three phases. All too complicated and testosterone-laced for the average patient.

But wait a minute. Isn’t the average patient (and their doctor) supposed to be the target audience here?

So what now? Now that we’ve reached a Shakespearean standstill, what’s next? I have a suggestion: Can we finally try to sideline the insurance lobbyists (AKA THE SWAMP) and work to please the average patient (and their doctor)?

Why not start with this -- ALL of my patients recognize that the high deductibles and high premiums of ObamaCare are prohibitive. Yes, the government (tax dollars) pay down their premium if they are lower middle class so their bottom line is improved, but they are still faced with that mountainous deductible and few insurers, few doctors and few labs to serve them. That’s why ObamaCare doesn’t work.

Many of my young, healthy patients want catastrophic insurance that they can use if they are in an accident and have to go to an emergency room rather than be faced with a huge bill. But most would rather buy a low cost policy than be forced to pay a high premium to cover someone else's mental health services or a copay on someone else’s colonoscopy. Can you blame them? No wonder that according to HHS 45 percent of those who took the penalty rather than buy ObamaCare are under 35 years old.

In other words, my patients need a catastrophic option without all the “essential” benefits of ObamaCare. They need to NOT be forced to buy health insurance if it doesn’t guarantee actual health care.

Medicaid needs to be made more efficient, but NOT overhauled at this point. The popular expansion needs to stay. How about simply introducing a bridge-to-jobs program and premium pay-in for extra services and rewards for efficiency and good doctoring. 

Planned Parenthood needs to be kept completely out of the equation; it has nothing to do with reforming or replacing ObamaCare and should never have been glued into a replacement bill.

I bet if Medicaid is left alone we can get some Democrats to vote for a new bill. I bet that if we remove the one-size fits all prix fixe solution from ObamaCare and offer a la carte choices we will attract more small insurers to the market -- which will introduce competition and bring down the price.

I also bet that if we increase Health Savings Accounts as part of the health care soup we will encourage patients to negotiate for services -- which could also bring down the price. While we’re at it, why don’t we pay doctors a bit more and add malpractice reform which will lead to less defensive doctoring and also bring down the price.

But the truth is I don’t care about pleasing Democrats OR insurers or even doctors, for that matter. I care about my patients. I want them to understand what’s happening and to feel taken care of.

I want my patients to choose what happens next.

Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He has been a medical analyst and reporter for Fox News since 2008.