A healthy new year to all my patients and to patients everywhere. This year will decide the future of the insurance-expansion albatross that doctors and patients alike have come to call “ObamaCare.” My regular readers on this website and elsewhere have come to know my opinions.
• We don’t have the horses to pull the ObamaCare cart. The insurance expansion was done without attention to the doctor shortage and the growing doctor discontent and dropping out of insurances especially Medicaid and Medicare.
• No tort reform leaves doctors continuing to practice defensively, while increasing regulation restricts our use of essential technologies.
• What I call the overuse syndrome pervades current health insurance (public and private) and is even worse with ObamaCare, where insurance covers too much without a built in disincentive for overuse of non-essential services (such as a large co-pay or deductible or expanded health savings account).
• Universal health insurance should be focused only on severe illness – a catastrophic-plus policy.
• Insurance should be portable across state lines to encourage competition.
• The individual mandate is not only unconstitutional, it also undermines the essential role of government. If the government believes there is an unmet health care need, it should provide for it directly, as with a vaccine or anti-viral drug in a pandemic. If the government finds that the poor are under-served, it can expand the National Health Services Corp and provide more federally funded clinics.
• The age of qualifying for Medicare should be raised to 68, and Medicaid should not be expanded.
By contrast to my own “in the trenches” as a practicing physician position, here are the major positions of the GOP frontrunners, including Ron Paul, who was a practicing physician for many years who did not accept Medicare:
Mitt Romney: As governor of Massachusetts, helped to formulate and signed the 2006 state law mandating insurance (known as Romneycare) which included an online marketplace called the Health Connector. Hasn’t renounced it despite escalating costs in Massachusetts and a shortage of physicians leading to longer waits and E.R. visits increasing by at least 9%.
Argues that ObamaCare did not grown out of Romneycare and that if elected he would allow states to opt out and encourage Congress to repeal it. Wants to strengthen health saving accounts by allowing people to use them to pay insurance premiums. Wants caps on medical malpractice lawsuits (non-economic damages) while providing states grants to find other solutions. Favors portability of insurance. Wants to bar insurers from denying coverage to those with pre-existing conditions while restricting federal regulations. Opposes Obamacare Medicaid expansion.
Ron Paul: Outspoken opponent of the health reform law. Believes the individual mandate is unconstitutional and introduced legislation to end it. Doesn’t believe that people have a fundamental right to health care. Believes that Medicare is one of the entitlements that provide unnecessary dependence on government. Favors free market approaches for patients not yet on Medicare. Favors tax credits and deductions for medical expenses, high deductible health savings accounts, and portability of insurance.
Newt Gingrich: Also urges tax credits for purchasing insurance. Founded the Center for Health Transformation. Believes in increasing transparency as a way of reducing medical errors. Would repeal Obamacare and replace it with portability, tort reform, and an emphasis on health savings accounts and electronic medical records. Believes states should have high risk pools to cover those without insurance who become sick. Extensive revamping of Medicaid in ways to give states more freedom and encourage user financial involvement.
Rick Santorum: Emphasizes repeal of the health reform law and believes health care entitlements get patients “hooked.” Supports the initial Ryan plan to replace current Medicare with a voucher program. Supports caps on medical malpractice. Would like to see Medicaid revamped and scaled back.
Rick Perry: Believes Obamacare is unconstitutional and supports its repeal. Does not support state insurance exchanges or high risk insurance pools. Favors state solutions. Opposes Medicaid expansion in 2014 and the current Obamacare provision that states can’t restrict Medicaid eligibility. Believes states should be able to opt out of Medicare. Supports tort reform to reduce frivolous lawsuits and has instituted it in Texas.
I can find GOP candidate positions on the health reform law and the current health care system to endorse and even to admire, beginning with the recognition that ObamaCare will lead to out of control spending, reckless entitlement expansion at a time of economic hardship, and that the law is unconstitutional and should be repealed.
But a problem I have with each candidate’s position is the failure to recognize that health insurance itself (private as well as public) covers far too much and is too easy to overuse for non-essential services.
We won’t reign in the health care costs in the U.S. until we all realize that we are too addicted to the concept of health insurance itself.
Only when our doctors won’t see us now will we really begin to realize that even if health insurance is universal, health care definitely isn’t.
Only when we have to pay for a service out of pocket will we really begin to know and feel again what that service really costs.
Marc Siegel, M.D. is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical Contributor and author of several books. His latest book is "The Inner Pulse; Unlocking the Secret Code of Sickness and Health."