What Obamacare Means for Patients

While any law relating to healthcare should logically begin, center on, and end with the patient, such is not the case with Obamacare. I will discuss what Obamacare means for patients. I have read, reported on, and even helped Tweet the Affordable Care Act, which requires ongoing reading of The Social Security Act, The Public Health Services Act, The Internal Revenue Code of 1986, The Federal Register, and countless laws it amends and usurps on an ongoing basis.

My father grew up poor in South Texas. I’m reminded of the old branding iron they used-a random, rusted “2P” they found- in someone’s trash, their treasure. Through hard work and education, he became a physician, who taught me and his residents to “serve the patient-examine the patient, listen to the patient, and he will tell you the diagnosis.” While I would like to say the “2P” stands for Patients and Physicians, I must confess it affectionately stood for “Piss Poor”. In this vein, I will discuss What Obamacare means for patients based on 3 major “2P’s”: 1. The Philosophy and the Politics, 2. The Plan and the Planners, and 3. The Players and the Profits.

1. Philosophy and politics:

a. Philosophy

The American patient is a blessed lot. In a mere 250 years, American independence, sustained through The Constitution, unleashed unfathomable human ingenuity unlike anything in the preceding 5000 years. Individual freedom and incentive to innovate and prosper resulted in an eruption of scientific discovery and technological advancement that makes American medicine the best in the world. American medical freedom and ingenuity catapulted man from plague and scurvy to vaccination and vitamins, from compresses and couching to antibiotics and laser vision, from bullet biting and amputation to anesthesia and artificial limbs. We don’t blink at organ transplantation, in vitro fertilization, open heart surgery, brain surgery, or targeted gene therapy. We have doubled the average length of human life. We value life; we seek to improve, protect, and prolong it.

As Americans we value the individual. We see God-given gifts and precious potential in each unique individual. For this reason, America’s physicians have traditionally practiced medicine according to the Philosophy of Hippocrates. We take the Hippocratic Oath. We are healers who do everything within our power to the best of our ability for each patient.

The antithesis of the philosophy of Hippocrates, where medicine serves the well-being of the patient, is the philosophy of Plato, where medicine serves the welfare of the state. Sadly, Obamacare is a manifesto contrived to achieve the fundamental transformation of American medicine from Hippocrates’ healing hand to Plato’s statist scepter. Obamacare replaces the miracle of individual liberty with the proven failure of central planners’ false Utopia.

The architects and implementers of Obamacare espouse the philosophy of Plato to a tee. They are affronted and baffled by Hippocrates; in fact, many see most of Earth’s problems as stemming from over-population, whereby, the doubled length of human life is more of a problem “to be dealt with” than an achievement “to be built upon”.

This fundamental philosophical shift is the greatest threat to America’s patients under “The Law of the Land”, the paradoxically named Patient Protection and Affordable Care Act.

b. Politics

How in the world did we get here? Obamacare passed against the will of the people amidst the perfect political storm of single party rule. The law was born of 100% unadulterated politics and extreme ideology utilizing unprincipled tactics of enticement, extortion, lawlessness and false promises propagated by a political elite who subscribe to Alinsky’s Rules for Radicals and his notions of “relative truth”, “ends justify the means”, community organizing, division, and crisis-creation-promising repeatedly, “If you like your doctor, you can keep your doctor. If you like your health plan, you can keep your health plan. Period.”, all the while knowing that was not the truth. The politicization of medicine will in due course give birth to the weaponization of medicine. Politically expedient medicine is lethal for individual life and liberty, the profession of medicine, and The Constitution. Obamacare’s effects on patients are immeasurable and immeasurably bad, ever changing and changing everything.

Two examples of the politics of Obamacare warrant mention.

  1. The first sentence of the law amends the Public Health Services Act to establish coverage of preventive health services that insurance companies must cover without any cost sharing for the patient. These services must be “evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force”. Well, the Task Force(USPSTF) had just inconveniently established new 2009 guidelines regarding mammograms that were counter to the recommendations of the American Cancer Society and standard of care that have given American women the earliest diagnosis and longest survival of breast cancer in the world. There was massive public outcry that threatened the passage of Obamacare, so Secretary Sebilius added a new sentence, voiding the 2009 recommendations -so that the Act would get through Congress. Men didn’t fare as well. PSA’s are not covered based on Task Force recommendations. The outcry for men was ignored, because the women’s vote was all that mattered.
  2. Everyone recalls little Sarah Murnaghan who needed a lung transplant for cystic fibrosis. The Secretary declined to change rules to grant her a lung-until political heat mounted. Secretary Sebilius coldly stated, “I would suggest, sir, that, again, this is an incredibly agonizing situation where someone lives and someone dies.” Finally, she succumbed to political pressure and granted Sarah a lung. Obamacare empowers non-medical political appointees to decide who gets an organ and who doesn’t; if the media and political climate are on the patient’s side, it helps, if not- no such luck.

    Sebilius, the daughter of a governor, is accustomed to wielding power and playing politics. A former director of the Kansas Trial Lawyers Association, she also served as president of the National Association of Insurance Commissioners. As Governor of Kansas, she provided a key endorsement to Barack Obama over Hillary Clinton in 2008, and in return was appointed HHS Secretary.

If anyone doubts that Obamacare politicizes medicine, just look at last week’s HHS appointment of Lori Lorde as Director of Communications for CMS, just in time for the November exchange enrollment- Lorde is a Senior VP for the Center for American Progress and former SEIU director.

The ramifications of such a philosophical shift and the politicization of medicine are staggering for patients going forward.

2. The Plan and the Planners:

a. The Plan

As Democrats frantically rushed to pass Obamacare, instead of working out crucial details they effectively created a blank slate and a blank check for the Secretary of Health and Human Services to write the law as she goes along.

The Secretary was given unprecedented power. There are more than 2,500 references to the “secretary” in Obamacare, where the law says she “shall” do something, she “may” take some form of regulatory action, and that things will be done as the “Secretary determines.” She can allocate money “in such sums as may be necessary”.

The Secretary determines what type of insurance coverage every American is required to have and which insurers, hospitals, and doctors are qualified to participate and ultimately what treatment qualifies as “value-based” and will be covered. The law states The Secretary “shall, by regulation, establish criteria for the certification of health plans as qualified health plans.”; “the Secretary shall define the essential health benefits…”, so the Sec can single-handedly force every American, under the threat of a tax penalty, into purchasing any health benefit she deems “essential.” Government’s prescribed and mandated benefits increase premiums and drive up health care spending. We are witnessing premiums, deductibles, and copayments skyrocket.

The specific benefits under each category (Sec.1834 SSA) can change from year to year and will depend on Task Force recommendations (Sec.4105).  We now know that the 2009 breast cancer screening recommendations value cost versus life in unprecedented fashion. The Task Force used faulty data selection and analysis, factored in allocation of resources and strategically did not note in their report that patient outcomes were 70% better under the OLD recommendations. There were no breast cancer experts of the panel. The current planners are willing to lose a few lives to save a little money-unless it becomes a political threat.

Federal money comes with strings attached in the form of increased regulation and ultimately control over medical decision making. Obamacare planners call this “Comparative-effectiveness research”, “Pay for Performance” and “Meaningful use” and grant the Secretary, a non-doctor political appointee, limitless power to enforce her will on patients.

A most alarming section of Obamacare is Section 1311(h)(1)(B),

Beginning on January 1, 2015, a qualified health plan may contract with–

(B) a health care provider ONLY IF such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.

1311 gives the Secretary, a bureaucrat with no medical training, absolute power to dictate how doctors treat patients- patients in both government and private insurance programs.

The Federal Register revealed that these rules were delayed but will be written, and when they are in place, insurance companies will only be able to contract with doctors who comply with the Secretary’s rules. The government will be calling the shots on what patients get- and worse, what they can’t get. The government will punish doctors who do not obey their rules.

She’s running demonstration projects set up by Progressive allies, funding “education” she deems appropriate, and making strategic appointments to control the agenda using billions of dollars in grant money- enabling the administration to reward political pals, such as unions and activist groups, and offer political favors to cooperating private corporations, effectively paying them off to do her bidding.

28 States and DC expanded Medicaid. 15 million people are added to Medicaid rolls-Medicaid, the unfunded liability of epic proportion that has the poorest outcomes for patients in the developed world at exorbitant cost. Medicaid patients are using the ER 40% more than the uninsured. The increased ER use and uncompensated care makes premiums higher. Medicaid doctors are paid less, resulting in poor access to care for Medicaid Patients. Medicaid, designed as a safety net for the poor, sadly results in worse outcomes than if one is uninsured. Instead of getting people out of poverty and reforming Medicaid, the definition of poverty is expanded, so more people can be forced into it.

Obamacare creates countless new regulations on the health care industry and taxes innovation, which increases costs, which are passed onto patients.

The Secretary creates and controls a government rating system to evaluate all exchange plans on “quality” and price, thus giving her the power to lure consumers toward her preferred plans and eliminate those who are out of favor- expediting the move toward single-payer. She set up the Federal Exchange for the 34 States that refused to set up State Exchanges and, with adoration and support of the IRS, funded it with billions of dollars not authorized by the law itself.

TITLE III- Improving The Quality and Efficiency of Healthcare Delivery System, Subtitle A-Transforming the Healthcare Delivery System, Part I-Linking Payment to Quality Outcomes Under the Medicare Program begins on page 235 H.R.3590 (PPACA) and instructs The Secretary to create a rating system for hospitals and all healthcare entities by which she will preferentially judge and pay (or not pay) them. There is no administrative or judicial review for any of her decisions.

 The Secretary is creating a payment structure for “rewarding quality”, and she defines “quality” to reward those who meet her measures. Providers are paid for meeting her measures regardless of whether the care is delivered by a doctor, nurse or other.

Revolutionary, if not frightening, is SEC 1842(b)(18)(C) of Soc.Sec.Act modified by ACA.

January 1, 2017, the HHS Sec may regard eligible providers the same as physicians per ACA SEC.3007(7).

Eligible professionals include the following practitioners:

(i) A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)).

(ii) A certified registered nurse anesthetist (as defined in section 1861(bb)(2)).

(iii) A certified nurse-midwife (as defined in section 1861(gg)(2)).

(iv) A clinical social worker (as defined in section 1861(hh)(1)).

(v) A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)).

(vi) A registered dietitian or nutrition professional.

If you like your doctor, too bad, you might get a mid-wife or social worker-if you’re lucky.

Part D- Clinical Comparative Effectiveness Research (CER) is the way government will decide what patients get-

Sec.1811. (42 U.S.C. 1320e)(2)

(A) In general.—The terms “comparative clinical effectiveness research” and “research” mean research evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of 2 or more medical treatments, services, and items : health care interventions, protocols for treatment, care management, and delivery, procedures, medical devices, diagnostic tools, pharmaceuticals (including drugs and biologicals), integrative health practices, and any other strategies or items being used in the treatment, management, and diagnosis of, or prevention of illness or injury in, individuals.

The Patient Centered Outcomes Research Institute (PCORI) facilitates the implementation of CER on patients.

Translation of its purpose and duties: the PCORI will choose and set up the research agenda by which government will dictate how doctors will diagnose and treat America’s patients.

While Sec. 1182 Limits certain uses of Comparative Clinical Effectiveness Research, Sec. 1182 (c)(2) allows the Secretary to use evidence or findings based upon COMPARISON of the difference in the effectiveness of ALTERNATIVE TREATMENTS in extending an individual’s life due to the individual’s age, disability, or terminal illness…

Logically, the older or more disabled or sick you are, the less likely a treatment is to extend life, especially if the treatment is expensive. You will no doubt get palliative care.

(d)(2)(A)(i) allows the Sec to apply different copayments based on cost and type of service (ii)allows CER to be used in determining coverage, reimbursement, incentive programs based on a comparison of differences in effectiveness of alternative treatments in extending life due to age, disability, terminal illness.

Translation-if government doesn’t want patients to have certain treatments, they can either make them cost prohibitively expensive by applying a huge co-pay or pay doctors so little that they won’t even do them; ultimately, patients are denied the care.

It is very telling that “Advancing Research and Treatment for Pain care Management” is a significant part of Obamacare

Sec. 759. Program for Education and Training in Pain Care

(d) PAIN CARE DEFINED. – For the purposes of this section the term ‘pain care’ means the assessment, diagnosis, treatment, or management of acute or chronic pain regardless of causation or body location.

(e) Authorization of Appropriations.- There is authorized to be appropriated to carry out this section, such sums as may be necessary…

Translation- find how to best provide palliative care (pain control) regardless of the underlying cause-even if it’s from a ruptured appendix, or gallbladder, or disc, broken hip, or aneurysm, or angina…Then this modality-comfort care- can be the “second thing” compared to anything in CER.

So, when the Interagency Pain Research Coordinating Committee findings are compared to any and everything related to CER and PCOR, what will the government tell insurance companies to cover?

Again- the painkiller or the pacemaker? Obamacare “will let doctors and patients know.”

While the law mandates coverage, coverage is not care, the law will result in rationing and redistribution of care. About 48 million Americans are on Medicare, and 11,000 Baby Boomers a day become eligible, while at the same time Obamacare takes over half a trillion dollars from Medicare. More patients times less money equals less care. The IPAB will be there to enforce the cuts and comparative effectiveness research will show if it is better for seniors to have palliative care or other more expensive treatment. Medication costs are skyrocketing and patients are going without. Using Patient-Centered Outcomes Research (PCOR) and value based medicine to pay physicians, the sickest, neediest patients will become “too risky to treat” and IPAB will set pay so low for some treatments that physicians would be foolish to do certain operations with the associated inherent risk. Patients will be waiting on long lists and care will be given by a new definition of eligible providers as of 2017.

Features of the plan, which are proving to be as much of a failure as the inept insecure rollout of Healthcare.gov, are Accountable Care Organizations, which are essentially HMO’s on steroids that reward doctors and hospitals for not spending the money on the patients and are proven fails per the law’s own demonstration project.

Meaningful use medical records are mandated; physicians were bribed into implementing them initially, and will be penalized going forward, but EHRs have proven to be expensive, subject to privacy breeches, time and staff intensive, and take the doctor, money, and privacy away from the patient and care. They are untested, yet mandated. Patients are experiencing actual medical mistakes as a result. Here is my own wristband. I don’t read barcode, do you? I discovered after hemorrhaging post op that an elderly male spine patient’s barcode had been errantly scanned to my chart, so that his list of meds showed up on my EMR. I wonder how often that happens. From barcodes to sticky notes, actual “unbiased physician-guided” not “biased government-established” research is needed to see if there is truth in what government speculation mandates. If the Healthcare.gov rollout, IRS hard-drive “crashes”, and privacy breeches of medical records are any indication of the government’s sophistication with computerized data, patients must not be subjected to the meaningless use of meaningful use.

Sec. 3002- Maintenance of Certification (MOC) is nothing more than an attempt to control physicians and squelch any last speck of physician autonomy. This leaves patients with “government approved providers of government’s allowed care” instead of “autonomous physicians providing best available care.”

A wellness industry is taking money and resources away from actual patient care for the truly sick and disabled.

And finally, the plan is enforced by the oppressive, political, deceitful, and citizen targeting IRS.

b.The Planners

President Obama routinely changes the law- now somewhere over 30 times. Whether to appease lobbyists, his progressive base, or members of his party up for reelection, he changes the law with ZERO regard for the individual patient.

If he truly cares about individual patients, why did he selectively delay Obamacare for those with employer- sponsored plans but NOT for those with Individual plans? And if he truly cares about individuals, why did he delay the cap on their out of pocket expenses?

He responds to lobbyists and politics, money and power. Individuals do not have the lobbyists, money, or power.

Obama’s promised fundamental transformation of the USA requires that physicians break the Hippocratic Oath, serve the state first and patients second, and according to government diktat; thus he surrounds himself with advisors and appointees who will facilitate this. Obamacare architects like Ezekiel Emmanuel, MD and implementers like Donald Berwick, MD decry the old-fashioned Hippocratic Oath and seek to replace it.

Dr. Ezekiel Emmanuel, a bioethicist and Obama’s key health advisor on the Affordable Care Act, bemoaned that doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others.” As long as doctors are in charge, cost control would not be possible. He believes true reform includes redefining doctors’ ethical obligations. He believes medical students should be trained “to provide socially sustainable, cost-effective care” instead of thinking only about their own patient’s needs. In his classic 2009 Lancet article on rationing, “Principles for allocation of scarce medical intervention”, Emanuel advocates for federal rules to allocate resources to patients based on what he called “social justice”. His article is telling, and in it he introduces his new rationing system- “The Complete Lives System”- “which prioritizes younger people who have not yet lived a complete life” and “The Grim Reaper Curve”, which shows care preferentially given to patients between the ages of 15 and 40.

Emanuel concedes that his plan appears to discriminate against older people, but he refutes the assertion that Ageism constitutes unfair discrimination- “Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had
more life-years is not.” “Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25.”

He further believes that “the constant introduction of new medical technologies, including new drugs, devices, and procedures…”is a major contributor to rapid increases in health spending. This conveniently ignores reality like the fact that patients with cancer in the U.S. have a better chance of surviving the disease than anywhere else in the world, and that the U.S. is rated first out of 191 countries for responsiveness to the needs and choices of the individual patient by The World Health Organization.

In certain empires in history, like Plato’s republic, the state’s interest were primary, so physicians responded to the needs of the state by devoting resources to the workers and ignoring the elderly, very young, critically ill, and those who were considered genetically inferior. Vile immorality and atrocities resulted. Obamacare architect Ezekiel Emanuel, espouses the principles of Plato, and is a member of the Federal Council on Comparative Effectiveness Research.

Dr. Emanuel has fought for the government takeover of healthcare for over 20 years. In 2008, he wrote “Every favor to a constituency should be linked to support for the health-care reform agenda.” He operates Chicago style, “If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration’s health-reform effort.”

Dr. Donald Berwick, Obama’s first head of Centers for Medicare and Medicaid Services (CMS), likewise opined that the federal government must step in between doctors and patients to curb and redistribute the use of medical resources with allocation based on “important subgroups.” He said “Groups”, not the “individual patient in the doctor’s office”, should be the “unit of concern.”

The new “group-medicine” of Obama, like the old statist medicine of Plato, is counter to everything we have believed or experienced as a moral and virtuous society of free individuals under The Constitution. These master manipulators seek to transform physicians from compassionate, personal healers to cold hearted weapons of mass discrimination.

Berwick loves the British system of socialized medicine.
He is, quote, “in love” with NHS… it’s a global treasure…it’s such a seductress.”

His own words say it all:

“Any health care funding plan that is just, equitable, civilized and humane must- must- redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition re-distributional.”

“The decision is not whether or not we will ration care. The decision will be whether we ration care with our eyes open.”

“Health care is a common good—single payer, speaking and buying for the common good.”


“Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”

Sensing intensifying political opposition, once again, President Obama bypassed Senate confirmation and just appointed Berwick.

First, Sebelius ,now Sylvia Burwell, and ultimately whomever the President appoints out of “maximal essential politics” will decide “Minimal essential benefits, Qualified Health Plans, Qualified Providers, Qualified Hospitals”, medical research, medical education, quality measures and relative value- essentially everything-who gets treated, what the treatment is, by whom, where and for how much.

Burwell, Obama’s newly appointed Secretary, has been described as “willing to do anything her boss asks”. She even rummaged through a dead man’s trash to retrieve damning evidence for the Clintons during the Vince Foster fiasco. As Director of the Office of Management and Budget, she closed national parks barring WWII veterans from their own memorial during the government shutdown, showing how the White House was deliberately inflicting as much pain as possible on the public in order to gain political points.

As Secretary will she focus on the best interest of the patient or the politics of the president?

3. The Players and The Profits:

a. The Players

Within the law are dozens of boards, councils, task forces, and agencies comprised by hundreds of political appointees, bureaucrats, and cronies.

The President creates the Interagency Working Group on Healthcare (Working Group), Agency for Healthcare Research and Quality (AHRQ), National Advisory Council for Healthcare Research and Quality, Patient Safety Research Center, The Board of Governors of Comparative Clinical Effectiveness Research (The Board), the Methodology Committee, the Advisory Panel, The Patient-Centered Outcomes Research Institute (PCOR), The Independent Payment Advisory Board (IPAB), The US Preventive services Task Force (USPSTF), Elder Justice Coordinating Council (Council), the Interagency Pain Research Coordinating Committee (the Committee), and so on which will work with existing Departments ,agencies, and institutes like The National Institute of Health, Center for Medicare and Medicaid services, The Institute of Medicine of the National Academies, the CDC, Departments of Treasury, Homeland Security, Defense, Justice,and on down the line.

The powerful Agency for Healthcare Research and Quality’s Board of Directors will have 19 members: the Director of the AHRQ (or designee), Director NIH(or designee),17 appointees-3 patients or HC consumers, 1 surgeon, I nurse, 1 state-licensed healthcare practitioner, 1 hospital representative, possibly one more physician, 3 health insurance reps, 3 pharmaceutical, device, or diagnostics reps, 1 QI person, and 2 members of the Fed/State govt. Out of 19 appointed members, there is only one surgeon guaranteed and possibly one other physician on the entire board.

Billions of tax dollars are spent by these groups to influence every aspect of our lives.

The philosophy espoused by the players is like that of Obama, Emanuel, and Berwick. The favored physician Members of the Obamacare related groups like the IOM and ABIM, such as Christine Cassel, MD, and their Journals and Editorial Boards, such as JAMA, reflect their alliance with the federal government and their goal of nationalized, single-payer healthcare. Even the AMA has become a quasi- governmental agency preaching and “educating” implement and comply while profiting from compliance courses, books, and software physicians can buy. But, these intrinsic players pale in the shadows of the extrinsic big money players, who have effectively formed a syndicate for profit from the patient.

The Big Money Player Syndicate is composed of Government, Insurance Companies, Hospitals, and Pharmaceutical companies. The syndicate feeds off the “healthcare” of the American patient in an effective money laundering scam that has resulted in healthcare costs skyrocketing to over 1/6 of our economy and makes actual medical care as much as 80-90% more expensive than it could be with real reform. Lobbyists spend $Billions to broker deals persuading politicians to maintain the profits for the big money players.

b.The Profits

Our tax system is perverse. Individual polices are taxed while employer sponsored insurance is not. Hospitals benefit by creating huge bills but accepting small allowables from the insurance companies to create fabricated losses, called “uncompensated care”, which are effectively subsidized by government. Hospitals stay “non-profit” while profiting greatly, as do their insurance compatriots who benefit as well from phantom savings from the allowable vs. the Chargemaster bill. Patients and taxpayers lose.

The irony is that patient-centered, free-market driven healthcare reform exists-but if implemented would drastically cut into the players’ profits. Recently, employees of Oklahoma County were given the option of having their surgery at the Surgery Center of Oklahoma. Within three weeks, the county saved $140,000. In two months, $400,000, for a potential savings of $2.4M yearly. Analysts believe that if Oklahoma would offer state employees access to such a center, state taxpayers save up to $20 million dollars a year. Lo and behold, lobbyists showed up and State politicians did not expand this working model to State employees.

“The Big Lie” of keeping your doctor and plan has been exposed. The reality is premiums, deductibles, and out of pocket expenses have exploded, while patient choice and access to actual care is shrinking. But have no doubt, the powerful hospital and insurance companies will squeeze out profits even if it is at the expense of the patient and requires government subsidy from the taxpayer.

Narrow networks are characteristic of the Exchange plans, and patients are having to travel further for care, wait longer for appointments, choose from a shorter list of doctors, meds, and hospitals-and do not have access to the best specialty hospitals. We are paying for the minimal essential benefits that we may not want. We are even paying a dollar a month forever for a secondary abortion policy-even if male or otherwise unable to get pregnant.

Cost of medications is skyrocketing. Many of my patients pay $200-$300 for a tablespoon of eye drops. Many choose to go without.

Patients up to 133% of poverty are forced onto dysfunctional if not dangerous Medicaid in many states, while those earning between 134% and 400% of poverty get inversely related premium subsidy-only to find they cannot afford care with the onerous deductibles. People are going without care and without medications, and ER use is up. A person making 134% poverty cannot afford a $7000 deductible before anything is covered, even if 99% of the premium is covered.

A Facebook Friend sums it up well:

Deb. I am sick of this whole Obama care nightmare. Just got the cost here in FL for me. $845 monthly and nothing covered until after 6k deductible. Totally cost prohibitive considering the cost of my diabetic medications and supplies. My husband’s work plan would cost 945 monthly. Lost my health coverage after 28 year career with an Insurance company due to downsizing 7 years shy of having it for life. If we choose either plan we cannot pay my 300 monthly meds nor afford our own place anymore. A true nightmare…. Sickening is an understatement.

Hospitals are buying physicians’ practices and making doctors employees subjecting them to absurd, abusive government regulation and loss of autonomy to care for their patients. Hospitals are pocketing the savings on expensive meds under the 340B plan instead of passing the intended savings on to patients.

Physicians are leaving the profession in droves under such circumstance, and we as patients are faced with a critical doctor shortage.

The recently exposed VA scandal and coverup is but a glimpse of what is to come on the grander more horrific scale.

When Obama takes his finger out of the dyke and the employer mandate is implemented, over 100 million Americans will lose the coverage they liked and could afford only be mandated to buy the Obamacare policies covering unwanted benefits, while making it too expensive to afford the actual medical care they need.

As a physician, I have been distraught over this travesty and vowed to not participate in the Obamacare exchange. A 2013 survey showed that 44% of physicians say they will not participate in the Obamacare exchange. There are about 800,000 practicing physicians in the US, and if almost half of us refuse to participate, ObamaCare will be exposed as nothing but a punitive tax, a false promise, and a VA-style dead-end waiting list. In a recent interview with O’Reilly, Ezekiel Emanuel said that doctors won’t opt out of the exchange. “It’s not doctors who participate in the exchange, it’s insurance companies who participate in the exchange.” He then stated “The doctors will take who’s in the exchange, because they have to.” Translation: the government-insurance company syndicate now controls the patients and the doctors.

In the real world trenches, I logged on to discover that Aetna and BlueCross and Blue Shield of Texas both advertise me as a “provider” on the federal healthcare exchange. They do this without my
permission or consent nor even notice. I have never contracted with either company or consented to see any subscriber of theirs with a policy purchased through healthcare.gov.

To meet the requirements to be deemed a “Qualified Health Plan”, an insurance company must have a certain number of contracted providers listed. To attract new customers a company must list respected, experienced, established physicians. These government-colluding, patient-betraying companies are listing me (and countless other unknowing physicians) for their personal financial gain against our will, in violation of personally held beliefs, and to the detriment of the patients they profess to serve.

I insisted they remove my name from the Federal healthcare exchange immediately. This has not been done. I am stonewalled, while the Aetna CEO’s salary has increased from $17M to $30M peddling the promise of my colleagues’ and my services.

Insurers need providers, but physicians are not indentured servants whose labor may be compelled.
Patients need physicians. Obamacare and its players are destroying millions of patient-physician relationships.

Aetna won’t take me off their list despite unabashed letters of resignation, while Blue Cross says I must either agree to be an Obamacare provider or resign all of my patients. They refuse to put this in writing-telling me “you have our verbal response.” This proves the lists of doctors who insurers advertise to attract patients are meaningless. The insurance companies and hospitals regard doctors
as tools. We’re not.

If a majority of Americans doctors would stand up and refuse to play the game, it would end, and we could actually achieve true healthcare reform.

Our overlords may have no strategy for ISIS, but they most certainly have a strategy for us. Comparative effectiveness research will compare 2 or more treatment modalities, and the Patient Centered Outcomes Research Institute will then decide in the words of Obama “whether it’s better to have the surgery or take the pain killer”. This, combined with sections in Obamacare entitled “Elder Justice Act”, the Independent Payment Advisory Board, and Sec 4305 The Institute on Medicine’s’ Interagency Pain Research Coordinating Committee IS TELLING. The architects use Ezekiel
Emanuel’s Complete Lives System, which preferentially treats people between 15 and 40 and applies the term Elder Justice to those over 60. For those over 65, billions of dollars are taken from Medicare to pay for the research which will ultimately tell them they can’t have the pacemaker, but they can have pain meds-Palliative care, comfort care-whatever you want to call it. As of 2017, the Secretary can redefine the meaning of the term “physician” to include eligible professionals – from a nurse practitioner and midwife to a psychologist and dietician. You won’t get to keep your doctor, your plan, or your freedom. You will however, get plenty of pain meds.

In a few years we may just become a chill group of elders who sit around and smoke- a joint- by therapeutic design of Obamacare. Who knows, we may get pot vouchers instead of Medicare cards -and be forced into complying with our daily Smoke! Sorry to sound so cynical, but Coverage is NOT Care. Coverage is the term used to justify the legalized theft and government control of a once free people. Our President always tells what he’s gonna and what he’s not gonna do,so when he said, “We’ll let doctors know, and your mom know, that you know what, maybe this isn’t gonna help; maybe it’s better not to have the surgery but to take the painkiller”-he meant exactly that.

They will let us know…

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