My daughter returned from a Fourth of July Weekend whirlwind boat ride with a huge tangled mess smack dab in the front of her hair. She snapped me a picture of the knot and asked for my advice. I told her to cut her losses and cut it out. She decided to sleep on it and see if it might be better in the morning. Of course, the knot was still there- worse, entangling more strands and then increasing clumps of her hair. I, a surgeon, proceeded with knot dissection and disentanglement using fine instruments and detangler, persisted momentarily, then called for the scissors. This was met with shrill cries of resistance, and we were immediately joined by two more of my daughters who flew down the stairs in response to the cries for help. One added peanut butter, the other added baby oil, each professing it was a guaranteed fix, and I left the room thinking only of the mess I would have to clean up. At which time, I realized we were enacting a real life metaphor for the huge tangled up mess that is healthcare law in America in 2017.
In 1942, Congress passed the Stabilization Act to control wages in the workforce. Because government restricted employers from paying workers more, employers could not attract nor compete for the best workers. But American ingenuity prevailed and a way around this progressive Congressional Act was forged. If they couldn’t increase wages, they’d offer benefits-and make them tax exempt to boot- a “win, win” for all- as another strand was added to the government knot. This is how tax exemption for employer based health insurance was spawned. Individual Americans who wield relatively no power and money are still subject to taxation of money they use to buy individually purchased health insurance. Think of the unintended consequences. Now, if you leave or lose your job, you lose your health insurance. This contributes to the pre-existing problem. Also, businesses are looking to cut expenses every year, so they may change insurance companies every year; this too is expensive, inefficient, and wasteful. Individuals who purchase their own plans bear the financial burden for this mess and pay taxes on top.
Then in 1965, President Johnson signed Medicare (medical care for the elderly) and Medicaid (a safety net for the poor) into law Title XVIII of the Social Security Act replete with Sec. 1801. PROHIBITION AGAINST ANY FEDERAL INTERFERENCE.
“Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.”
After you clean up the coffee you just spewed, flash forward through ERISA, HIPAA, the HITECH (The Health Information Technology for Economic and Clinical Health Act) and CER (Comparative Effectiveness Research-now called Patient centered outcomes research) parts of the American Reinvestment and Recovery Act of 2009, and myriads of acts, laws, rules, and regulations culminating in the “Affordable Care Act” and the supreme tyrannical Act of all time- the Medicare Access and CHIP Reauthorization Act of 2015… Trillions of dollars intertwined with innumerable third, fourth, and higher order intermediaries, politicians, bureaucrats, administrators, physicians and patients has resulted in a giant hairball of epic proportion.
All the detangler, peanut butter, and baby oil in the world applied by all the sisters with all the best intentions and promises cannot fix this. It is time for the scissors! Congress must enact the complete repeal of the Patient Protection and Affordable Care Act. Fixing it only twists and tangles it more. Why should the American people spend over $3 TRILLION annually to make matters progressively worse? I bet half the people in DC don’t even know the difference between Medicare and Medicaid. I know they haven’t read these absurd, if not diabolical, laws.
People say- “But what if the insurance companies fail?” REALLY? Does any sane adult with any speck of reason seriously think these mega insurance companies with billions in profits run by CEO’s making hundreds of millions will fail without the government teat to suck on? Quite the contrary, I venture to say, unleashed from the government constraints a plethora of amazing, innovative, inexpensive medical insurance plans could be devised on a weekend corporate brainstorming retreat and on the market in three months. I’ll host it at my office. No one will die. No one will go without care. These shrill cries for help must just stop.
I pray that just as the American people rallied to elect a majority in the House, Senate, and White House based on their promises to “Repeal Obamacare root and branch,” we will rally once again and descend on the offices, phone lines, emails, and Facebook pages of those we elected and demand accountability and action. There is NOTHING a single Democrat will support now. So proceed with full repeal effective December 31, 2017. Then continue to repeal more, most importantly MACRA. Do this in fewer than 1500 words. The word count of the Declaration of Independence itself is 1458- including the names of the 56 signers.
Then do just a few things. 1.) If we profess that we want everyone “covered,” we must practice what we preach and extend the tax exemption to individually purchased plans. 2.) Free insurance companies to innovate and sell a robust offering of insurance plans of all shapes and sizes, predominantly composed of low premium, high deductible major catastrophic plans 3.) Empower Americans to put tax-exempt dollars into large Health Savings Accounts to use prudently at their discretion for medical expenses, including meeting their deductibles should a medical crisis occur. 4.) Allow free market competition to commence with transparent disclosure of the cost of medical goods and services across the board from doctors offices, operating rooms and hospitals to labs, imaging, and pharmacy. 5.) Allow these free market forces to operate across state lines. 6.) The truly sick and disabled do not need “insurance”; they need actual medical care. For this establish high risk pools at the state level and allow true charity care 7.) Return Medicaid to its intended purpose, a safety net for the poor, not a flawed plan for single payer, socialized medicine, “Medicaid for ALL.” 8.) Allow seniors the choice to go on Medicare or keep their individually owned tax-exempt plans purchasing insurance they have chosen using their HSAs dollars which have grown through their lives of individually responsible savings. 9.) Enforce the 4th Amendment and restrict government and government authorized data collectors from unfettered access to patients’ medical records without their consent. 10.) Use government grants for credible, meaningful medical research and innovation and quality medical education, not progressive indoctrination.
It’s time for the scissors, America. Cut the knot out. Then start with a fresh cut (actually massive cutting). Restore America to a land of personal and individual liberty, opportunity, and freedom of human minds and spirits of an exceptional people gifted by God and endowed with inalienable rights. Unless we do this, we will have to continue to be on defense, trying to pass laws to grant us back our rights from government and to protect us from progressive government command and control, peanut butter and oil.