Lots of  hyperbole and finger-pointing in the news this week about the Health Care bill, so  let’s look at a few facts.

One:

While you weren’t looking, medicine has morphed into big business.

The days when your friendly family doc could throw away the bill and give you free medicine are long gone. If I tried to do the first, but billed Medicaid for treating a similar patient, I could be sued for fraud, and lots of new regulations meant lots of paper work and trained staff for simple in office lab/x ray and pharmacy services, so I no longer could do them myself, which meant lots of overhead added to your bills.

Running your own office became so complicated and expensive that nowadays, most docs just join to HMO’s, and alas, this means a new “business” ethic for medical practice, where profit is the bottom line (which is why I worked for the federal government as a doc rather than an HMO).

Sigh.

Two:

All that fancy stuff new stuff in medicine that saves lives, lets you live longer, and lets you live more comfortably costs a bundle of money.

When I started medical school, pap smears were new, we had one high blood pressure medicine with huge side effects that didn’t work well. We didn’t have ICU’s or coronary care units, and I saw two middle aged ladies die of renal failure because they didn’t have access to dialysis.

Under old fashioned medicine, Dick Cheney would have died, because bypass surgery was in it’s infancy back then and rare (whereas now it’s common) and heart transplants were unknown.

Now we have all these things, and without insurance of some sort, few could afford these things.

Three:

Most of us had insurance via our jobs. The poor had Medicaid and the old had Medicare. However, the working poor and those who changed jobs a lot had nothing for routine care or emergency care, and heaven help you if you got laid off, especially if you had a chronic disease like diabetes or cancer.

Which brings us to:Four:

The way it stands, it is a nightmare for doctors:

We now have to “document” on fancy electronic medical records on computers with special software that we have to buy and install in our office; We have to obey lots of “guidelines” that we have to take time out of our busy practices to memorize, and we now will find that some treatment that works for some of our patients won’t be paid for because some “health care panel” will make the decision for us.

Then there is the perfect storm of capping medical spending, cutting Medicaid reimbursement to physicians, and underestimating the problem.

If you want a summary, read this report from American Medical news that paints a gloomy picture:

Washington Medicare’s fiscal caretakers warn that the already dismal view they have of the entitlement program’s long-term financing is probably overly optimistic given that it relies in large part on reduced payments and increased efficiency-of-care assumptions for health professionals that might never become a reality.

A lot of folks are of the idea that if you order them to do it, they will say “yes sir” and obey.

The dirty little secret is that a lot of docs are quitting practice early,, and others who would be the best and most independent physicians will simply chose another profession.

If Physicians morph from the independent thinker/gung ho healers to obedient obedient employees, the future may be that you will now see the less ambitious types working 40 hour weeks, and of course other physician extenders” who will work for the lower pay.

So expect your “doctor” in the future to be a friendly nurse practitioner who follows the guidelines correctly and gets along with the regulations, not a feisty trouble maker like myself who fights the bureaucrats to get her patients the best medical care, the budget be damned.

Five:

ObamaCare was passed in a partisan fashion, and this has resulted in more opposition than was necessary.

Thank God I live in the Philippines, but I suspect those of you in the US will have to put up with wall to wall political lies on this by both sides for the next six months.
Six:

To make things worse, the President promised the blue dog pro life Democrats that the bill would not cover abortion and other controversial problems.

Whoops: Obama lied.

We may end up with medical rationing, but by God, thanks to president Obama, we taxpayers will be stuck with paying for the ten dollar birth control so coeds at expensive universities can avoid pregnancy while vacationing in Spain.

This was not in the bill, of course, but some anonymous “health care panel” in the HHS bureaucracy decided it should be covered… but Obama promised the feminists he would give into their demands.

So voila, watch me pull a rabbit out of my hat…and give you (tada!) Free Birth Control and abortion pills.

Whoops:

I think we have a small problem…

Yes, those nasty Catholic bishops are there trying to oppose it. Hey, what do they want, freedom of religion or something?

Don’t worry: my minions in the media will spin it or ignore it, while my more liberal than thou radical feminist nuns will protect my back…

Or maybe not.

The Obama partisans have a small problem: not only is the alternative press/blogs/talk radio going full steam against him, but the faithful will be getting lectured during the sermons.

The bishops are even pulling out the big guns: The are praying about it:

We are Catholics. We are Americans. We are proud to be both, grateful for the gift of faith which is ours as Christian disciples, and grateful for the gift of liberty which is ours as American citizens. To be Catholic and American should mean not having to choose one over the other

So where does this lead to? The courts.

Seven:

Small problem.  The way the Obamacare bill was written, if one part is called unconstitutional, the entire law would be destroyed.The press is already trying to paint the bishops as the enemy, and if the bishops prevail in court, they will be demonized for taking medicine out of the mouth of babes.

This could get ugly quickly.

Eight:

This “all or nothing” rule also was part of the reason for last week’s Supreme court decision.

In the kerfuffle, a lot of folks on both sides are forgettingthat this ruling by the Supreme court was only on one question: if the government could force you to buy insurance. Period.

It was not if the bill was good, or if they agreed with the entire bill, or if other provisions in the bill were constitutional.

As Justice Roberts wrote:

We do not consider whether the Act embodies sound policies. That judgement is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions…

By ruling this way, essentially Roberts is saying: Your elected leaders who passed it. If you don’t like it, they have the power to change it, and you have the power to vote for someone who will.

However, this single lawsuit might not be the only problem that the bill will face: other lawsuits are working their way up. It is not only Catholics who oppose certain medical treatment: there are other other religious groups who see certain medical treatments as immoral and do not want to pay for them…

From what I understand, these things are not in the bill per se, since the Obama administration could have easily given waivers to these religious groups. The Muslims got waivers, for example. The question is why they chose not to do so for the larger Catholic community. (My suspicion is that they want to remove the Catholic influence now, because down the line there will be healthcare “guidelines” mandating that all hospitals and clinics cover abortion and euthanasia as part of routine medical care, even if they are run by religious groups that oppose these things. Destroy the bishops now and half the fight is won).

More importantly, if these First Amendment cases get to the court, it might not only be the “conservative” judges who might block it.

This article at RealclearReligion, discusses the issue of forcing Christian Scientists to buy health care insurance:

In yesterday’s opinions, Justice Ginsburg clarified that First Amendment objections would make any mandate unconstitutional:

A mandate to purchase a particular product would be unconstitutional if, for example, the edict impermissibly abridged the freedom of speech, interfered with the free exercise of religion, or infringed on a liberty interest protected by the Due Process Clause. — Nat’l Fed. of Ind. Business v. Sebelius, 567 U.S. ___ (2012) (Ginsburg, J., concurring in part and dissenting in part).

This bill infers with Christian Scientists’ free exercise of religion, so under Justice Ginsburg’s qualifications, this law is unconstitutional. Christian Scientists didn’t receive a religious exemption and are being taxed for adhering to their beliefs.

So there you have it: a very flawed bill that was pushed through by a radical president who was willing to divide the country to quickly pass a health care bill without compromise, in order to win the next election.

Because the president needs the feminist vote, he is willing to let the bureaucrats in the HHS write mandates that go against religious beliefs of many Americans.

More subtle than the religious problems, the bill will put the last nail in the Hippocratic idea of independent physicians, who now will morph from putting the patient first to a federal employee who will consider the good of the budget in treatment decisions.

Finally, (and I put this last because it is outside my area of expertise) it will probably bankrupt the country.

And it is Obama’s fault for pushing it through without input from all sides. And his legacy is a flawed bill that might make things worse, and a country divided by partisan hatred, all of which could have been prevented if Obama had been satisfied with “half a loaf” in stead of his huge agenda to redesign American medicine.

The good news is that the Republicans are not running a conservative, but a “RINO”, a mainstream governor who actually passed health care in his own state by working a bipartisan agenda.

Indeed, this bill was commonly called “RomneyCare” by locals.

So although Obamacare is a terrible law, the good news is that with time, and with a president who can actually work in a bipartisan manner, we might actually get some good out of this fiasco.

Roger Ebert put it best:

The Supreme Court has done us all a kindness. Obamacare shows the human community working at its best. For me, that’s what it finally comes down to. If all of us, even the least fortunate, have access to competent medical attention, isn’t that a wonderful thing? The poor, the old, the unemployed, those with pre-existing conditions?…

In the long term, Obamacare will work itself out and be perfected through countless tweaks and improvements. It is like that with all major new legislation.

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Nancy Reyes is a retired physician living in the rural Philippines.

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