Obamacare has been ruled constitutional by the Supreme Court, those esteemed individuals we consider sages when they agree with us and tyrants when they don’t. The decision has rendered supporters of the law positively apoplectic, even rapturous. Detractors have been lying in fetal positions taking antacids and trying to figure out how it all happened. Either way, for now it’s a done deal. The politics of the matter remain to be seen.
While not a supporter of the legislation, I am man enough to concede and say that I hope it works. I admit that there are a couple of provisions that are (at least temporarily) merciful in its pages. Among them, coverage for preexisting conditions; a thing that could be very useful for my diabetic teen as he grows older. In addition, there’s the ability to keep children on their parents’ insurance until age 25. Withunemployment soaring even among undergraduate and graduate degree holders, mom and dad may have the only insurance available for the kids as they ply their advanced degrees and theses by serving fries and burgers.
The problem I have with the Affordable Care Act (well, one of the problems I have) is that it presumes a certain amount of responsibility among the populace and due vigilance in the government (not particularly common on either part.)
What I mean is, the Affordable Care Act requires that individuals purchase health insurance or face a fine. The same goes for businesses. Of course, businesses are easy to fine. But individuals? Less so. And really, if the government is unwilling to deport illegal aliens in custody for crimes, or imprison multiple offender drunk drivers with suspended licenses, do we really think they’ll take a person to the mat if they neither purchase insurance nor pay the penalty for failing to do so? Seems unlikely to me. Thus, individuals will not add to the fund from which they’ll draw deeply when they are sick themselves, and finally get insurance (like a death-bed baptism).
The other problem is not about fines or rules, but about lifestyles and attitudes. Hospitals have all too many patients with no sense of accountability, who ‘take’ as a way of life. Not a majority, mind you, but a powerful minority have developed an incredible alacrity for navigating hand-outs, programs, criminal courts, government checks and assorted entitlement programs. This isn’t a screed against the poor, but a shot at the manipulative. All too often they come to hospitals only for pain or anxiety medicine or work excuses. Or for manufactured drama on weekend nights. Frequently, they come to add weight to their somewhat spurious disability applications for things like ‘I can’t keep a job,’ and ‘I get angry a lot.’ (Yes, we actually heard those from healthy young men seeking disability checks.)
These persons, soon to be eligible for insurance, are superb at obtaining food, medicine, money, drugs and influence at the expense of others. They understand how to use state and federal programs with maximal efficiency. And they know that speaking loudly, calling out for ‘patient care representatives’ and filling out negative satisfaction surveys will generally, in most large facilities, get them their snacks, drinks, pain medicine and excuses. The amount of money hospitals spend tracking down frankly false complaints, for pain prescriptions alone, is staggering.
To understand the depth of this problem, just ‘ask a nurse,’ and you’ll get an earful about the awful treatment they endure, the way nurses and other care providers struggle to care for their own kids and make ends meet only to be told by a fully capable adult, ‘I need you to give me my prescription, since I don’t have any money.’ This as their i-Phone and cigarettes spill out of their pockets, and their drug screen lights up for marijuana, cocaine, opioid pain medications and the now ubiquitous Methamphetamine. (All of which they can magically afford).
Here’s my point. If anyone thinks that providing a means to insurance for everyone will make all people better or healthier, they’re wrong. While it will likely benefit many, the patients I’m discussing won’t work on their diets, smoking, drinking, Meth use or their serial paternity. All they’ll understand is that there’s one more way to get things they want without contributing to the solution.
Ironically, in this way the ACA might inadvertently cause entitlement to metastasize even more widely than it already has. I hope I’m wrong. But experience, in the real world, with real human beings, suggests I’m not. I suppose only time will tell.
Dr. Leap’s Blog can be found here: http://edwinleap.com/blog/