Uh…Dig In? by Pat Conrad MD

Speaker Paul Ryan and the GOP fulfilled the script this past week when they threw the white pigeon that is the American Health Care Act up in front of a crowd of shotguns. The liberals are screaming about how this will hurt the poor, the elderly, the young, the reproductive, the trans-, the immigrants, the…and so on. The conservatives are hollering that this is “Obamacare Lite,” not a grand departure from a collapsing idea, but a fiscally irresponsible mess with a new, if thin coat of paint.

Pick your side, you’ve got an easy target. I’m trying to do something damn near impossible for an ideologue like me, which is to be dispassionately pragmatic: will the thing work?

  • The AHCA gets rid of the hated (and often ignored) individual mandate, but allows insurers to charge an extra 30% (of the monthly premium) surcharge to those who had a lapse in coverage.
  • The AHCA gets rid of the budget-busting subsidies for lower income purchasers, and replaces them with budget-busting tax credits based on age and income.
  • ObamaCare allowed insurers to charge older customers up to three times the premium of younger customers, based on age. The replacement bill would allow Big Insurance to charge the middle-agers up to FIVE times the rate for the college crowd.
  • The replacement bill would double how much we could contribute to tax-free health savings accounts, up to $6,550 per individual or $13,110 per family.
  • The additional taxes on investment income, on more wealthy individuals, and on tanning parlors are done away with.
  • Insurers will still be banned from denying coverage on the basis of preexisting conditions.
  • Dependents can still stay on mom and dad’s plan until they reach 26.
  • Insurers are still required to offer ten essential benefits (Are those the same as under ObamaCare? I skimmed the 123 pages of the bill and couldn’t find that part, but hey, I skimmed.)
  • An additional 11 million were moved onto Medicaid rolls under ObamaCare; the AHCA will deal try to cap costs for the 70 million on Medicaid by sending states a fixed amount per enrollee, the “per-capita cap.” (There is a provision in the language – no kidding – of the bill “Letting States Disenroll High Dollar Lottery Winners,” which probably covered a lot of people…sigh.)
  • There are a lot of nooks and crannies in this thing, and you will still need a lawyer and an accountant to read over your shoulder to understand it. Small businesses and HSA’s seem to be treated better – I think. I didn’t see any provision blatantly call to kick someone to the curb, but maybe it’s there. From what I can tell both liberals and conservatives are unhappy, which does not necessarily define a success.

What I didn’t see was the oft-proclaimed Republican intention of allowing the sale of health insurance across state lines. What I didn’t see was anything involving malpractice reform, or dealing with defensive medicine. If I missed it, Dear Reader, please correct me.

Let us stipulate in a non-partisan fashion, that ObamaCare is collapsing rapidly, that it has been a huge sop to Big Insurance, who gleefully screwed the paying customers. Access if anything, worsened. ObamaCare was a huge, additional expense to the taxpayer. That is the record.

Presently I see no curb to Big Insurance, which will wave its beggin’ bowl at the capital and poor mouth, even as premiums increase for everyone possible. The inability to deny coverage, keeping millenials on their parents’ plan, mandated essential benefits, and permission to charge the older more will all provide reason – or at least excuse – for the insurance companies to dig in on the site of their inflated premiums. The spin is still whirling the CBO estimates around, but it’s hard to see how this replacement will cost the taxpayers less in the next few years. I don’t see how this replacement bill will lower costs, or increase access. The GOP says this is just the first step. That’s the same GOP that voted repeatedly for outright repeal for the six years until they actually had the power to do just what they claimed they wished.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Uh…Dig In? by Pat Conrad MD

  1. rsw
    March 11, 2017 at 2:21 pm

    Employers are allowed to inflict heavier fines on employees who don’t participate in so-called wellness programs, which have been proven to be completely worthless

  2. Sudha Prasad
    March 11, 2017 at 12:19 pm

    Does anyone ever mention the elephant in the room, the BIG INSURANCE and BIG PHARMA conspiracy, or to borrow from Eisenhower: The MEDICAL INDUSTRIAL COMPLEX? All of these plans attempt to “mitigate the soaring expenses” that individuals must pay for health care. BUT no one mentions why the expenses are so high! No one mentions how to decrease costs outside of some pathetic cuts in physician salaries and cuts in reimbursement for delivering care and some “mandates” to bring about watery excuses for “efficiency”. Its like serving water in ever decreasing sizes of cups to a thirsty population. Not sure how those cuts, which are significant to individual health care workers, really add up to much overall to the GDP. Why is it NEVER brought up? (I know, I am asking rhetorically). Is it because the politicians have stuffed themselves so deep with the money from these firms that they will become literally eviscerated if they admit the truth? Is it that they will be branded as “socialists” and someone who spouts nationalized health care?
    As long as these politicians are all feeding off of the teat of these huge industries, every health care proposal will be nothing more than a smoke and mirrors extravaganza.

  3. March 11, 2017 at 10:27 am

    Don’t know if it’s true, but “across state lines” and “tort reform” are both supposed to show up in part II or part III, because it can’t be done in reconciliation.

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