An Objective, Evidence-Based Opposition to ObamaCare

U.S. health care is sick. Practicing good medicine on this critically ill system starts with empathy but none of the other, more voluble emotions currently on display like anger, name-calling and blaming. Good medicine requires objective evaluation of evidence, not depending solely on logic.

Popular science fiction author David Weber penned these wise words: "Logic is a way to err with confidence." Nowhere is this truer than in Congress' legislative actions: UMRA, HIPAA, CPSIA to the currently proposed AAHCA (newspeak name = America's Affordable Health Choices Act). Consider the evidence pro and con.

TennCare was a universal health care single payer approach analogous to AAHCA that was tried in the state of Tennessee starting in 1994. It became what then-Governor Bredesen called "a disaster." It nearly bankrupted the state; forced the governor to raise taxes, and to disenroll nearly 200,000 people; and ultimately required rationing the care of those who remained on the TennCare rolls.

The best person to evaluate AAHCA objectively is Phil Roe, MD. He was a practicing doctor (obstetrician) in Tennessee who later became a mayor and is now a first term congressman. He lived both sides of the TennCare nightmare. Practicing good objective, evidence-based medicine (on health care), the Congressman recently wrote, "The kind of universal care that TennCare embodied [should be placed] in the 'don't try again' column."

TennCare is strong evidence AGAINST passing AAHCA. Let us consider the evidence for its passage. ... I'm waiting. ... Still waiting. What has been offered as "evidence" is the president's statement that, "The system is broken." Though clearly true for health care, any assertion about the gravity and severity of a problem is not evidence for a proposed cure. The fact that health care is so sick does not support a treatment plan that will not work. That is like saying, "The patient is dying. We don't know why. Let's sprinkle Dr. Scholl's foot powder on her. It hasn't worked before but we have to do something!"

The highly vocal and emotion-laden support for AAHCA is ironic. I have previously described the ten root causes for high U.S. health care costs. Two add value to all of us: improved technology and more people living longer. The other eight add no value and waste hundreds of billions of dollars. Top of this waste list is "action without evidence," into which AAHCA unfortunately fits.

Whether you look at the scientific literature or simply everyday experience, one conclusion is crystal clear: making decisions without evidence that proves the decision will achieve the intended outcome is a sure-fire recipe for failure.

This leads to a straightforward, objective evidence-based conclusion: we should oppose ObamaCare and find a solution for health care that will work.

Follow Deane Waldman on Twitter: www.twitter.com/systemmd

Comments

[Ameriki]

There are millions of us who do not have health insurance and therefore do not get health care. There are millions more who are only one medical claim away from increased premiums or canceled policies. We want health care for ourselves and our families. We really don't care what form any program may take. Why not open up the existing government health insurance plans to any American citizen and then you can sit around and argue with each other.

[systemMD]

Did you know that at least ten million of the 46 million "uninsured" Americans are eligible for existing health insurance programs (primarily MediCaid); choose not to sign up; and yet get care through Emergency Rooms. In other words, not having insurance does not mean not getting care. Sorry for the double negative.

Query: Imagine a person who is eligible for government health insurance and decides not to sign up. SHOULD an ER not provide care? CAN an ER not provide care? If no, why not?

I think it would be great simply to offer the same plan to everyone that is available to Congresspeople. How do you think THAT would go over in Washington?

[Obenauer]

Now this isn't a recent blog from Huffington Post, but this goes through some of the problems with the US Healthcare system. Article by Maggie Mahar discusses the Massachusetts model.

http://www.huffingtonpost.com/maggie-mahar/on-healthcare-reform-stim_b_150572.html

[PlaceboStudman]

Why were these programs such a failure?? Because, while more and more money was being poured into making sure that everyone who wanted or needed insurance got it, absolutely nothing was done to ensure that fewer and fewer people needed the insurance in the first place. No insurance system is going to succeed so long as people continue to get sick and continue to demand that every little bump bruise scrape and scratch are treated. Do we file an insurance claim every time a light bulb goes out, or every time someone accidentally drops a plate at dinner? Of course not. We clean it up and move on. Same thing goes for health care.

Honest to God, you'd think that no one got sick in colonial days when there wasn't insurance. Actually, they didn't need insurance because they were generally smarter than we are (sorry, that's just a fact) and werent as lazy as we are, and generally kept in better shape to prevent the diseases and disorders that keep good medicine from the people who need it most, those who are critically or chronically ill or those injured in the service to our country (military and social service like police and firemen)

[jmpurser]

I'm sorry, was this supposed to be sarcasm? A rant full of baseless assertions and a basket full of rhetorical gimmicks that purportedly calls for evidence and reason as the basis for action?

[Horatio]

Really because Massachusetts seems to have a fairly successful model for a Public Health option.

[Dale Larson]

Sure... let's look at a tiny state that operated within a large for-profit system. Of course it failed. Hybrids are not the answer.

It's time to end our "risky experiment" of "For-profit health insurance". It's a proven failure.

Support HR676. It's a Single Payer system that is proven, pro-business and pro-people:

* Slashes at least 30% of costs off the top by removing private insurance overhead.
* Companies take health care expenses off their books. Stock value increases. Better able to compete internationally.
* Small companies could have access to higher skilled workers because previously they couldn't compete in the labor market by offering similar benefits.
* More entrepreneurial ventures will launch since they have more money and less unrelated risk.
* Dramatic drop in bankruptcies.
* Dramatic drop in lawsuits. Most of these lawsuits are simply to obtain money to cover health care if something interrupts their coverage.
* Reduced system complexity. Greater efficiency due to fewer regulations.
* Savings from employees not having to fight with their insurers during work hours.
* HSA and MSA dollars redirected back into the economy for goods and services.
* Additional money to spend from not having to carry "uninsured motorist coverage" on your auto policy.
* Contract employment is more viable for workers since they are guaranteed access to health care.
* People are covered when unemployed. No chance of being wiped out financially if you lose your job.
* Health care providers (doctors, hospitals, therapists­...) see increase in business with

[SelenicMagick]

And specifically EXCLUDES Indigenous People... just like every OTHER plan that has been put forward.

The REASON that EVERY plan EXCLUDES Indigenous People? Because they are "already covered" by the "Indian Health Service". IHS medical care is WORSE than NO medical care but EVERY "plan" so far specifically excludes Indigenous People.

[DarkWitch]

"Let us consider the evidence for its passage. ... I'm waiting. ... Still waiting."

Here's some evidence. I don't have ANY health care insurance for my kids. And I'm waiting...­for a catastrophic illness or accident so I can lose my house and go live on the street with them. Everyday I have that hanging over my head, and we are only one of way too many families in the same situation.

So why don't you also show us how Medicare has almost bankrupted the country. Then you can show us how single payer systems in other countries have almost bankrupted them. That might bolster your argument for your evidently poorly run state program to be an example of why I should hope I'm never able to get affordable healthcare for my kids.

[schatsie]

thank you so much for sharing your situation.

[greguva]

You seemed to have missed a major point of the proposals that have come or are coming out of Congress - a single-payer system, such as TennCare, is not under consideration. Your argument is completely irrelevant.

[jmpurser]

TennCare was not a single payer system.

[greguva]

According to the article above: "TennCare was a universal health care single payer approach …."

[zull2]

Since you seem to NOT be offering an alternative plan to the only chance I and a whole lot of other folks have at having reasonably consistent health coverage..­.

I propose that all doctors, to obtain and maintain their license to practice medicine, must be government employees. They will be paid along a standard government pay scale, you get all those benefits that government employees get, the government pays for what you need to do your job, and you take care of anyone who comes in and needs medical care.

Oh...shoot­. Forget cutting out at 3 pm and driving that Lexus. If that's the main reason you got into medicine, instead of helping people, then get out. Be a lawyer or businessman or manager. There are a lot of social workers out there that make a pretty modest salary, have masters degrees, and do it because they want to help people. Lots of them hold government jobs. Seems to work alright.

[femalevet1977]

You might also want to look at Peachcare in Georgia. It has recently been reinstated with the help of some federal subsidies, but it went bankrupt a couple of years ago when Georgia had it...and it was just for children.

[JScott]

There's no such thing as Obamacare, why is this lie perpetuated?

[mbaty]

Many countries use very efficient systems of health care that cost a lot less than what we are paying. Therefore, we should be able to cover everyone at a fraction of the cost. However, cost should be no object when considering the health of the nation. We can conjure a gabbillion dollars for the banks, but we can't find the money for the well-being of the nation? We can spend a gabbillion dollars on weapons of mass destruction, but can't find enough money to pay for our sick fellow citizens to get better? Health care shouldn't be for-profit anyway.
If we can take care of AIG, we can take care of you and me.
We made up the bailouts from thin air. Now it's time we all had health care.

[grogan1964]

Healthcare should not be for profit?
If we follow your line of thinking..­....
Food should not be for profit because everyone needs to eat..
Housing shoud not be for profit because everyone needs a place to live...
Clothing should not be for profit because everyone needs clothing..­...

However, I will agree with you in that the goverment should have stayed out of the banking industry.

[LeftLeanWing]

The problem with your extrapolation is that people can survive with cheap clothes, cheap housing and cheap food.

We don't have 50 million hungry, homeless naked people running around.

If we did ... I would expect my government to do something.­.

Wouldn't You ?

[greguva]

Another problem with your logic is that the other items (food, clothing, shelter) are real goods that are delivered at the time that they are paid for. The debate we are having is not really about health care, it's about health care insurance. And the problem with health care insurance on a for-profit basis is that the best way to make profits on insurance, is to deny coverage.

Anything that decreases the amount of money that the insurance companies have to pay out for claims results in extra money for the investors. So the insurance companies will do all that they can to restrict the number of people covered who are likely to cost them money down the road, and to deny payments once claims are made.

[jeffhussein]

Insurance companies don't provide ANY healthcare, they ration it as much and as often as they can, to maximize profits. Of course health providers (nurses, doctors, etc.) should make a nice living, but insurance companies are an unnecessary middle man. This is why a public option -- a real one, not the so-called co-op model -- is needed. Stop and ask yourself what has an insurer ever given you that you haven't already given them first. We need the public option so these giants have at least some competition. I thought conservatives like competition. Hmmmm...

[1will]

The fact that Obama wants government healthcare should be reason to look more closely at the program and beware. Obama is a liar and not very bright. He has no idea of economics and trusting him with 1/6th of the US economy (healthcare) is a recipe for disaster. As for him being a liar....do you remember the pledge that no lobbyists would serve in his administration in the areas in which they lobbied? He broke that promise very quickly. How about the transparency pledge? Do you remember the promise to post all Bills online for 5 days before signing? Broken. How about the promise to veto pork ladden Bills that are filled with earmarks. Broken. This list can go on and on. If Obama had integrity it would be easier to trust him on healthcare.
By the way, why are lawyers the only ones that are not "Reformed" in the new healthcare reform? Doctors order many unnecessary tests solely out of a fear of lawsuits. Malpractice insurance drives up costs and let's face it. Lawyers are parasites that do nothing but spread misery and generate paperwork. It's odd that this is the only part of healthcare that will be left alone.

[CTtransplant]

People, we can no longer afford to stand by and do nothing! The only way to get solid health care/health insurance reform is to continue to push for it - and not let up! To this end, I have set up a petition to have paid health care removed from our representatives in Congress until such time as they reform health care - to include a strong public option - for 'we the people' who they are supposed to represent.

If you agree with what I am doing - I am going to ask you to do what I have been
asking others to do...sign it, then spread the word to anyone and everyone you know!

I am but one person - and cannot make a difference on my own...but there is
strength in numbers and, if we work together, with assistance and determination, all things are
possible! Please do what you can to help us further the cause of health care with a strong public option! Thank you!

http://www.petitiononline.com/PubOp676/petition.html

[GarthR]

Unfortunately, Congress is not seriously considering a single payer system, so if you are opposing the current proposals on this basis, you might want to look at the legislation before posting. If you are concerned about physicians being paid a salary rather than being paid a cut on every specialist or test ordered, just say so.