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Friday, June 29, 2012

Obama Care is Constitutional

Last week, the Supreme Court of the United States ruled that Obama Care is constitutional under the right of the government to tax the citizens. Personally, I was surprised that it was upheld. In my opinion, there were several areas of the Constitution that had been violated. I do not represent myself to be a very learned scholar of the U.S. Constitution, nor am I an attorney. I do read quite a bit on law and politics and I do not restrict my reading to sources that are sympathetic to my beliefs. I do interact often with the legal system and do a lot of case research for the times when I appear before the court. I am not interested in presenting an arguement about whether this legislation is constitutional. Perhaps I might write about this aspect of Obama Care in the near future.

But I want to explain why as a health care provider, I am opposed to a socialized medicine system. Personal Disclaimer: I am going to be severely financially damaged on a personal level by Obama Care. There are two reasons for this. One is because of massive raises on  individual federal income tax rates. Consider that just less than 50% of people pay federal income taxes. The second reason is because it will seriously degrade the health care system in the United States. This is what I would like to discuss.

Essentially there are two ways to have a health care plan on a national level. There is the system that we have had, mostly funded by private insurance providers for profit, along with a basic safety net of  health care that by varying degrees is funded by private insurance policy holders and the government's funding through the confiscation of an individual's wealth through taxes. There is a social contract that we as a nation have agreed upon to provide indigent people with health care. This is mostly provided by Medicare and Medicaid. My hospital also gives away millions of dollars each year for uncompensated health care, as do many health care facilities and private providers of health care.  Locally we also have the Health Department programs and a regional Free Clinic.  The other major social program for health care is that under the Veteran's Administration for those who have sacrificed so much for our freedom.

The other system is what we commonly call "socialized medicine". It includes health care systems of Canada, Mexico, and the member states of the European Union for example. Many people tend to think of these systems as providing "free health care" but the reality is that health care is not free and that the taxes needed to sustain socialized medicine come with tangible and less tangible costs and in no small measure  are the reason that the European Union is in an economic crisis that will not likely allow it to survive. We have seen the EU cast aside member states who have become too large a sinkhole of capital. One or two of the member states who are subsidizing the European Unionwill likely decide to pull out before they reach the point of no return economically. All this may become a death nell for the "Global Economy" that every president since George H. Bush supported in 1988, Bill Clinton supported in 1992 George W. Bush supported in 2000 and Barak Obama supports. Note that there are two Democrat presidents and two Republican presidents, so the idea of the world economy is pervasive across the U.S. political landscape. I can't say the same holds the same for those who identify as conservative and those who identify as liberal. There are clearly drawn lines on which group thinks one or the other is the wiser economic model to implement. There will be millions of individuals who will be irrepairibly damaged through increasing federal demands for tax revenue to move to a socialist model of health care. No government can even be described as one as benevelently as Machiavelli is referred to as a "benign despot". Then again, I believe Machiavelli first referred to himself that way, not his peers.

My objections to socialized health care is that is doesn't improve the level of health care for a nation, it actually degrades accessibility to specialized care and leads to even more rationing of health care than exists under private insurance and managed care health plans. People who participate in the present system of care who have government entitlement services, specifically Medicaid and Medicare use medical services more often than those who have private insurance and are more inclined to go the the emergency room for issues that could wait for a primary care physician. They are less likely to access primary care first.

But if you like visiting the emergency room, especially like on a Friday evening- this is going to be your thing when you go to the primary care doctor. It will be just like that every time. Bring a book or your favorite electronic pastime. It's going to be awhile.

I can cite examples of problems both from what I have personally encountered with a friend and I can tell you of two example from my professional experience of a number of others in various countries in both North America and Europe. No one talks about nationalized health care in South America or Africa or China. We only tout the best of a failing system of health care emulate. How very capitalistic of a socialist ideal. That's what sells it.

The first example comes from my own profession in Great Britain. A woman fell into a terrible post partum depression. Despite A. Beck's evidenced based research that medication AND cognitive behavioral therapy work better than either one or the other alone and also better than doing nothing at all, she was determined too ill to benefit from psychotherapy. She went to the bottom of an 18 MONTH waiting list to get psychotherapeutic treatment. This was determined by a medical review board that functions to make treatment decisions. They are a function of the government NHI plan in Great Britain.

The tragic outcome of this sorry decision making was that the woman deteriorated to the point where she needed long term institutionalization and even more unfortunate was the eventual need to subject her to electroconvulsive therapy to due the extremely agitated and highly suicidal quality of her depression. that could have been avoided with psychotherapy.  This was printed in the British Journal Of Psychiatry.

A situation I personally know of is that of a Canadian citizen who in about 1996 blew out three lumbar vertebrae. I mean, destroyed the discs with near crippling pain. She was told that she could not have any surgery until she was actually unable to walk by the National Health Service. By then, severe nerve damage would continue to develop that would result in a life time of chronic pain. This is a person who would be in chronic pain anyway, but this plan of care resulted in unnecessary misery and further permanent debilatation.

I had an interesting conversation with some medical personel at the WPATH International Symposium this past year. They were from an European Union country and were explaining how superior their health care system was because they paid for gender reassignment therapy. They seemed quite proud to tell us about their 900 patient waiting list for the surgery itself after qualifying for it. Ok, I did the math on this. Based on the average of 5 a week, I came up a 4.5 year waiting list to have the surgery. I used the number of 5 based on doing surgery three days a week, scheduling six a week and bumping one due to complications during surgery at least once a week. I factored in time off for vacation and travel for professional activities. I factored in three week days in clinic and not in surgery for preop visits, consultations and post op care.

Here in the U.S. a number of private insurances are funding more and more transsexual services. the average wait to have surgery is 6 to 9 months depending on the surgeon. Who wants to throw three years of their life away waiting to have their surgery and be whole?

Lastly, please recognize that Canada's national health care system has dropped coverage for gender reassignment surgery in some provinces due to their system collapsing under the costs their system requires. Also, please remember that even Candada's Premeir came to the U.S. for open heart surgery because in their system of care, there wasn't anyone he wanted operating on him. If that is the one of the shining examples of excellence in health care that the leader of a great nation has to seek health care outside of his country, then this example is highly tarnished.


  1. Sherri Lynne, I am a lawyer and know quite a bit about constitutional law. I am also well read on politics and policy issues.

    I'd like to know what is the basis for your opinion that there will be "massive tax increases." Secondly,this law is far from "socialized" medicine so your comparisons to other countries appear to be exaggerated and misplaced.

    I realize that more private group insurance plans now provide coverage for transsexual procedures than was the case a few years ago but as far as I know most group and individual insurance plans do not cover and still explicitly exclude these procedures. I know many, many individuals who have been forced to delay surgeries for much longer periods than you have described.

    I don't think there is a perfect answer but the current system is not the answer and the health care reform was an imperfect political compromise.

    The examples you have provided are anecdotal and, in my experience, anecdotal examples can be provided to support almost any position.

    Let's just say you have not convinced me.

    1. I base the opinion that there will be huge tax increases because as it stands roughly 52% of the population pay the federal taxes and 48% of the population don't. The Congressional Budget Office states that taxes will rise markedly. They are non partisan. You can't add a new entitlement and not expect it to cost more. In order to avoid a significant tax increase, one would have to fold Medicaid and Medicare into the system, clearly not the stated goal of the Obama administration. Health care, other than primary care will have to be rationed as it is in Candada and Europe.

      One of the reports I cited I stated was anecdotal as it happened to a friend. When a prestigous medical journal such as The British Journal writes of the problems with their system using one case as an example, they have picked a case that is representative of their health care system's break downs.

      I appreciate you taking the time to add to our discussion!


  2. Sherri Lynne, I grant you your points. There are huge problems with the new system..coming on line(ObamaCare as its commonly called). But it is I suspect a lot better than what we have in place currently. Anything would be better than the slapdash system we currently have(if you can even call it a system). As some one who worked in emergency rooms/trauma centers and in outpatient settings. I saw entirely too many cases of people presenting with routine problems and that had no insurance period as it was to expensive to get or they had so called pre exsisting conditions that eliminated them as users. I grant you that there are many of us who do have insurance of one form or another but there are far more of us who do not for the reasons I gave. The medical profession no longer controls the health field its controlled by bottom line accountants and actuaries. They claim they do not and the doctors can treat without interference that is a pure crock of humbug. You yourself I suspect have been confronted with the stark choice of wether or not to treat a patient based on what the insurance company will or will not pay you. Anecdotal incidents may lead you to believe otherwise but the simple fact is the insurance companies can and do control what doctors or hospitals either can or will do. Obamacare is a bad plan in many ways and can stand to be modified if desired and needed. However it is still at present the only ball game out there that will cover almost everybody. And until the other side can present something just as good or better then I suggest follow the old rule of leave it alone unless and until you can do better. All I have seen so far from the other side is a lot of bluff and braggadocio but nothing solid or concrete to put in place. Oh they talk a good game but when the rubber meets the road they dont come across with anything but.....passing gas. I have personally nothing but contempt for them on this issue among others. Yes, this may appear simplistic but at least something was put into place to help the present users and future users of the health system, sure its socialized medicine if you will but again....whats the other side have to replace it? As near as I can tell *they are full of sound and fury and signify nothing*. It all comes down to the bottom line.....*If Obama is for it we are agin it* I contend if you claim to want to *pull it up root and branch* then you better have very SPECIFIC things to put in its place....the same old haphazard routines are not going to get it either. I for one do not need maybe we can do this but maybe not all depending....that is nothing more than mere cavailling , whinging and posturing for the media. GIVE ME SPECIFICS.

  3. Sherrie Lynne...I agree with you. From the countries that do this, basic medicine will be fine. You will get what you need. If you need more, you will wait.
    As for costs, ObamaCare spreads out the cost across all tax payers (those 50% that pay) to cover everyone. Currently (as you stated) taxpayers cover those who can't pay thru different systems.
    As for the request from your reader for "what has the otherside provided", I don't go with an us vs them attitude. However, the Republicans has provided an alternative. You just have to search for it.
    Also, the "we have to do something because something needs to be done" is a bad attitude. If we do something that negatively affects the system, then that was a bad move.
    Lastly, When Congress goes on this healthcare program and all Obama PAC supports such as labor groups don't get a pass and have to go on it, then I know it is what we need. Most kids don't like "do as I say not as I do" parenting. I don't want to hear that from DC either.

  4. I acknowleged that one example I used was anecdotal, but when the British Journal of Psychiatry discusses problems with their health care system, I don't consider that anecdotal, nor is the waiting list for gender reassignment surgery in a particular European country an anecdotal report.

    While there is much that could be improved upon in our health care system, I prefer the devil we know as opposed to the devil we don't know. In a socialist medical system, health care necessarily must be rationed for cost controls. The financial problems the European Union is about bankrupt in no small measure due to the cost of their socialized medicine.

    Our present administration has squandered billions upon billions of dollars that we don't even have. Try operating your own personal budget as the government has done, not just as the current administration has done, but more of them than not in my life time. The present administration in less than two years spent more than the prior administration in eight years, with proposals to spend trillions more. There is no end in sight. The debt owner, principally the People's Republic of China, grows impatient with our fiscal irresponsibility. We spend more in debt service (read interest payment) than we produce with the Gross National Product. We can't even make a payment on the principal. Care to speculate on what the collateral might be when we default?

  5. Sherri Lynne,

    I think you are confused about who squandered billions of dollars that we don't have. The most recent figures I have read are that the misguided adventures in Iraq and Afghanistan have already squandered over 3 Billion dollars that we didn't have and don't have. The estimates I have seen are that the health care revisions, admittedly imperfect, are projected to cost one billion dollars over the next years.

    You are wrong that the current administration has spent more than the prior administration over any period of time.

    Look at the military budget compared with other expenses in the budget. Health care, while expensive, is not the primary problem. Admittedly, social security and medicare need to be dealt with in some fashion over the next several years. I think you're singling out the wrong issue and the wrong source of the problem.

    And are you seriously arguing that health care isn't rationed under the current system as well? And do you really believe that the cost to taxpayers of uninsured medical costs is not a serious if not greater cost than under the new law. Come on...

    1. Medicare and Medicaid medical services don't seem to be rationed at all. I know that managed care is going to review cases and require preauthorization, but it is rare that if a physician is willing to take the time to write out the basis for a procedure being medically necessary, then they will approve the services with few denials.