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.