I will respect the ruling of the Supreme Court in upholding the subsidies under Obamacare, but the decision was wrong.
Those who drafted, supported, and voted for Obama care clearly intended to withhold money from those states that did not set up their own state health insurance exchange – just like many other laws that require states to meet certain requirements in order to get federal money. In this case, they intentionally wrote the law to provide subsidies only to people in states who purchased their health insurance through an “exchange established by the state.” It was intended as a carrot or a stick to get the states to comply. Many did not comply, so the strategy backfired.
The job of the Supreme Court is to resolve disputes based on the law, the facts, and the Constitution. It is not the job of the Court to fix mistakes in political strategy. That is what they did, and it was wrong.
The Register recently criticized our fee-for-service health care payment system for causing over-utilization and for driving up health care costs. (2/12/2015 – “Florida, home of medical scans — and scams” – see link below) They gave examples of doctors ordering unnecessary test because they get paid more for every additional service that they provide. They advocated paying physicians a salary like Mayo Clinic does, so that doctors, “…have no personal, financial incentive to provide unneeded care.” They urged the Obama administration to, “…continue to work toward reimbursing providers based on quality instead of quantity while fairly reimbursing them.” I agree with the Register that, “Ultimately, reducing the overuse and misuse of health care falls to patients.” They urge patients to not rush to the doctor for every ache, ask questions when doctors order tests, resist clinic staff who want to schedule tests and procedures.
One thing the Register failed to mention is the importance of patients being required to pay out-of-pocket for some portion of their health care costs. To the extent that patients are not required to pay for some portion of their costs, they will not question the recommendations of doctors and other providers and they will tend to over-utilize health care. Requiring patients to make some out-of-pocket payment will also help reduce fraud, since patients won’t want to pay part of any fraudulent charges that billed to their insurance. Many insurance policies under Obamacare do seem to have significant deductibles and co-payments. That will go a long way to help keep down health care costs.
Link to Register article: http://www.desmoinesregister.com/story/opinion/2015/02/12/florida-home-medical-scans-scams/23278965/
Republicans are right to not increase the debt ceiling without some action to reduce our Country’s spending deficit. They are not right to pick out Obamacare as the only possible target. President Obama and the Democrats are wrong to insist that the Republican in the House of Representatives pass a “clean” debt limit expansion bill. The compromise should be to agree on spending cuts that are not specifically related to Obamacare. The four big drivers of the Federal budget deficit are Medicare, Medicaid, Social Security and Military spending. Any other spending cuts, although helpful, do not really solve our long-term problem. Republicans should propose some type of binding agreement on entitlement and military spending cuts in return for passing a debt increase bill. The real problem to be solved is that we must stop spending beyond our means.
The Register advocated for government operated long term care insurance in its lead opinion on 7/15/2013. (“Long-term care policies need attention”) We don’t need or want a government financed program for long term care insurance. President Obama backed out of a government sponsored long term care insurance program when he felt unable to promise that government would not some day step in and require taxpayers to subsidize the plan. We have Medicaid for the poor. That is enough. If anything, our government should encourage people to buy long term care insurance and/or to save for their own long term health care needs. Instead, our government seems content to keep interest rates artificially low so that people will borrow and spend. Low interest rates reduce the returns that insurance companies earn on their reserves, which in turn causes them to increase their long term care insurance rates. Letting interest rates rise to their natural levels would be one of the best ways for government to help improve the incomes of seniors, and help hold down the cost of long term care insurance.
Contrary to the letter to the Register on 5/28/2013 by Michelle Anderson, “Iowans should have access to naturopathic docs”, we already have open access to naturopathic doctors and medicines. What we don’t have and don’t need is for our government to license practitioners and then require that their services be covered by insurance. Individuals are not calling for licensure in the interest of public safety. Practitioners are calling for licensure in order to have their products and services be a required service under Obamacare. Unfortunately, as long as our government continues to use its power to force insurance companies to cover politically favored medical products and services, there will be many special interests, such as naturopathic doctors and pharmacists, who will try to get on the government gravy train.