2011: Health Insurance Increases, Obamacare Responsible [Basil & Spice]

Sept. 14--How many people in the United States would be opposed to the health care law if it reduced costs? How about if it spread healthcare to everyone while allowing individuals to keep their current plan and doctor if they wanted? Common sense tells you that the answer is zero. If Congress drafted a law that provided those 2 key components as promised, the Democrats would be heroes. Such a law could have been drafted, but Government control could not have been part of it by definition. Hence, the provisions are absent in the law.

We got a health care law that does not allow you to keep your insurance if you like it. Reports state that employers will be more likely to pay a fine than provide insurance for employees. You will lose the insurance you like under the new law. You will not have access to the doctors you want. The White House health care team admits that they plan to have all physicians employed by hospitals. You will only be able to see a physician who is employed by your ACO (Accountable Care Organization) or "health home." If you need a specialist in muscular dystrophy or cystic fibrosis for your child and the doctor is in another ACO, too bad. If your family doctor is in another ACO, you will have to find a new one regardless of difference in quality or the relationship your family might have established with the doctor over years.

What should make everyone even more angry is how the health care law will cost you more and deliver less. We have been told that EVERY health insurance plan will be more expensive, even in 2011. As of next year, children up to age 26 are covered under their parents' plans. Also, co-pays for primary care and emergency room visits disappear. Sounds great, right? Who do you think is going to flip the bill for these added benefits? You are! You are going to pay for everyone's ER visits even if you never go there yourself. You will be paying for services that you do not utilize whether you like it or not. The politicians will lie to you and tell you that it is just the "greedy insurance companies" increasing premiums to increase profit. This is a political lie and I will explain below.

A pharmaceutical representative and I had a very disturbing conversation the other day. Her company sells a medication that is used primarily in the elderly (who have Medicare) and the drug is not available in generic form. It is therefore very expensive and my patients often suffer without the drug as they can't afford it when they go in the "doughnut hole." When Medicare patients enter the doughnut hole, they pay cash for all medications. This can represent $ thousands. The representative said that she had "very good news." Apparently, the pharmaceutical companies struck another deal with the politicians. They promised to provide financial help to Medicare in order to provide drugs for almost nothing to patients in the doughnut hole.

I think the representative expected me to rejoice when I heard how my patients on Medicare would now be able to afford their drugs and their suffering would end. Was I happy about this information? Of course not because my common sense looked down the road and saw the major problem this would create for all of us, including my Medicare patients. You may remember in the summer of 2009, the pharmaceutical industry came up with a similar deal and started supporting Obamacare legislation. We were told that the industry would sacrifice about $10 billion under Obamacare as part of their sacrificial deal with Mrs. Pelosi and Mr. Reid. They then raised the prices on all drugs by historic proportions and made over $13 billion extra in just 1 year. Who then paid for the deal from the pharmaceutical industry; the drug companies? No, the American people did. Our insurance went up and our out of pocket expenses went up. Who do you think will pay for the closing of the doughnut hole in Medicare?

To understand the lies you will hear from the politicians in the coming months, one must understand the truth and see how the ball rolls downhill. Under the new law, the politicians limit how much profit a health insurance company can make. Do you remember the term MLR (medical loss ratio)? The law states that an insurance company must use 80% of the revenue they bring in for medical expenses (85% for larger companies). Therefore, their profit is pretty much fixed (they cannot raise rates and make any more of a profit). Here's how the ball (or doughnut) will roll down the hill. The pharmaceutical companies raise the prices of all drugs. They give some of that money to pay for drugs for the elderly. The insurance companies pass those costs on to the rest of us in the form on yearly premiums and higher drug costs. Their profit doesn't change a single bit as they are bound by the MLR. You and I will pay for the difference and the politicians will buy off votes from the elderly who are on Medicare.

The ball will not stop rolling there, however. Small business will be hurt first. Those who work for big companies get great insurance rates because their employer buys for thousands instead of just a few. Insurance rate hikes will be levied upon the smallest businesses and individuals looking to buy insurance for their families. The big companies will always be able to leverage their size against big hikes, otherwise they threaten to go to another insurance provider. Small businesses and individuals purchase insurance with no leverage whatsoever because the insurance company cares far less about losing a few enrollees.

In the end, the elderly will be equally devastated as the jelly doughnut explodes all over them at the bottom of the hill. As costs go up in all health care and rationing by age will occur in order to keep Medicare alive. Embedded in the law is the $500 billion reduction in payments for those on Medicare. Medicare patients may get their drugs for cheap now. However, they will have a limited number of drugs that are allowed, a limited number of procedures that are approved, and they won't be able to find a doctor who takes Medicare any longer to write orders for drugs or procedures.

If it wasn't so disgusting, I would laugh at some of the Democrat's campaign tactics over the last few months. They signed a bill into law without reading it and didn't understand what would happen. They are now in grave danger of losing their jobs as people hate the law. It didn't provide any of the benefits or changes wanted by the American people. Many Democrats are promising to fix all of the aspects of the law that the American people hate. They are now asking us to "trust them" to fix the problems in the future. They want you to believe that they will go against the White House, Nancy Pelosi, and Harry Reid to do what is right for you. What evidence do we have thus far that would lead us to believe any Democrat in Congress will go up against Nancy Pelosi? Bart Stupak (D-Mi.) sacrificed his life-long political promise to make sure tax payer dollars would not go to fund abortion when he caved in to Mrs. Pelosi and voted for the law. Tax payer dollars are already paying for abortion in high risk pools and the law is only 6 months old. He just decided to quit instead of trying to explain himself to his constituents in the next election.

The HHS Secretary wrote a threatening letter last week to the President of America's Health Insurance Plans. In the letter she stated that, "there will be zero tolerance for this type of misinformation and unjustified rate increases." A federally appointed official is threatening an industry to keep its mouth shut about the reasons for price changes "or else!" I ask you, Mrs. Secretary, if the cost of health care has to go up to cover office and ER visits with no co-pays, to cover children to age 26, and to cover the increased prices on drugs while at the same time the insurance industry profit is at a fixed amount, who is to blame? The politicians have no option but to threaten anyone who tells the truth.

The opinions expressed by Dr. English are his own and do not reflect the opinions of any affiliated institutions.

Dr. Jeffrey B. English is a Board Certified Neurologist with sub-specialty training in Clinical Neurophysiology. He is in private practice in Atlanta, Georgia. Dr. English is the Clinical Research Director at the Multiple Sclerosis Center of Atlanta, a non-profit organization for the treatment of patients with multiple sclerosis. He helped develop and helps run the Center. He is also a national speaker on multiple sclerosis and on the economics of health care delivery. Author Dr. Jeffrey English writes the HC On Call series exclusively for Basil & Spice. Visit his Writer's Page.

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