In 2010 Nancy Pelosi (D-CA) then the Speaker of the House of Representatives is famously quoted as saying "We have to pass it before we know what is in it (the Affordable Care Act more commonly called Obamacare)." While this was a contextually parsed phrase it made me think back to that employer many years ago. He wanted me to take a job without knowing all of the particulars. Our government wanted to pass a piece of legislation that effectively gave government control over 1/6 of our economy (and growing) without really educating anyone on what this law would change.
|Minority Leader Nancy Pelosi after a Democratic caucus meeting on November 14, 2013. John Shinkle/POLITICO|
The context of that statement by Ms Pelosi was that it would take years for the people to learn how great this piece of legislation really will be. It has been years since this quote, and I think it is time to review what we know at this point. Certainly there is much to learn in the future, but if the past is any representation (and if you are reading this blog you are a student of political history) then hold on because it is going to be a bumpy ride.
Whenever a historical issue is debated it is always from the position of hindsight. It is easy to take potshots at figures of the past (recent or ancient) and expect that they should act in a certain way. It is easy to say we would have done things correctly without having to do so. This situation will be no different. It is universally believed that the United States has the greatest healthcare services available anywhere in the world. The rich, famous and powerful all tend to come to the US for their urgent medical needs. This speaks volumes about the quality of care received here. This is not to say that outstanding medical personal don't exist elsewhere in the world, but the US tends to excel in more areas than any other country.
What is also universally understood, is the costs associated with this care. Doctors routinely perform tests that while informative are not truly necessary in all cases. Why is this done? To prevent someone (i.e. malpractice attorneys) from second-guessing their decisions. Believe it or not there used to be a time when doctors opinions were valued, and the patient trusted the doctor to do the best job they could. Today, we expect our very human doctors to be perfect at all times. You should give me a ring when you have made it through a single day being perfect. I won't be waiting by the phone anytime soon. Doctors make mistakes. We hope those mistakes aren't huge and certainly hope they aren't on us. "Routine" surgery simply means that it is done frequently. It doesn't mean that it is done perfectly every time. The old phrase, practice makes perfect, has some bearing. Instead, we expect, perfect practice to make perfect. Good luck finding that anywhere in this world. Suffice it to say that costs have skyrocketed with new, novel testing and the need to cover the physician's behind from a legal standpoint. Is it any wonder that costs have increased exponentially over time?
In an effort to control costs, a number of first world countries have tried to institute universal healthcare. Simply, if you live there, you get care. In theory this makes moral sense because the risks are shared, and all could benefit. In reality (as with many things) it leads to a reduced amount of care and in a number of cases reduced quality of care for most. So what sounds good in theory doesn't work in reality.
Now transition to the Obamacare situation in the US. The bill was passed to much fanfare but very little concrete understanding of what had just been signed into law. Now three years later we are finally seeing some of the fruit of this labor.
A national website that doesn't work as promised (that is putting it mildly). Those in authority were told that the website was not working correctly and wouldn't be correctly operational nearly 7 months before it went live. I didn't hear anything about that on October 1st, did you?
The company that built the website was run by a political donor and close friend of our President and First Lady. Even if there was no impropriety here, doesn't the President need to remove even the appearance of impropriety? Based upon the facts we have been shown, apparently not.
The President promised that if you liked your health plan you could keep it and the doctors you were comfortable with as long as you like. Seems this might have been false as well for millions of current citizens as well as millions to come. In fact, an internal HHS audit predicted that nearly 70% of all Americans would be unable to maintain the health plans they were currently in and would need to change to one of the exchange plans. I am no mathematical whiz, but I believe 70% (245 million people) is just a bit larger than zero.
So Ms Pelosi, you were correct when you said we would need to pass the legislation in order to see how sweeping a change it really would be. I am not sure that anyone in the government was exactly clear at how sweeping a change it would be. Get ready to pay more for less. It is a simple economic principle. There are limits to everything.
We have effectively added millions of people to the rosters of patients needing care. Many of these are people who couldn't get insurance coverage previously. There is a limited number of physicians and how many patients they can see and surgeries they can perform. Adding millions of patients and no additional physicians seems like a recipe for disaster. There is a limited pool of money with which to pay for these services. If you go to the grocery store and try to buy a gallon of milk, but only have enough money to buy a quart, I am certain you won't be walking out of the store with a gallon of milk. This is no different. In our system, someone needs to pay for the service. Who will this be?
If you are naive enough to believe the following:
- Millions of additional patients
- No appreciable increase in physicians, hospitals or medical care facilities
- Increase in quality of care
- Reduced cost to consumer
then you truly deserve the government that you have elected. If instead you believe what you can see with your own two eyes and what you know from your own lives then welcome to the clear headed rational thinkers. You are in a distinctly small minority. Too many people want to believe what they are told simply because accepting the truth makes their lives harder and less enjoyable. What these people fail to realize (much like the ostrich with it's head in the sand at the first sign of danger) is that your life can be worse even if you don't want to acknowledge it. The first step to change is recognizing that there is a problem. Can you see the problem?