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Guest Commentary

July 19, 2012
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Healthcare is not for sharing

By Jane M. Orient, M.D.

Congressman Barney Frank, in an unusual flash of common sense, told New York Magazine that he thought President Obama made an error in pushing healthcare reform too hard. Not that he disagrees with the law — it’s the politics, not the principle.

People don’t see how you can extend care to people who don’t now have it without hurting the people who do have it now, he said. “So I think [Obama] underestimated, as did Clinton, the sensitivity of people to what they see as an effort to make them share the health care with poor people.”

People see it correctly. “Healthcare reform” is Newspeak for redistribution. People don’t want to “share” their doctor — they want his undivided attention. They don’t want the excellent facilities near their home to be moved far away in order to even out “healthcare disparities.” They don’t want funds used for treating their child’s rare cancer to be shifted into buying free drugs for people with HIV or AIDS.

Americans are very generous when it comes to voluntary sharing — also called charity. But they are selective. They choose to give to those they consider truly needy and deserving — say children with heart defects, burns or hemophilia. They might not care to give to folks that Barney Frank calls “disadvantaged” or “vulnerable,” politically correct causes or law students who want free contraceptives.

Americans can be quite stingy about paying for other people’s medical care. That’s why the “free rider” argument was effective in selling the individual insurance mandate, even though unpaid bills by uninsured persons are a tiny part of the problem.

Given a choice, people at low risk would buy health insurance that bases premiums on risk, rather than on “community rating,” and that covers only the services they might need. The young, healthy and prudent don’t want to share the high premiums of the old, sick or reckless. Teetotalers resent having to pay for other people’s alcohol and drug rehabilitation.

People tend to like ObamaCare to the extent that they think they will get more “free” benefits. Some will, but there will be less available to divide up. That is not an unintended side effect. The reformers tell Americans what they’re up to. They think Americans get too much medical care. They want the money to go into “population health” instead of helping the sick, especially if the sick people are old.

Since people aren’t willing to share enough to bring about the equality and the optimal average health statistics that the reformers desire, the big-government answer is to take. Set up a commission of right-minded people to decide how much money is required to pre-pay for all “necessary” and “appropriate” healthcare services, and how much is each person’s fair “share.” Hire enough IRS agents to enforce the “contributions.” Then set up bureaucracies to allocate the booty, first to highest priorities like curbing smoking and obesity.

ObamaCare does not have crude rationing boards, but a more subtle system of incentives. The unaccountable bureaucrats, as on the Independent Payment Advisory Board, delegate the hard choices to Accountable Care Organizations (ACOs), where “providers” coordinate, manage, document, collect data, delegate, prioritize and provide some care — always with an eye on the ACO’s bottom line.

The Supreme Court case on ObamaCare focused on the individual mandate to purchase insurance and the limits of the Commerce Clause. But the real issue is the fact that the whole law is a mechanism for taking.

The Fifth Amendment to the U.S. Constitution forbids taking private property for public use without just compensation. Does it thereby forbid taking a portion of one’s earnings for the public purpose of promoting population health? This question is part of the lawsuit filed by the Association of American Physicians and Surgeons (AAPS) three days after ObamaCare was signed. The case was stayed, pending the decision by the U.S. Supreme Court, but the issue will not go away.

It’s not just about sharing, Mr. Frank. It’s about having one’s access to live-saving medical care taken away. CV

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine.

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