The fate of the Affordable Care Act (ACA) won’t be known until at least June- and that adds a significant element of uncertainty for physicians trying to manage their practices. The Supreme Court is expected to issue an opinion on the law’s- and its components- constitutionality some time before its current term ends in late june. Given the complexity of the issues heard during oral arguments in late March, most observers do not expect an opinion any earlier.
The tenor of the four conservative leaning justices’ questioning during arguments suggested at all, or at least some, of the law might be struck down. Justice Clarence Thomas, who generally is silent during arguments, is seen as being in the conservative camp, as well. But there needs to be some caution, because questions by the justices don’t necessarily predict what they’re going to do and how they’re going to vote.
The court will decide on four questions:
1. Is it within Congress’s authority under the Commerce Clause to require Americans to buy insurance?
2. Can Congress levy a penalty if they don’t?
3. Can the reminder of the law outside the mandate be upheld separately?
4. Is the federal requirement that Medicaid be made available to Americans up to 133% of the federal poverty line an acceptable use of federal powers?
Some physicians might not even be aware of the potential ramifications of a partial or full appeal. If they throw the whole thing out, its like throwing a hand grenade into a crowded room. I don’t think many physicians have given thought to the confusion and huge chaos that would be created if the ACA is overthrown. If it is then put back together on a piecemeal basis, it’s going to take a long time, and there will be a lot of confusion along the way. One area of confusion will be Medicare offering patients free preventive services. What about the health insurance exchanges? It is costing the states millions of dollars to set up and many are not doing it until they heard of the Supreme Court’s ruling. For the states that have already begin the process of setting up the exchanges, they could lose millions of dollars that could have been put to better use.
Some above excerpts are from OB.GYN. NEWS. May 2012
While there are many potential benefits to the ACA, there will be a number of long lasting disadvantages. In the next 25 years or less, you will no longer recognize today’s health care in the US; and it will look, and probably be, identical to the European health care system. Socialized medicine only works in countries with small populations, between 20-50 million people, and than barely. How can it possibly work in a country of 350+ million people. Lines for health care will be staggering and people will start to embrace the thinking, “if it is free why should I pay for it”, which is true in countries where there is socialized medicine. The quality of health care will plummet significantly and access will be difficult at best. We have the best health care in the world. Most of the new technologies, medications and advanced treatments come from the United States. Clearly the system is broken and needs to be fixed. The ACA is not the answer and will change the way medicine is practiced in the United States forever. Physicians and health care providers will be reduced to laborers providing a government sponsored service and many may become less than enthusiastic about providing that service, let alone even deciding to go into medicine.
One idea getting a lot of attention and championed by Paul Ryan is replacing traditional Medicare with a premium support model. The premium support model would limit government’s Medicare spending by offering a defined contribution per beneficiary. Beneficiaries would use the voucher to purchase a plan of their choice, paying higher co-insurance for additional coverage; but at the same time forcing insurance companies to lower their premiums in order to be more competitive and thus giving a choice between a private plan and a premium support-style Medicare program. There are a lot of smart people in this country that, in a bipartisan fashion, if given the courage and commitment for change, can profoundly alter the current system and create a modern and efficient health care model that benefits ALL the citizens of this great country.
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