“If the Republicans win big they plan to choke off health care reform,” said my wife while reading the morning paper. “That’s what you want, isn’t it?” She’d heard me rant about the long-term negative effects that the recently passed bill would have, and I think she was hoping this election cycle might put an end to it.
“Oh, I want to choke somebody, all right,” I said, “I’m just not sure where to start. It’s barely out of the blocks and they are starting to politic this thing.” My wife looked at me quizzically. “Take this ‘McDonald’s thing’ to start with. First, the Congress says that they are going to make everyone buy the government mandated health plan. But McDonald’s finds that their ‘mini health plan’ that they have provided for all their minimum wage earners doesn’t measure up to the government standard. So what do they do? Since they can’t afford a $5,000 a year policy for everyone, they plan to drop everyone from insurance all together and just pay the fines.”
“That’s terrible,” my wife said sympathetically.
“No, that’s just dumb. If McDonald’s had to provide a Cadillac policy for every kid who flipped a Big Mac, that burger would cost fifteen dollars instead of five. Besides, they cried so hard to the Feds that they got a waiver. And now their insurance policies don’t have to meet the same standards that other businesses.”
“That’s not fair!” my wife said indignantly.
“No, that’s just bad planning. They could have seen this coming if they had just taken their time writing this legislation. They could have gotten one part of it right and then moved on to the next part. But nooooo, ‘we have to pass this bill so we can find out what is in it’,” I said in my best wicked witch voice. “In any event, now they are going to have the law apply to some people and not to others.”
“What a mess!” my wife said, waiting for me to correct her again. But I couldn’t think of anything.
“I wish they would scrap the whole thing and start all over again,” I said.
“Do you really think that could happen?” she asked incredulously.
“Not on your life. We are married to this big fat cow. It’s until death do us part.” There was a long silence.
“Why did that metaphor come to your mind?” she asked. I froze. My wife knows her weight within a half pound on any given day, so carelessly dropping the ‘f’ word can get a husband in serious trouble in our house. I knew that my next words needed to be chosen very wisely.
“The big fat cow,” I said slowly, “is the bureaucracy that health care reform has created. Did you know that the new law creates at least a dozen new federal programs, boards, and task forces? And the rules and regulations for all these have yet to be written by the various agencies. The two thousand page health care bill that no one read is going to span another ten thousand pages in regulations. And you can bet everyone will be reading those. But it will be too late.”
“Once bureaucracies get created, they take on a life of their own. They do things just to justify their existence and keep their budgets flowing. And then the very people they set out to help end up getting hurt.”
“How is that?” My wife had heard all this before and was starting to zone out. But she knew there was no stopping me. So she just played along, being the straight man to my monologue. She was just happy that I wasn’t accusing her of being...I’m not even going to utter the word.
“Billions of dollars get put into the budget to write and administer all these well-intended rules,” I said. “And those dollars have to come from somewhere. So they end up with a larger budget while spending less on individual patients. The whole thing just gets so out of shape and bloated.” My wife’s eyes snapped back to meet mine. “What? Did I say something?”
“Are you trying to tell me something?”
“I’m just trying to say,” I said carefully, “that even when the government tries to do something good, like get everyone insurance, they somehow end up screwing it up.” I could see my wife relax. “Take the federal health insurance exchange, for example. It’s going to take a whole administration and years of implementation to get this to work. And even then, it is going to be a political football as to what is covered and what is not. Did you know that there are at least three separate boards that have been created just to advise the Secretary of Health and Human Services? The Health Benefits Advisory Committee will recommend what benefits should be covered by the policy that the government decides to call ‘qualified’. I can only imagine the back room deals that will go on in that committee.” I could see the glazed look coming back over my wife’s eyes. “You don’t really care about this, do you?” I said with a hint of frustration.
“Oh, I care,” she said rather nonchalantly. “I just don’t see the benefit in getting riled up about.
What do you tell me that you do when a really complex problem comes into the ER?”
“Break it down into its component parts and work the problem,” I said, repeating what I had taught the kids for years. I paused. “You don’t lose fifty pounds over night. You have to lose a little bit every...”
“What is your problem, Buster?!” I could see fire in her eyes. “I gain 4.5 pounds at the ACEP convention and you are talking like I need a gastric bypass.”
Now it was my turn to be confused. “What are you talking about?”
“You know what I’m talking about. Just say it!”
“The Patient Protection and Affordable Care Act is a crummy piece of legislation,” I said slowly as if creeping out on a frozen pond.”
“Is that what this is all about? All this frustrated talk about McDonald’s and Big Macs and getting fat and bloated? Is there something on your mind that you want to say?”
“Sweetheart,” I said, taking my wife’s hands. “I think you are just fine the way you are.” I could see her squint suspiciously at my qualified statement. “No,” I said, rephrasing. “I think you are just perfect. You don’t need to lose a pound.” I saw her smirk at me, cock her head, then relax finally and smile. “In fact, you might need to gain a pound or two.” I realized I had overshot the mark when she turned loose of my hands in exasperation.
“You are so full of it.” She began to walk away, leaving me to read the paper after breathing a deep sigh of relief.
“Did you know that waste, fraud, and abuse in Medicare has been documented at thirty per cent,” I read aloud. “They need to get serious about cutting out the fa...” I stopped myself. “Uh, you know, I hope the court finds this unconstitutional.”
Mark Plaster, MD, is the founder and executive editor of Emergency Physicians Monthly.