By Birdstrike M.D.
Yesterday, my 2 year old asked me, “Daddy, do clouds make rain by forming condensing nuclei of water vapor which act to form droplets which fall to the ground?” I said, “No, son. No. You’ve got it all wrong. Actually, those drops of rain are the tears of our founding fathers crying over the recent Supreme Court decision on Obamacare.”
Supreme Court upheld the Affordable Care Act (ACA). I was against “Obamacare” as it has come to be known, from the very beginning. I am still against it, for reasons too numerous to count. On the face of it however, the entire rationale for declaring Obamacare unconstitutional was absurd, and rather disingenuous. Amongst the 2000 pages of this behemoth of a law, the one portion that makes the most sense is the “individual mandate”, which is the single portion that actually attempts to require all Americans to take at least a sliver of responsibility for the cost of their own health care expenses. This is the one and only portion of it that is actually revolutionary and acts to reverse the central core of what is wrong with the health of our people, and our healthcare system itself: the complete lack of responsibility of so many individuals for their own health, and healthcare expenses.
Like many of you, I wished that the Supreme Court would overturn the law so that we could rebuild it in a way that makes sense both to patients and physicians, and less so to politicians. However, as much as it pains me, I have to admit that Chief Justice John Roberts’ opinion was courageous and brilliant. It tears my heart out to write it, but its true. As I interpret it, what he essentially told America and the opponents of Obamacare was, “Don’t ask me or the spirits of our Founding Fathers to overturn your law, written by your representatives, and approved by your President with some fabricated technicality to fix your ‘Oops!’ Man up, and live with it. Otherwise, if you don’t like it throw the fools out, elect a new government and start over, or fix it”.
Indulge me for a minute and allow me to play the “What Would Our Dead Relatives Have Thought, Game”: The Founding Fathers of this country lived under true tyranny. They were ruled by a tyrant King that would not hesitate to jail or execute someone for speaking an opinion infinitely less offensive that my own, and simply on a whim. Many of them lost their lives fighting for the right simply to have representation. (Remember your history class, “No taxation without representation!”?) I’m sure they would conclude that we have that luxury, and many other life easing luxuries they did without. (You know, real important stuff like electricity, running water, insulin for diabetics, iPhone 4s with integrated Siri personal assistant.) They didn’t have to worry about 40 million people being uninsured. Health insurance didn’t exist. It wasn’t a crisis for them, that only 80% of people could get an MRI. 0% of people got MRIs. MRIs didn’t exist. Neither did door-to-doctor times, ED wait-time billboards, sterile technique, antibiotics, cab vouchers or Sierra Mist with a meal tray.
If the “individual mandate” for all Americans to buy health insurance was severed from the ACA and we had to choose between it and the rest of the bill in its entirety, I would choose to keep the individual mandate, and strike down the other 2000 pages from this complex bill, the details of which no single person on Planet Earth has read let alone understands. Most unknown, are the costs and unintended consequences of this bill. As Nancy Pelosi has been repeatedly been quoted, so tragically and accurately, “We have to pass the bill so you can find out what is in it.” This is an irresponsible and dangerous attitude that would never meet the “standard of care” any of us physicians have to live under, yet we are now ruled by it.
For decades I have been required to pay Medicare tax to pay for your Grandma’s health insurance (Medicare). For decades I’ve been required to pay taxes to pay for your unemployed uncle Ed’s health insurance (Medicaid). How come these things are not “unconstitutional”, the “Joe’s Grandma Mandate” and the “Billy Bob’s Uncle Ed Mandate”? Now that the ever so radical concept comes along, of requiring me to pay for the health insurance not only for your Grandmother and your uncle Ed, but also for myself, all of a sudden it’s a cruel violation of my constitutional rights? Give me a break. The government can send 58,000 men to die in Vietnam, and that’s constitutional? The government can take your house, bulldoze it and build a road in its place “for the common good” and that’s “constitutional”? But to require Joe Six-Pack to chip in a few bucks for his ER course, ICU stay and redo CABG, half of the cost of which is eaten by insurance-buying Americans in inflated premiums, the other half of which is eaten by the doctors that took care of the patient in the first place, is unconstitutional? Give me a break.
As much as it pains me that Obamacare stands, since I’ll be paying higher taxes, certainly get paid less from Medicare, Medicaid and private insurance all of whom will cut payments to doctors to cover the newly insured, and likely be overwhelmed by the masses of newly insured patients with government insurance that pays pennies on the dollar…. I still think John Roberts did the right thing. We as Americans, and we as physicians allowed this to happen. We let them walk right in, take over our house, repaint it, decorate it, rob it and remake it in their own image with nary a fight. We are amazing healers, but the most hapless complainers and the feeblest of pushovers. Let this be a lesson to us all. We have allowed them to raise the stakes to a much greater height and will face a much more epic battle to save God’s profession.