I anesthetized a 208 pound, eleven-year-old female recently.  Her parent’s combined weight was well over 700 pounds.  Both parents were smokers.  It occurred to me that the Unaffordable Care Act (UCA) guarantees that they will never be turned down for insurance.  What does that mean for you and me?  

If you think that including folks who engage in this level of self-abuse on your insurance plan will drive your premiums through the roof, you go to the head of the class.  If you believe that health care is a right and that these folks have a right to health care, you may think differently when their “right” to health insurance causes your premiums to skyrocket and you can no longer afford or obtain care.  What would happen to life insurance rates if skydiving and previous suicide attempts could not be considered for exclusion?

“But wait!”   “These folks are going to get care anyway and the hospitals charge us more now (because they don’t have insurance) to cover them!”  Right?  If you believe that the hospitals plan to lower their charges after implementation of the UCA, you go to the back of the class. 

Actually, community, not for profit hospitals made a deal years ago to deal with the charitable care issue.  These hospitals, having been required to care for the indigent, were relieved of any tax liability.  “Not for profit” really means “don’t pay tax.”  The value of this “tax free” condition is never discussed as this excessive number would make Donald Trump blush.  Not satisfied with this loot, the hospital lobby has successfully saddled us with the uncompensated care scam and convinced us all that “cost shifting” was necessary to avoid bankruptcy. 

What does the UCA do to address this?  Pour gas on the fire.  Anticipating the unmanageable increase in demand for the now “free” medical services, the authors of the UCA birthed the IPAB (independent payment advisory board), which puts price controls on….ready?….physicians.  In this stealthy way, physicians will become the de facto ration police of health care by avoiding patients whose care is intentionally “underpriced” by the IPAB. 

$15 payment to the physician for an evaluation of a morbidly obese, hypertensive diabetic with obstructive sleep apnea and coronary artery disease with a history of foot ulcers, is a price that will cause lines to form and doors to close.  If $15 dollars doesn’t close the doors, the IPAB will try $10.  These unfortunate patients will be armed with a worthless insurance card, one that ironically denies them access, like never before when they were uninsured.   Premiums will skyrocket to allow for inclusion of these patients who will be denied care, and more and more people will surrender to the ultimate goal of the state:  to control your health care with a  single payer system.  To control your health is to control your life.  While the current system is a government-created mess, most people I know would rather be bankrupt than dead. 

G. Keith Smith, M.D.