Lest we get too excited about all of the bad news surrounding the unworkability of The Unaffordable Care Act (TUCA), we should remember that this “law” has already achieved much of what its architects intended. If you believe as I do that this “law” was meant to a)line the pockets of certain connected cronies

b)create an industry-wide consolidation in the insurance and hospital business

c)inject mass chaos into the already dysfunctional medical marketplace

d)generate fear amongst physicians such that many would succumb to the hostile takeover offers of the rich hospitals

e)implement the most egregious breech of patient confidentiality by collecting private health information and records

…then you would have to agree, I would think that if the whole thing is repealed at this point, the bureaucrats would declare their efforts a success.   Let’s look at each of these government “victories.”. 

1)TUCA is crony capitalism at its finest.  How would you like to own a company the purchase of whose product was mandatory?  Sound like a money-maker?  Can you say “electronic medical records?”  While there was a limited market for these products, the mandatory purchase made many of these software giants unfathomably rich.  The principal of Epic, one of the largest manufacturers in the Health Information Technology (HIT) sector, was one of the authors of this fine “law.”  Oh.  And let’s not forget health insurance.  The purchase of this is mandatory now, also….or at least the threat of fines if you don’t purchase it is still alive.  Think this will help their profits?  Did you see their stocks soar when “Robed Roberts” ruled on the constitutionality of this “law?”

2)Medical Loss Ratio:  How well do you think large insurance companies are able to comply with this regulation when compared to the smaller insurance companies?  20% of $5 billion dollars is a lot of money for overhead whereas, 20% of $5 million might make staying in business tough for the smaller players.  The industry consolidation that will result is what Jim Epstein from Reason calls the smoking gun of government corruption and bribery. 

3)Small hospitals and electronic medical records:  This has the same effect on the small hospitals that the medical loss ratio has on the smaller insurance companies.  These systems are simply too expensive for many of the smaller players to buy.  That makes these small hospitals easier to buy for the big boys, the intended beneficiaries of TUCA.

4)No lifetime limits and no pre-existing exclusions.  Sounds good doesn’t it?  This is like buying an insurance policy on your home after it has started burning.  What do you think this will do to the premiums of everyone else buying insurance from that company?  The high prices and chaos that will result from TUCA are intentional, in my opinion, so that we will all beg Uncle Sam for relief from the crisis the government has intentionally caused, the relief taking the form of single payer.  Remember “don’t ever let a crisis go to waste?” Four or five big insurance companies will then divide the country up like wolves and extract their premiums from unwilling taxpayers, rather than willing customers in a competitive market place.

5) Physician fear:  Physicians know what past government interference has accomplished in medicine and are fearful that a complete takeover is imminent.  Many understandably want to cut their losses, mitigate their risk and seek secure employment.  This, of course, is exactly the chute the central planners want to see the sheep doctors ascend on their way to complete control or slaughter.  Employed doctors, after all, will be much easier to corral than independent patient advocates.  Employed doctors are much more likely to betray confidential patient records than independent ones.  And when the interests of the patient and the employed doctors’ bosses are not aligned, on which side will we likely find the doctor employees?

 6) The health exchanges are currently collecting confidential patient information and in order to demonstrate “meaningful use” doctors will soon be required to betray their patients to an IRS that promises confidentiality out of one side of its mouth, while admitting to targeting those with whom they differ politically out of the other side.

There is more, of course. This “law” much of which remains unwritten, cannot be complied with to any degree to which it is not in existence.  Leaving everyone guessing at what the “law” actually will say, is a tyranny that even the worst of past tyrants wouldn’t attempt. 

While certain provisions of this law appear to be unworkable or unenforceable, we should be aware nonetheless of the damage already done so cleanup efforts can be focused.


G. Keith Smith, M.D.