I’ve been asked how physicians and patients will be affected by the Court’s declaring the Unaffordable Care Act unconstitutional.  My sources tell me that this is extremely likely.  I am reminded of the comment of the brilliant Joe Sobran, who said, “…if Iraq needs a constitution let them have ours…we’re not using it.”  Incredibly, this “brother-in-law” court appears poised to reject Obamacare based on “the constitution.”    It is useful to review the reasons this legislation was passed in the first place to keep any specifics about the bill in proper context.  The bill served at least two purposes, neither of which has anything to do with health care.  

A tax increase:  Taxes are sent to the government with the hope that some of them will be returned for roads and bridges, that kind of thing.  Politicians make more money, however,  by doling taxpayer loot out to those who bribe them.  We all remain hopeful that some of the bribers will be road and bridge builders, I suppose.  Insurance works the same way.  We pay premiums, hoping that when the day comes and we need to make a claim, some of our premiums will be returned.  Insurance companies are prevented from becoming too abusive (refusing to pay claims) through competition.  If one insurer is too abusive, another will gladly accept a disgruntled customer.  With the government acting as the only “collector of premiums,” customers (patients) are disarmed, unable to retaliate against poor service.  To the extent that claims are denied or delayed this amounts to a simple tax increase.  The federal budget will look improved at first with loot from this new robbery rolling in and rationing of care in full swing.   Later, as demand outstrips supply, the program will become bankrupt, the bankruptcy assuming the form of long lines for care.  The political hacks that dumped this on us won’t care a flip, as they will be long gone, leaving future politicians to deal with the politically impossible chore of dismantling a federal program, or alternatively  will be smeared as mismanagers of the earlier politicians’ great idea.  FDR understood this.  To this day he is considered one of the great ones because he introduced the Ponzi scheme of old age pensions, a program that threatens to bankrupt us today.  

“Return on Investment”:  Health information technology companies, big pharma, big hospitals and big insurance companies either have already received huge benefit from this law and/or stand to in the future.  This quid pro quo of political bribery was very successful.  HIT companies were successful in getting Uncle Sam to declare the purchase of their products mandatory.  Incredibly, 20 billion dollars in taxpayer subsidies were doled out to buy this product.  I like to refer to this as a “bail in,” as opposed to a “bail out.”  Close negotiations with the big pharma lobbyists in connection with the health care law insured maintenance of their profits.  Big hospitals were granted the upper hand in hostile takeovers of physician practices and smaller hospitals due to the intentionally expensive mandates that the little guys couldn’t handle.  The big insurance companies supported this effort in anticipation of the country being carved up into regions over which these big boys will have complete control.  The medical loss ratio provision of the bill insured that their smaller rivals would be destroyed, a political gift,  the deception of which can not be overstated.

The players haven’t changed.  Bankruptcy due to cancer is the fault of the government-created cartel of big hospitals, big pharma and big insurance companies.  Death from rationing (the favorite budget-balancing tool in the universal health care bag) will likewise be inexcusable, but will be implemented by the same cast.  The free market, one characterized by real competition and transparent prices, has brought a standard of living to the world that no other economic system could have produced.  Why do most continue to believe that the application of this mutually beneficial system of exchange does not apply to medical care?  

After this law is overturned, lawmakers will be in a heat to “fill in the gaps.”  My advice:  take some deep breaths.  A real opportunity to return to healthcare sanity is upon us and the solution (a transition to a free market) will not come from Washington, short of repealing countless past laws bought with bribery.   Application of the libertarian principle of non-aggression is indicated.  By this I mean that no individual’s health needs should be the involuntary responsibility of any one else.  Short of this, the feds should turf as much of this as possible to the states for them to figure out on a local level, as local politicians are more accountable to their electorate.  Washington politics has made millionaires too numerous to count already, as a result of this fiasco.  That is what politicians do:  make already rich folks (who agree to kick back bribes) richer.  To paraphrase the great libertarian Harry Brown, “..this is much too important to leave to the incompetent, inefficient and corrupt officials in the federal government.”

G. Keith Smith, M.D.