What if I were to tell you that those insiders who wanted the Unaffordable Care Act, aka, Obamacare, don’t care what happens at the Supreme Court hearings?  What if I were to tell you that those big money supporters of this legislation have already received much of the benefit coming to them and aren’t nearly as worked up as those who will be effected by this legislation if upheld?

If this sounds crazy, bear with me and I’ll try to make sense of what sounds like a wild claim.  One of the huge supporters of the Unaffordable Care Act (UCA) was the electronic medical records (EMR) or health information technology (HIT) industry.  GE Healthcare and Allscripts (clients of New Gingrich) were big winners.  Physicians and hospitals were presented with a carrot and a stick by our big brother, Uncle Sam.  Taxpayers would pick up a portion of the expense. That is, whatever the cost of the EMR system, the taxpayers would pay for part of it.  Later in this blog I’ll explain why there was a critical difference between this carrot for the doctors and this carrot for the hospitals.  The stick was that if EMR wasn’t implemented, Medicare payments to physicians and facilities without EMR would be slashed.  There was even some talk that the reduction in Medicare payments would be accelerated each year, the stick hitting harder as time went by.  This subsidy of the HIT (health information technology) industry provided for a boom in their sales.  Remember Mises:  “that which is subsidized proliferates and that which is taxed is destroyed.”  These clients of Mr. Gingrich have made billions that they would never have made without this provision of the law (UCA).  I’m not sure that now they care what happens. 

The central planners that would plan every move of our lives that support the UCA have already received most of what they want.  (You didn’t think they really wanted you to receive health care did you?)  You see, they have EMR in place, so they will know whether you have cancer or heart disease or diabetes, or whatever, and will also know how much you or others with your disease “cost.”  This is the ominous death panel feature that without EMR has no teeth.  The bill gets overturned by the Supremes and the EMR is still in place.  Oops. 

Now here is a part that needs to be understood, to which I referred above.  The requirement to implement EMR in a doctor’s office is different that a requirement to implement EMR in a hospital.  Picture a doctor, who is busy, pays all of his bills, has no debt, minding his own business, taking care of his patients.  A government goon sends a letter that says “buy this EMR for $100,000, or we’ll cut your reimbursement.”  “Do it now, or it will just get worse for you.”  “Oh.  And if you buy it now (from the following list of approved bribers…cough…vendors) we’ll pay for a portion of the expense.”   This letter could represent a “practice-ending” event for this doctor.  It might be the last straw for him/her.  Keep in mind that this doctor, like any sane physician, wanted no part of the UCA.  Now contrast his experience with that of the big hospital.  The hospital gets the same letter.  Big bucks to buy this EMR.  But wait!  The hospitals supported the UCA and this provision of the law in particular.  How can that be?  It doesn’t make sense!  Or does it? 

Hospitals wanted this “purchase of EMR at gunpoint” for two reasons.  First, physicians shoved against the wall would be more likely to fold when raided by the corporate sharks from the big hospitals attempting a takeover of the doctor’s practice.  Inside the doctor’s head it sounds like this:  “OMG!  I’ve got employee expenses, malpractice insurance, office rent and now this EMR thing!”  “I can’t take it anymore!”  “I just want to practice medicine.”  “I’m going to give these problems to someone else and just take a salary, or I’m quitting!”  Hospital then has him where they want him.

The second reason the hospitals wanted EMR was that once the physicians surrendered and became employees, the EMR would be the remote control of those doctors and their practices.  No longer would the physicians be able to send their patients to the best surgeon.  They would have to send their patients to the surgeon the hospital had hired.  No longer would the physicians be able to order this or that test, or more importantly, not order this or that test.  They would order the tests or not order the tests that the hospital wanted them to, all the while guided by their intense desire to “not make a profit,” of course.  No leaks.  No surgeries or referrals outside of the “network.”  If a doctor employee doesn’t comply with this, a flip of a switch removes him from the grid. Out of business.  

This big EMR ticket provided another benefit to the big hospitals.  Easier takeovers of the little hospitals.  I have no doubt that the price of this software was set such that only the big boys could play.  Crushing the small hospitals with these mandates simply places more power into the hands of the fewer and relieves the hospitals of competitors, a relief big businesses are more than willing to pay big bucks for.   

The big payoff for the insurance companies is coming.  The “Medical Loss Ratio” provision will do the same thing to the little insurance companies that EMR has done and will do to the little hospitals, leaving only the big boys to play.  The only folks left we haven’t discussed, that are in favor of this law are those idiots who think the bill had something to do with health care.

As patients we should care whether this insanity is overturned.  Having said that, however, I don’t think the players that came up with this scam care at this point.  

G. Keith Smith, M.D.