The "Affordable" Patient Care Act?

Imminent and vast Medicaid expansion threatens the nation's economy.

A local newspaper headline reads, “Feds Will Cover Most New Medicaid Costs,” to which I would respond, “How?” 

The article details the vast expansion of the Medicaid rolls which is to take place under the “Affordable Patient Care Act”/”Obamacare,” and notes that the federal government pledges to cover all of the new costs for a period of three years, and thereafter to be responsible for 90 percent of the bill. 

A separate article in the same publication notes that the Medicaid rolls in Pennsylvania alone are expected to balloon by 800,000 individuals.

The eye-opening word in the title of the legislation is “Affordable”, which surely will come to be recognized as comical.

We are a nation with a debt of $16.4 trillion that is on the books, tens of trillions more in unfunded entitlement program promises and trillion dollar plus annual deficits. We borrow 40 cents of every dollar we spend. We face the potential for interest payments on the debt alone to rise to one trillion dollars per year at the point at which the Federal Reserve Board is no longer able to manipulate interest rates to be close to zero. One trillion dollars is almost half of current annual federal government revenues.

The Obama administration would have us believe that savings can be wrung out of the health care system in large part through slashing payments to health care professionals and facilities. This is nonsense, and if there is an attempt to implement it, it would serve to push many hospitals into insolvency and would bring about a further decline in the number of health care providers that are willing to accept patients that are covered by government insurance.

At a time that the American people are becoming more obese, sedentary, disease-ridden, and dependent on dangerous drugs that merely treat symptoms, the Affordable Patient Care Act, with its elaborate new benefits, is certain to bring further fiscal distress to our nation.

What will happen when our economic system collapses under its own weight, when American currency is no longer king, and the government loses the ability to write checks with borrowed money for our panoply of entitlement and welfare programs?

I believe that the failure to tighten our belts and be sensible now is planting the seeds for future calamity and widespread and potentially devastating civil unrest which will make that which has occurred in Greece appear tame by comparison.  The road ahead is certain to be rough.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Jason Bahr November 28, 2012 at 06:56 PM
Yes that is correct - other developed world economies are models we should follow. Expecially Western Europe - those countries are performing wonderfully!!
SWYKLocal November 28, 2012 at 07:25 PM
@Steve Karas – I think if you delve down into the ACA it does nothing to insure the level of coverage you list. “Preventative Care” is just a marketing moniker. Visiting the doctor regularly doesn’t prevent anything. While it is true that early detection with some illnesses may produce better outcomes, cost saving are often hard to quantify. As more general testing is touted as a way to shave costs, any cost savings generated by early detection programs will be offset by misdiagnosis and treatment of those impacted by far less than perfect diagnostic programs. If you take a look at the socialized medicine programs in other counties, the America medical consumer will have a “hard pill to swallow”. Most of the programs in other countries limit benefits and treatments with long waiting list for treatment depending on your illness. In some countries a budget is set for each major illness and if you are diagnosed with an illness that has run out of money you have to wait until the new budget year arrives if you last that long. This is all done in the interest of cost containment and the US will be no different. I hope that you are aware that the Supreme Court struck down the Medicaid provision of the law. Oren is right, the potential burden of adding such a large number of Medicaid beneficiaries will break the bank at both the State and Federal levels.
Jon Wain November 28, 2012 at 07:28 PM
wow these statements from upttidy st clair patch.behead steven and jason for they are commies. lol i can just hear it
SSB November 28, 2012 at 08:21 PM
I thought surely Jason was being sarcastic.
Robert A. Shoaf November 28, 2012 at 08:27 PM
Thanks so much for the coherent, literate, and profoundly thoughtful post. Kudos to you, for sure!
Erin Conners November 29, 2012 at 12:42 AM
Preventative care measures in the PPACA have more to do with than just increased doctor's visits. I worked in health information systems and saw first hand the increased government funding, and increased private investment, in new technologies that help increase communication between hospitals, employees within a hospital, and between the patient and doctor. Part of the preventative care measures have to do with increasing access and clear communication in a patients file. I was shocked at how huge of an issue this was and what a booming industry health information technology is. This is certainly the less interesting part of the PPACA's preventive care measures, but a lot of people give these measures credit for creating jobs, more efficient health information technology, and for making a whole bunch of money. I did not know anyone in the company that I worked with who saw these preventive measures in the PPACA as a bad thing. This also serves as an example (I think) of a successful partnership between the federal government and private industry. At least the HIT/HIS fields are doing well, and there are some amazing technologies being shared (I worked on some radiology software that was pretty cool) that can really help catch problems faster, improve communication between doctors, find various trends in health issues that lead to diagnosis/solutions. I have witnessed it being more than just a marketing moniker, or I would be tempted to feel the same way.
Erin Conners November 29, 2012 at 12:44 AM
Also, the bank is already broken and has been for some time.
Erin Conners November 29, 2012 at 12:58 AM
I definitely share your concerns, but I suppose I would say that I am less apocalyptic as far as the eventual outcome. Correct me if I am wrong, but we are so far in debt that we are not coming out of it ever, and we have been for some time. People tend to blame presidencies but government spending increases with each new administration regardless of whether their tie is blue or red. Even the revered Reagan saw a stock market crash (a comparable recession I believe) in 1987? And we did not come out of it until the internet was established, and the internet was initially a government funded program (defense) and owes its expansion to both private industry and federal government. I read a really interesting article the other day negating the validity of a comparison between Greece and the USA. Mostly because we have a centralized bank that prints money (a different story, but I will leave the FED be for now). The euro has no replicating power. The US dollar does. So, though printing money is not a good thing, it keeps our currency afloat making our situation very different from Europe. I would add that our health care system is very different as well from Canada or Europe and socialized health care. I don't necessarily think any of these things are good (certainly not the inflation caused by the printing of money by a bank that is beholden to noone, and certainly not individual portions of the PPACA), but I am also not doomsday prepping just yet. ;)
Erin Conners November 29, 2012 at 01:07 AM
This is not the article that I had read concerning Greece and the USA, but it is all that I can find right now. The other article had no mention of the past presidential race. http://www.theatlantic.com/business/archive/2012/08/5-graphs-that-show-how-crazy-it-is-to-compare-california-to-greece/260939/ And these are some articles having to do with the more boring side of the PPACA and HIS/HIT that I mentioned in my response to SWYKLocal above. http://www.foley.com/ppaca-will-drive-quality-health-care-reform-05-21-2010/ http://www.beckershospitalreview.com/news-analysis/ppaca-ruled-okay-8-issues-hospitals-should-keep-in-mind-moving-forward.html Just in case anyone is interested.
Steve Karas November 29, 2012 at 01:34 AM
"Visiting the Doctor regularly doesn't prevent anything." WHAT? Detection of high blood pressure, early cancer detection, identification of prediabetis, cardiovascular issues, plus a long list of issues that simple education, blood tests, and simple screening can address. Granted the patient has to be involved, but often they are unaware of what they need to do. The cost savings you speak of are already being done in the name of profits for insurance companies. The ACA is no where near solcialized medicine (that is where the government is the only healthcare provider and the employer of health care providers) it isn't even universal coverage. It is a small improvement. We already pay for uninsured people! The costs are passed on to those who have insurance. We don't let them die on the street. Would you prefer that? That will save money. The supreme court said states can opt out of the Medicaid expansion provision...they did not "strike it down."
Steve Karas November 29, 2012 at 01:35 AM
From a health care perspective they are performing better than we are.
Roger November 29, 2012 at 03:18 AM
It is easy to sit around and talk about preventative care, and what the health care rules will provide. For the most part, people already know what needs to be done. Rather than do it, the topic just gets more discussion and debate. Consider, for example, obesity rates in young people. Over the past 20 years, the obesity rates for children have skyrocketed. I think the last statistics show that over 30% of our children are considered obese. This is outrageous! Who does not know why this has happened? Please raise your hand, so that we can recognize you. For this simple example, we have many "experts" telling us what program to follow.. We have new government rules about lunch programs in the schools (when childhood obesity was not a problem, we had NO school lunch programs). We have national movements toward exercise programs for children. With all this, the problem grows. The point is that all the talk of preventative measures reducing costs sounds great on paper, but experience shows us it is all bogus. People's attitude is far more significant and important in the process than "expert" programs, government involvement, new playgrounds, national movements. If parents want to do something about the problem, they have their own household to manage first. This is but one example. Many others can be cited for adults. Go to the mall, people watch for 15 minutes, and tell me we don't have an attitude problem. People know what to do.
Roger November 29, 2012 at 03:22 AM
Quoting: "... Also, the bank is already broken and has been for some time. ...." Yep, this is the approach for the young kids. Just keep marching toward the cliff, no reason to be concerned, because we are sure that somebody will come along to bail us out! Gotta' love it!!!
SWYKLocal November 29, 2012 at 05:10 AM
I have spent a number of years involved in health care information technology (Medical and Pharmacy) and have found that information systems will help with those who visit facilities that have a well architected system and the patient’s continuum of care is delivered within the reach of the system. It will be many decades before the owner of their health related information is empowered by the information so it can be utilized to their benefit. However Erin, I would hardly call it preventative care measures. For many years there have been tax dollar funded standards published to be used as quality of care measurements (HEDIS/NCQA/CMS and many others) the ACA adds yet another layer on to the already expensive and often misguided group of organizations. @Steve Karas – You confirmed my point with your response, early detection is not prevention. In your first post to which I responded you mention other counties with better outcomes, if you really understand the “systems” you would also understand that there are a lot of factors that go into your statement. In response to your statement “We already pay for uninsured people” if this is true we don’t need the ACA or its associated penalties (Taxes) they are just added expense something that is already too expensive. The Supreme Court did “strike down” the unfunded mandatory participation requirement for states to expand their Medicaid programs.
SWYKLocal November 29, 2012 at 05:10 AM
I will be interesting to see how the costs pan out for something that we are all required to purchase and what benefit levels will be offered. I am pretty sure everyone will be shocked at the price and what they aren’t going to get for their money.
Oren Spiegler November 29, 2012 at 10:11 AM
The comments to my essay are outstanding. Particularly worthy of commendation is this one from Roger, who has zeroed in on the primary problem in the health care debacle: us! Bravo!
Steve Karas November 29, 2012 at 12:14 PM
Early detection IS prevention. If you detect hypertension you can prevent a stroke. If you detect diabetes you can prevent blindness. If you detect polyps you can prevent colon cancer. If you detect high acid levels you can prevent gout. The list goes on. OK-right they made expansion of Medicaid optional.
Roger November 29, 2012 at 02:17 PM
Some new taxes that are part of the ACA (taxes that have nothing to do with fiscal cliff, and all will be implemented on Jan 1, 2013): 1.2.3% tax on gross sales of medical devices. The tax is due by the provider, regardless of profit or loss. $20B new tax revenue. 2.“Special needs kids tax,” is a modification of an existing provision. Flexible accounts are now possible that provide care for special needs children. The revision to generate more revenue is to put a $2,500 cap on these accounts for credit. This means the majority of the $14,000 (an average) needed to educate a special needs child will have to be paid without credit (only the first $2,500 will now be available for credit). $13B in new .... 3.3.8% surtax on investment transactions. This is in addition to the increases in cap gains and dividend tax rates. $123B in new tax revenue. 4.Changes in high-end medical expenses, with reduction is deductions for those confronted with expensive out-of-pocket medical expenses. $15.2B … 5.Change from 2.9% to 3.9% on gross payroll taxes for those making over $250K. This is a significant marginal tax rate increase for small business owners, especially those who are self-employed because of having to pay on both sides. $86.8B … Yes, the ACA title includes “affordable,” but can the American economy really afford these additional taxes? Some may say, “only effects the rich,” but remember all these costs get passed down to the middle-class consumer.
Roger November 29, 2012 at 02:17 PM
JS November 29, 2012 at 02:22 PM
It is of course true that we already pay for uninsured people. There are costs to treating them, it gets passed on to us. The CEO's of the health conglomerates do not give up one of their vacation homes to pay for the uninsured. The ACA is a first step in trying to fix a supremely broken system. We do need the ACA, then we need steps 2,3 and 4. Those with short memories forget the 20% increases in premiums per year in the late nineties and early 2000's. The ACA was (originally) a bipartisan idea to start to fix a system that wasn't working. Political posturing made it into a liberal Democrat idea when it was actually a Republican idea before Obama proposed it. Other options to the ADA that don't include going back to the broken system that we had are always welcome. We just don't usually hear them.
SWYKLocal November 29, 2012 at 03:32 PM
@Steve Karas – early detection isn’t prevention, when a medical condition is detected the person already has the illness. What early detection does is mitigate risk. Mitigating an individual risk, may lengthen that individual’s life expectancy depending on the condition. To bring cost back into the subject, early detection programs are often very expensive because tests are run on everyone not just those at risk. Over testing and treatment of false positives drive out much of the cost savings that could have been realized if the programs were targeted. Targeted programs will never work until Tort reform is implemented. Roger made some very good points regarding personal responsibility and the failure of recommendations by the “so called experts”. I hope you see the points I am trying to make it is really important to understand them.
Steve Karas November 29, 2012 at 04:39 PM
It depends if the ordering Physician overuses testing. You are correct. Too many tests, such as MRI for LBP or X-RAYS for knee sprains, drive up costs. So is tort reform the way to end "defensive medicine" and decrease the use of these tests or is it evidence based medicine and a part of medical education? Likely a bit of each. I would say that tests are not "run on everyone" and that a good history and physical exam tells you if you need a test. So just because your father had colon cancer, does not mean you need a colonoscopy at 40. BUT, if you are 50, AND you have persistent stomach pain, then you might want to have one. Some level of tort reform would be helpful and it probably should have been included. I do understand you points. Certainly personal responsibility helps a great deal. Sometimes people do get sick through no fault of their own...cancer, hit by a car, falls, heredity, etc. So the debate continues: Can we insure all people and still contain costs? We should look at what works in other countries, their outcomes, and try to implement policy without politics.
Sue T November 29, 2012 at 05:24 PM
Assuming that preventative care will reduce the overall cost of healthcare relies on the assumption that people will go to the doctor and take advantage of their health benefits. We have had preventative care covered 100 percent where I work for several years, and I can tell you a large number of people do not take advantage of it. They only go to the doctor if something is wrong. You have to change the mind-set of a large portion of the population to see any cost savings in the health care system.
Jason Bahr November 29, 2012 at 09:13 PM
These countries are broke, 40% of their youth do not have jobs, there are protests in the streets, they create nothing - only resell what other countries create and distribute to them, the probability that a cure for cancer or the next big technological advancement coming out of Western Europe is miniscule - entitlement programs are killing these countries. But hey . . . . . . they’ve done an awesome job educating their citizens about the negative effects of high cholesterol so I guess that means their “model” is a raging success!! All the 38 year olds still living with their moms are pump fisting right now in excitement!!
Roger November 30, 2012 at 01:34 AM
France has a 70% income tax rate, with a plan to make it 75% for the upper earners. It has continually gone downhill, and was recently downgraded in ratings. I've heard many suggesting the US follow the path of Western Europe. France, for one, continues to squeeze the top earners for more money, and yet fails to pay its bills (gets a rating downgrade. http://www.huffingtonpost.com/2012/09/28/france-tax-rich-rate_n_1922089.html http://www.telegraph.co.uk/finance/markets/9689885/Blue-chips-dip-after-France-downgrade.html Some continue to call for raising tax rates to pay for these social programs. Other countries are learning it does not work. Why would we want to follow?
Ed M November 30, 2012 at 12:23 PM
"Too many tests, such as MRI for LBP or X-RAYS for knee sprains, drive up costs" Here's the rub - insurance health insurance companies are issuing authorizations for these tests and then not paying for them because they are deemed to not be medically necessary! If they are not medically necessary, why did they issue and authorization?
Mike November 30, 2012 at 01:56 PM
We had school lunch programs in the late 1970's when I started school. Not sure when you're talking about, Gandalf.
Roger December 01, 2012 at 01:14 AM
Mike, good catch. Undoubtedly, not many Patch readers would have picked up on Gandalf in the late 70s. Gandalf communication devices were a significant breakthrough in electronic communications. Before the days of computer networks, Gandalf switching devices were important when needing to do the many-to-one connections. But, since you brought up the topic, this is probably not news to you. For those who missed the relationship between Gandalf and the late 70s, here is a brief description, http://en.wikipedia.org/wiki/Gandalf_Technologies Thanks, Mike for making the post. Reliving old technologies, huh?
Steve Karas December 01, 2012 at 03:44 PM
I agree. One way insurance companies are doing that already (UPMC) is waiving a very high deducatable for people if they go to a yearly "well visit" or physical. So I would think if UPMC is doing it, there must be some cost savings for them long term. So initially regulations and financial incentives might need to be used to change people's 'mind set.'
DanielBosh December 03, 2012 at 01:38 PM
I guess you've never heard of Sweden Denmark or Norway.


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