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What Will Obamacare Do –To You? Part 5

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As a physician (rheumatologist) listening to your guest, Jonathan Cohn, I found myself yelling at the radio “you have no idea what you are talking about!” repeatedly during the interview.

If he is going to hold himself up as an informed “expert” on the subject then he should know that physicians, after years of static reimbursement, are now facing a 21.5% cut in fees in January 2010 increasing to a total 40% cut in, I believe, 2014. In addition, starting Jan 1 2010, consultation fees for specialists are being eliminated (watch as seniors no longer have access to specialist care).

His comments on nosocomial infections and the ease with which they can be eliminated “if everyone would just wash their hands” exudes ignorance. Please send him into the ICU where someone has been on a ventilator for weeks, or the dialysis unit where the disease causes immunosuppression, or the oncology unit where chemotherapy has just wiped out an immune system. Every effort is made to prevent infections, but they occur anyway.

Then he tells me that once we all have electronic records we are going to become SOOO much more productive that they will easily be able to cut the reimbursement for the productivity part of the calculation! Funny, but every practice I know that implements EMR loses productivity and the records these things generate are generic and tell me, on the receiving end little about what is really going on with the patient. (Then there is the privacy issue…). I will have said goodbye to my Medicare patients long before.

I could go on. But the sad fact, as related to me by Phil Roe, a physician (OB-GYN) and Congressman from Northeast Tennessee, is that in neither the House or Senate was even one physician legislator asked for input on the healthcare bill. The law of unintended consequences is going to have a far reaching effect if this abomination becomes law.


Orlando, FL


My sister-in-law graduated from medical school in May, 2010. She will have a tremendous amount of debt as most medical students. She told us that she and her colleagues are very worried about how they will be able to pay off their debt. I don’t know if most people understand how difficult medical school is, how hard they work, the hours spent on call, studying, loss of vacation/holidays and cost. The number of doctors will go down if there isn’t some type of monetary incentive for all of the difficulties they incur.
Also, I heard on another show over the weekend a bit about Massachusetts where they have a similar plan to what is now being debated in the Senate. I was surprised to learn health insurance plan restrictions there, for example, the highest deductible plan allowed is $2000 a year. I currently have a $4000 deductible plan which I’m sure is less expensive. Also, in Mass. they have a mandate that the insurance plans have to cover invitro fertilization. That surely drives up the cost of insurance (who knows what other mandates they have there?). Mitt Romney’s future is not helped by what’s gone on in Mass.
It was scary to hear your guests and their uncertainty about what the plan will or won’t do. They are unable to foresee the consequences of the legislation, which is not surprising due to length and complexity of the bill.
This will be a disaster. My youngest son was diagnosed with type-1 diabetes last year. I just worry that the great care we have had so far is going to deteriorate in the future.


Well, you said you thought those Docs for Obamacare would view the real world from a distance, and that guy from Brookings sounded like just what you were talking about. When he claimed that Obamacare would increase efficiencies in health care delivery, would that be like the increased efficiencies of the Indian Health Service? Or the efficiencies of the Medicare billing center that the insurance IT caller deals with every day? Or would they be like the efficiencies of Britain’s NHS?
Talk about out of town!


Hi, Hugh,

Thanks for keeping up an informative discussion on healthcare. I’m sure you are getting swamped with e-mails on this!

First, here is a little about our healthcare situation. My husband lost his job at the end of August 2008. One of the first things we did was look for our own health insurance. A quick online search gave us 20 pages of offers. (So much for the argument that individual policies are hard to find). The costs range from $220 to $2,500 per month, depending on the coverage. When we found out that our COBRA would cost us $1,100 a month we wisely decided on a low premium ($370)/high deductible with a health savings account (HSA). The money we saved on the premiums would go into the HAS, tax free. In the mean time, my husband found a temporary job, making him self-employed so our entire premium amount also became tax deductible.

We are healthy, active, and in our mid-fifties. Our health emergency struck in March, and my husband needed emergency gall bladder surgery. Even after paying the premiums and the deductible, we still spent less than our COBRA would have cost. We had complete control over the treatment, and did not need permission to be seen. We are paying premiums we can afford, since my husband is now unemployed again. We are protected against a catastrophic health emergency that could wipe us out.

Here is where I see Obamacare having a profound effect on us. If there is a limit placed on the deductible, and the elimination of the HSA, our plan would be eliminated. We would be forced into a higher premium plan. So much for “if you like your insurance, you can keep it”. With the shortage of the vaccine for the H1N1 virus, the change in the recommendations for mammograms and pap smears, I can see the future, and I don’t like it. Right now I have complete freedom to seek my own medical treatments without having to ask the government, or any one else for permission. If I don’t like the decision by my insurance company, I can dispute it, and I have an 800 number to speak to Customer Service. Under Obamacare the treatments and innovation won’t even be there for me to use, and who will we be able to call to complain? The short answer to the effect on us is MORE expensive insurance and LESS choice in medical treatment.

I live in Illinois, and the person I would like to hear interviewed to defend Obamacare is our own Senator Dick Durbin. I have written to him at least two dozen times over the course of the summer and fall. I have asked him how I can keep my insurance, which he keeps insisting I can, when he will mandate what I must purchase. I have asked him how he can vote for a bill when he does not know what is in it, or how it will affect us, or how the inevitable mistakes in it will be corrected. I have asked him how I will dispute a denial of service from the public option, and who I would sue for any resulting damages. That is just a sample of some of the concerns I have, but I have received NO satisfactory response. I know it is just wishful thinking, but I would really like to hear him defend this in a tough interview. He actually sent me an e-mail claiming that 80% supported the public option! I’d like to know where he got that figure.

Thanks for seeking our thoughts on this important issue.

Mundelein, IL

P.S. I just finished listening to Jonathon Cohn while I was typing this. He sounds like a kid with book smarts and no common sense! He needs to get out into the real world.


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