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‘Obamacare’ is good first step

“Obamacare,” largely yet to be implemented, has never fared well in popular polling.

A recent CNN/ORC International poll pegged opposition to Obamacare at 54 percent and support for Obamacare at 43 percent. Of those opposed to Obamacare, 16 percent were opposed because Obamacare does not go far enough in changing U.S. health care, while 35 percent oppose the law because it is too liberal.

For those who oppose Obamacare, the most frequently mentioned alternative found acceptable is simply the continuance of the current system of American health care.

Given the extreme costs and inefficiencies of delivery of the current system, it seems intriguing that anyone might think the present system is sustainable.

Currently American health care is consuming about 18 percent of GDP and rising at rates higher than inflation. All of this while nearly 50 million Americans are uninsured and bankruptcies from medical bills are a continuing factor in American lives.

Worse yet, statistically, the quality of health in America is not near the highest rated nations. So Americans pay more for health care, that care covers fewer individuals, and Americans receive less care than virtually any developed nation.

That 35 percent of us want more of the same is perhaps evidence of two social factors; first, that the most affluent Americans have great care and good insurance, and consequently want no change; second, that marketing works. By demonizing Obamacare, people who would personally benefit from change in health care in fact oppose what would benefit them.

Consider the simple colonoscopy, a common procedure for many Americans over 50. If you are one of the 50 million uninsured at any point in time, you will be billed and expected to pay for your procedure at a far higher rate than Medicare, Medicaid, or private insurance. The difference could be literally thousands of dollars more than the negotiated rate paid by Medicare, the most frugal of reimbursement plans.

You may also be billed for using a hospital facility and an anesthesiologist for the procedure, though in many countries the procedure is done in a doctor’s office with a nurse present. You would pay these costs primarily because they are profit centers for those involved, far more than proven necessities for the procedure.

Some gastroenterologists have built facilities near theirs offices to take advantage of more generous billing opportunities. The gastroenterologist might be limited to billing no more than $1,000 for the procedure, but their helper, the anesthesiologist will earn at least that much and perhaps as much as double, or $2,000. And, the doctor can be reimbursed for a facility charge of more than either bill, as much as $3,000. Now a procedure that might have been done in the physician’s office for under $1,000 is billed at $6,000 and no one complains if their insurance pays a reduced, negotiated rate. But the uninsured? The bill may well stay at $6,000.

But consider that the anesthesiologist may not have even been necessary since for this procedure a general anesthesia is not recommend, only what is termed moderate sedation, that could be administered by the physician were it not for an FDA advisory, lobbied for by the American Society of Anesthesiologists.

The explanations are simple; we pay more because of aggressive profit-taking by hospitals, insurers, pharmacy companies, and specialty physicians, all of whom have influenced government to support their preferences with legislative inventiveness and creativity.

Consider this alternative: In Austria gastroenterologists are complaining because they cannot afford to do the colonoscopy for $300 including anesthesia.

American hyper capitalism has created our health care dilemma, and more of the same will not solve the problem.

While Obamacare will certainly require adjustments and repairs, it is a step in the right direction for the health care of all Americans.


Jim Crawford is a retired educator and political enthusiast living here in the Tri-State.