A Catholic Physician’s Perspective on Repealing Obamacare
By Steven White, MD
Chair – Healthcare Policy Committee
(As Published on CatholicVote.org on Jan. 24, 2017)
“A bad tree cannot bear good fruit. Every tree that does not bear good fruit is cut down and thrown into the fire.” Matthew 7:18-19
Obamacare, or the Affordable Care Act (ACA), is truly the fruit of a “bad tree.” The roots of this tree are decades old and include moral relativism and socialism with all their offshoots. Obamacare incorporates and perpetuates many of these offshoots thereby sustaining a twofold crisis in healthcare: ethical and economic.
The ethical crisis is a direct, albeit largely unrecognized result of the sexual revolution of the 1960’s and its fruits, particularly the two Supreme Court decisions: Griswold v. Connecticut legalizing contraception (1965) and Roe v. Wade legalizing abortion (1973). Contraception and abortion are the antithesis of healthcare and undermine the very nature of the medical profession. Fifty years later contraception and abortion are fully integrated into the ACA and widely accepted as fundamental to “reproductive rights” of women. This is an ethical disaster for those who are opposed in conscience to the ACA’s Health and Human Service’s regulations regarding contraception and abortion. If they refuse to comply they face ruinous financial penalties and furthermore are denied their religious liberty.
With the introduction of Medicare and Medicaid in 1965 the seeds of the economic crisis were planted. This “well intentioned” but ill-fated legislation led to government financing and regulation of the medical care of the elderly and poor.
The original 1965 projection for the cost of Medicare in 1990 was $12 billion dollars. The actual cost was $98 billion. Similar erroneous predictions have plagued Medicaid as well. Over the ensuing fifty years we have witnessed the incremental development of a socialized system of medical care culminating in Obamacare, at an annual cost to the federal government of over $1 trillion dollars!
In an effort to rein in these unsustainable expenses in the face of an $18 trillion dollar federal deficit, the ACA has spawned thousands of pages of regulations so that government now dictates how you purchase health insurance and what it must include, how much it costs, and how doctors, hospitals and insurers must organize themselves to deliver care and be paid. Physicians are completely frustrated with financial, regulatory and bureaucratic intrusions that dictate every aspect of the delivery of healthcare, threatening the very foundation of medicine, the doctor-patient relationship.
Seven years after its implementation, Obamacare has proven to be neither affordable nor economically sustainable. While Americans were promised universal access to affordable coverage with average family insurance premiums reduced by as much as $2,500, in reality, family premiums have risen on average 25% and by as much as 40 % in certain government sponsored exchanges. This is in spite of billions of dollars in government subsidies.
The ACA was also going to “bend the cost curve” of rising healthcare costs downward, making it less expensive, but in its second full year of operation the healthcare inflation rate was rising. And remember the promise that, “if you like your doctors and current insurance plan you can keep them,” – not true. Millions lost their employer sponsored coverage and were forced into government exchanges or Medicaid where they were not able to keep their doctors, as insurers created limited networks of providers to offset the increased costs of doing business in Obamacare.
While it is true that the number of uninsured Americans has decreased, the dissatisfaction with the ACA among patients, physicians, hospitals and insurers continues to rise. This is due in large part to rising costs with higher premiums and deductibles, diminishing choices and the oppressive burden of government regulations driving physicians, insurers and even some hospitals out of business or into large conglomerates who place monetary concerns and market share above the interest of individual patient care. Everyone agrees, on both sides of the aisle, that this is an unsustainable economic crisis. The disagreement arises when considering a solution.
The ACA was the solution proposed by the Obama administration and its supporters. As predicted however, it has gravely exacerbated the ethical crisis and to date has done nothing to resolve the economic one. It is incompatible with a vision of healthcare that supports life, individual freedom and personal responsibility inherent in the American way of life. It is fundamentally flawed. It is more bad fruit from the same bad tree and clearly must be repealed.
All agree that healthcare is desperately in need of reform and yet we all must also acknowledge the challenge of replacing the ACA with alternative policies which ensure broad access to affordable insurance coverage. This coverage must protect the right of all Americans to receive the medical care they choose, from the doctors and hospitals they want, in harmony with their religious and moral convictions.
Over a decade ago, the Catholic Medical Association addressed the ongoing crisis in healthcare in a document entitled, Healthcare in America : A Catholic Proposal for Renewal. It outlines the challenges we face in healthcare today, both ethical and economic, and proposes recommendations for reform based upon the Church’s moral and social teaching.
The foundation of any Catholic proposal for reform must first be the recognition of the sanctity of life from conception to natural death and God’s design for marriage and the family. Catholic social teaching then provides a framework with guidelines for considering how social institutions can be structured and public policies developed that order the delivery of healthcare to the common good of one and all.
The following principles are generally agreed upon and underlie many of the current proposals for reforming healthcare in the wake of repealing the ACA.
- Individuals and families should control financing their healthcare and medical decisions, not the government, by means of individually owned insurance, not bound to employment.
- Everyone should have access to affordable health insurance, including those with pre-existing conditions, that meets their individual health care needs and is in harmony with their moral convictions.
- Subsidies in the form of tax credits should be used to offset the tax advantage received by those with employer sponsored health insurance over those with individual policies and to support those who are economically disadvantaged and cannot afford basic insurance.
- State and federal legislation should support the development of more insurance options, including true catastrophic plans with health savings accounts used for ordinary care, and available in a market place designed to promote true competition, with appropriate consumer protections.
- People should be free to choose their own physicians and hospitals which also promotes healthy competition, innovation for better outcomes and medical services oriented to enhancing patient satisfaction.
- Patients and insurers must be free to purchase and provide insurance coverage, while all providers including physicians, allied healthcare professionals, and hospitals must be free to practice, with comprehensive protection of conscience, including the legal recourse to seek a remedy if this freedom is ever denied.
- The dysfunctional system of medical malpractice must be reformed.
- Government regulations regarding the payment for healthcare must be revised to allow for price transparency for all medical interventions so that informed patients, as consumers of care, can be involved in the determination of value of their medical services based on cost and quality.
- Due to the impending bankruptcy of the major government financed healthcare programs (Medicare, Medicaid and SCHIP) gradual reform is necessary to transition these programs to the premium support / defined contribution model of support without compromising the care of those currently participating in them.
- While advances in health information technology hold promise for better coordination of care, patient privacy and confidentiality must be ensured to avoid an erosion of trust essential to the doctor-patient relationship.
Although not an exhaustive list, these principles underlie many of the current, ethically and economically sound policy proposals shaping legislation for consideration in this Congress to replace the ACA.
Over the next few months we can expect a flood of dire predictions related to current plans to repeal and replace Obamacare. Unfortunately, most will be politically motivated and patently false. It is not easy to forget the deception of those who assured us we would love the ACA if only it was passed, and then everyone would see the wonderful benefits it provides.
If the results of the recent election are any indication of what many Americans think of Obamacare, they understand it is the fruit of a bad tree and the time has come to cut it down. Together, prayerfully, patiently and diligently, we must plant the seeds of a good tree that will bear good fruit and lead to reform restoring the moral foundation and economic integrity necessary to rebuild a “culture of life” in the medical profession, a culture where the patient and patient care are once again at the heart of our healthcare delivery system.