Thursday, July 11, 2013

It's. The. Law.

I recently admitted a patient post V-fib arrest.  Arriving intubated and posturing from the catheterization lab, he had an empty 12cc syringe stuck between his molars to prevent him from clamping down (and occluding) his endotracheal tube.

“It’s an Obama bite block!” joked the staff handing him off to me.  

They do manufacture bite blocks/guards specifically designed to protect ETT’s.  Apparently there were none to be found, and the nurses did what they do best: improvise.

My coworkers are a varied bunch, but there is a like-mindedness on Obamacare shared by few other issues. We eventually did find a proper replacement for the syringe.  But I know there will be only more corners to cut in the future.

Anyone catch the news last week?  The Obama administration announced it is relaxing its enforcement of its own darling but trouble-child legislation: the Patient Protection and Affordable Care Act.

Two big changes are underway:

  • 1    They are delaying by at least a year the enforcement of a provision that requires big employers to offer health insurance to their employees. 

This can be good and bad. Was this not a major component of the original plan—folks getting more coverage through their workplace? Or maybe Obama’s admin is awakening to the realization that, in a recovering economy, burdening employers is not the best way to encourage hiring or to decrease the unemployment rate.  Many big-time employers made plans to limit new hires or cut back hours so there would be fewer full-time staff eligible for the expensive mandated benefits.  Selfish? Maybe.  Just trying to stay afloat and competitive in this economy? Maybe.

  • 2.       In tandem with the above, the Health and Human Services Department is now relaxing eligibility standards for the insurance subsidies.  

Remember those exchanges where people can shop around for insurance plans, and be fined if they don’t purchase one? To offset your personal expense, your income level may qualify you to receive a subsidy for purchasing a plan.  And now, the government quietly says, they will be devoting less resources to verifying that you are reporting truthfully.

So, want to re-crunch those numbers to your benefit and get a bigger discount/subsidy than you deserve? Go ahead.  Chances are, nobody’s watching.   

Why is this? There are multiple reasons. Because of the delay in employer-provided insurance,  an estimated 10 million Americans (+their dependents)  will need to go to the exchanges for insurance instead of to their employers.  Obamacare will only [maybe] work if enough young and healthy people pool in and offset the cost of the unhealthy.  The government needs to encourage many, many young persons to jump in on these insurance exchanges.

They need to make the system easier to accomplish this goal, so they are relaxing administrative standards as a way of bringing down barriers.  Barriers meaning checks against fraud.  

Did Washington learn nothing from the recent housing crisis? Once our problem was financially vulnerable people buying houses they could not afford with loans they should not have been eligible for.  Now people can get subsidized insurance whether they truly qualify or not, and we tax payers must pick up the tab.

This bill was supposed to save health care costs!  In case you thought the fines for being uninsured would give enough incentive to fix this demographic imbalance, think again. Healthy people may reckon it’s still to their advantage to pay fines and forgo insurance.

As Betsy McCaughey points out,

“Some single workers will opt to pay the $95 first-year penalty.  After all, healthy people in their 30s or 40s won’t see the financial sense in writing a premium check for $125 or $150 or even $200 every month when the cheapest plan has a $5,000 deductible.  They’d rather make a car payment.”

The bottom line, however, is that Washington is only beginning to realize that they bit off more than they could chew with the Affordable Care Act.  

As the Wall Street Journal reports
“HHS is disowning eligibility quality control because pre-clearance is ‘not feasible’ as a result of ‘operational barriers’ and ‘a large amount of systems development on both the state and federal side, which cannot occur in time for October 1, 2013.’”

Health care makes up an estimated 1/6 of the national economy.  No small potatoes. 

Maybe rewriting the whole industry with a single, gargantuan bill that no legislator bothered to read before voting on was not such a bright idea.

“It's true that coordinating and managing vast amounts of information from hundreds of millions of Americans and corporations, and monitoring compliance with more than 10,000 pages of fine-print Federal Register regulations so far, is hard to do. Yet that is the system Democrats installed when they passed the law.” {Ibid}

Regardless of what’s on paper, we simply do not have the infrastructure to implement Obamacare.  Sadly, the administration can’t formulate its own position on the crisis. There’s a popular hashtag on Twitter right now for sharing complaints about the Affordability Act,  #Obamacareinthreewords.  Check it out. 

Ironically, the White House responded by tweeting:

“It’s. The. Law.”

Oh wait, except the parts they don’t like anymore.

Links to better reads:

ObamaCare's 'Liar' Subsidies: The White House says you can sign up 'without further verification.'

Constitutional Implications of Partially Enforcing a Law: Michael McConnell


  1. "It's. The. Law." That's so undignified.

    1. I love that it's actually four words. People seem to forget the details.

    2. Ha! Yes. And there are many, many details in that law. Scary.

  2. Superb. Even rationale, logical and reasonable. Therefore sadly the experts in this administration will never read or heed it.

  3. I'm glad I have you to explain to me what's going on. I'm for serious. You're far more interesting to read, too.