Not all the arguments about the Affordable Care Act take place in the Supreme Court. One major complaint from opponents is that they don’t want the government involved in their health care. I can imagine this conversation with a doctor:
Q: Doc, I’m worried about the new health care bill. You won’t let the government interfere in my care, will you?
A: Of course not, Mr. Smith. I should warn you, though, that the drug companies are tracking my prescriptions, and offering me rewards if I give you their pills.
Q: I’ll double-check with my pharmacist. But the government won’t step between us, will it?
A: No, the government won’t, but the hospital just bought a new MRI machine, so they’re pushing me to use that a lot. I get paid extra for the MRI’s, too.
Q: A couple of MRI’s more or less won’t hurt. But no government telling you what to do, right?
A: No, but I’ll tell you something that does frustrate me. There are certain treatments some insurance companies don’t allow. They call them “experimental,” and won’t pay for those treatments.
Q: I don’t want anything experimental. Anything else?
A: Well, your boss, your doctor, your hospital or your insurance company can block some treatments or prescriptions for religious reasons. I might think they are right for you, and you might want them, but they wouldn’t be covered.
Q: All those people can decide about my health care? Wow. But that’s mostly about women’s stuff, right? I mean, they can’t make decisions about guys like us, can they?
A: They might not cover vasectomies, and you know that end-of-life agreement you signed, where you told me you didn’t want them to keep you alive with tubes for breathing and feeding, if you didn’t have any chance of getting better? If they don’t agree with that, they’ll just ignore it. Remember Terri Schiavo?
Q: They can do that, Doc?
A: Some state governments are already passing laws to make that possible. We can hope the US government keeps that from happening by establishing a bottom line for what every policy has to cover.
Q. But what about my religious beliefs?
A. It seems our system works for the health care providers, not the patients.
Q: So the federal government is trying to protect my health care rights?
A: Not only that, they’re collecting information about what treatments work best. For example, doctors used to take out lots of tonsils, and now they aren’t doing it as much. There’s a debate about when to use by-pass surgery, stents or medication for heart problems. The government will collect all the data on the treatments to make recommendations. That would help doctors like me a lot. And with enough information, we might figure out how to hold costs down. The United States does about half a million knee replacements a year. Some places charge about $45,000, and others charge about $70,000. Let’s learn how to do them cheaper.
Q: Okay, but I still have another question. Maybe the government won’t force you to change your practice, but what about forcing people to get insurance?
A: You already have insurance, so that won’t change. And each year your family pays an extra $1,000 in your insurance to cover those people who can’t pay. The government already pays for about half the medical expenses in the country now – the military, old people, poor people, and so on. People who can pay should pay. It will save you and the government a lot.
Q: A thousand dollars extra? That’s not fair. At least I don’t have to pay it. My company pays most of my insurance.
A: Unfortunately, Mr. Smith, your company counts your health care in your wages. Most of your pay raises in the last decade have gone to health insurance. But the new health care law only allows insurance companies to take 15¢ of every dollar for their profits and expenses. They used to take about 20 percent, or $1 for every $5 spent on medical care.
Q: One last question, Doc. Can you give me anything for my headache?
Tim Butterworth, an Institute for Policy Studies associate fellow, is a former teacher, union negotiator and New Hampshire state representative. www.ips-dc.org