G. Keith Smith, M.D.

Several governors aren’t setting up the health exchanges mandated by the Unaffordable Care Act (UCA).  Either they see this as constructing their own gallows, or see it as an unnecessary expense if the election goes the way of the GOP.  Any honest governor knows that this is the tool that will be used to crush smaller competitors and stifle any innovation in the health insurance industry, both of these components intended to drive costs to levels never seen, levels that will bring people begging to the government on their knees for a single payer system.

My liberty-loving friend Jonathan Small at OCPA (Oklahoma Council of Public Affairs) thinks it’s time for the state government to get going and create an exchange, as Lord forbid the federal government sets one up for us.

He has a point.  But think about what he has said.  If you agree with him, then you share his fear of being subject to federal control.  But why do you fear this wonderful government that has come to our rescue and brought each of us everything we need, even free health care?  You know, they’ve done such a great job up to this point, why not just sit back and let them craft an exchange out of whatever mold they think is best for us?  Aren’t they there to help us and make our lives better, more secure?  

I don’t know the answer.  I think many don’t fear the government and are therefore, in my opinion, asleep.  The statists are counting on enough folks not waking up until it’s too late.  By then these big government types will be long gone with their loot, blaming whoever follows them of mismanagement of their ideas and policies if things aren’t going well. 

Maybe the answer is to let the feds set up all of the exchanges so people  can see first hand and soon what this bill was meant to accomplish.  Maybe the states and the governors shouldn’t soften the blow this health care law represents.  Maybe this approach will wake more up faster.  Or maybe Jonathan is right.  Who knows?

G. Keith Smith, M.D.

The socialist editorialist Clarence Page has called the GOP out, Mitch McConnell, in particular, for not having a replacement plan for Obamacare if they can manage to repeal it.  This very short-lived interlude, void of any more health care ideas from Washington, is kind of nice.  I’m sure the GOP will spoil the silence, though.  Seriously, what on earth would lead someone to believe that any answer coming from Washington wouldn’t be designed to line the pockets of the special interests at the table writing the bill? 

I’m all about repeal.  But let’s not stop with Obamacare.  Let’s move on to many disastrous legislative interventions brought to us from the other side of the aisle.  How about Medicare Part D, brought to us by a GOP-led executive?  Why didn’t the GOP change the tax code to end the discrimination against individual purchases of health insurance during the time they had all the power?  Hint:  see paragraph one of this blog.  This tax reform isn’t likely as the shift away from employer-purchased plans will gut the scam of PPO repricing, a devastating blow to the big insurance companies. 

Remember how “repricing” works.  My apologies to loyal followers of this blog for repeating this, but it is important…I’ll have something new at the end.  Insurance companies are perversely rewarded by seeking out the most expensive “providers” they can find.  They subsequently “reprice” a bill of $100,000 to perhaps $28,000 and charge the employer plan a fee percentage to the extent that they have “saved” them this $72,000.  Hospitals gladly produce these bills for their pals, as they can write the fictitious loss off as “uncompensated care” and bill Uncle Sam for a percentage of this number.  Insurance companies agree to lock out certain competitors to garner the hospitals’ participation in this little scam. 

Insurance companies make more money doing this than they do from premium collection!  This money isn’t included in the calculation of the new MLR (medical loss ratio) requirements of the UCA (Unaffordable Care Act).  This MLR only applies to premiums collected.  Beginning to see why the big insurance companies wrote the bill this way?  Administrative fees and PPO access fees are also not included in the MLR calculations. 

Changing the tax code ends this scam.  Individual policies (as opposed to group or employer-sponsored policies) are not subjected to “repricing” fees.  You will know that the GOP is furious with the insurance companies when this tax reform passes.  If the GOP threatens to pass it, then doesn’t, you will know that they did this to raise money from the insurance companies as extortion. 

What would the reaction of the average working person be to the following from the GOP:   “We aren’t advocating a replacement plan because this government is so completely compromised, corrupt and incompetent that something as important as health care can’t be trusted to it.  We are going to fade back and punt this to the states and let them unwind the insanity we have thrust on everyone in the country.  Our gift to you is to remove ourselves from this issue entirely, rather than continue to sell our influence at your expense.” 

I know.  It will never happen.  Fun to think about, though.

G. Keith Smith, M.D.