Observations on Obamacare

George, you just caught me listening to Susan Boyle singing "The Winner Takes It All", an ABBA
song -- very apropos to the ACA situation.  Now that some probably very ill people have been able
to sign up for health insurance, it can never be taken away from them without triggering political
repercussions.  The health insurance companies are now administrators of a federal scheme.

Entitlements have proven to be irreversible.  Universal health care is the goal.  Wouldn't Teddy be
proud!  Step by step, a single payer system has crept in to full enactment.  Sometime soon everyone
will be issued a card like my Medicare one, now twenty years old.  The problem arises -- where and
how can they be honored?.  That's where the U.S.A. is in danger of sharply reduced medical care,
as new practitioners fail to enter the health professions.  The low-cost ride of our generation is soon
to end.

It is almost too late for reasonable alternatives.  The best of them proposes taxpayer support for
local clinics to replace ordinary care in the emergency rooms for people without insurance.  My
local guy is the only one left of four in private practice.  The others retired early.  And he will
get whacked by the reduction of Medicare reimbursements.  They I will have to rely on a
walk-in clinic that I used to frequent.  Just like good old Army medicine.  Not bad, not too good.

You may remember my recent piece, "Providence and the Nutter."  The president deserves
neither credit nor blame for his eponymous health law.  History will reward him.

The rector of my church just returned from a three week holiday in England, meeting with old friends
from his early stay in the UK.  He reports that the National Health Service is in such disrepute that
the government has permitted private practice to return.  Harley Street is doing a brisk business.
We call that option "concierge practice."

Canadians are enthusiastic about their quick and satisfactory primary care.  Their complaints
are the delay and rationing of surgery.  The premier of Ontario is insisting on further cost
reductions.  So is our governor of Massachusetts.  Here there is some cost control voluntarily
by our MDs who refuse to open their practices to any more Medicare and Medicaid patients.
I have primary care from my new wife's doctor.  She got into a closed dermatology practice by
marrying me.  Otherwise:  "I'm sorry, Doctor XXX is not accepting new patients."  MassCare
is seeing an increasing number of individuals paying the penalty rather than buying one size
fits all insurance.  That includes insuring men for pregnancy care, whether they like it or not!