Collapse of the U.S.A.

As we near the end of 2020,
It may be instructive to review
The events of five years ago
That led to collapse of the U.S.A.

In 2014, the nation continued
To struggle with the enrollment
Of individuals in the federal and
State health insurance exchanges.

Large numbers of very sick people
Sought insurance heretofore unattainable.
Young people stayed away in droves,
Thus running up the potential costs.

With the mandate of 2015 looming,
Corporations and other organizations
Threatened to throw their employees
Into the individual coverage pools.

The net result was a sharp rise
To the expected national debt.
Panicking, Congress decided to tax
Employer sponsored health care.

That led to a taxpayer revolt,
Wherein the rebels refused to file
Tax returns for the year, overwhelming
The enforcement mechanisms of the IRS.

Meanwhile, college students took that cue
To refuse to pay their loans, quickly
Followed by support from those
Who still owed substantial sums.

Within a year, the national debt
Was forecast to increase by two trillion.
Congress refused to approve it,
And the U.S.A. fell into default.

The rest is history.
Texas led the way out of the union,
Followed by Cascadia, California,
And The Republic of New England.

The latter is getting along very nicely.
They solved much of the health care issue
By encouraging the drug store chains to
Set up primary care clinics in their stores.

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!