Tags: Barack Obama | Healthcare Reform | Supreme Court | Obamacare | Supreme Court | Healthcare

Supreme Court Botched King vs. Burwell

Thursday, 25 June 2015 02:17 PM Current | Bio | Archive

As I predicted on this blog back in March, the Supreme Court upheld the Obamacare subsidies flowing through federal exchanges, contradicting the plain statutory language. In so doing, they invented “intent” that was clearly not there.

Congress intended for the subsidies to coerce the states into setting up exchanges. This decision is not surprising, yet it is deeply saddening. It sets a new low in jurisprudence, and drives what may be the final nail into the coffin of individual liberty in this once-free country.

There is officially now no hope of reforming, repealing or replacing Obamacare before January 2017, and it’s doubtful that a Republican victory would lead to this (and a Republican victory is far from assured, especially if the nominee is Jeb Bush, or another milquetoast RINO).

While politicians and policy wonks were giddily dreaming up legislative options to revamp Obamacare in the wake of a King victory, the Republican Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA). This law cements into place various payment schemes such as bundling, accountable care organizations (ACOs), and other forms of “payment-for-outcomes,” that will be applied to the Medicare program, and ultimately to private insurance.

All of these systems create financial disincentives to caring for truly sick patients. They will have a devastating effect on patients, and on physicians who remain under the system.

Patients will be increasingly subjected to one-size-fits-all care, dictated by algorithms inserted into the electronic health record. These will be created by professional groups, such as the American Medical Association, the American College of Physicians, and the American Board of Internal Medicine, and will be labeled as “evidence-based,” or “best practices.”

This will lead to massive over-prescription of medications such as statins, anti-hypertensives, and diabetes medications, based on achieving certain numerical “targets.” Many individual patients will certainly be harmed by this approach.

To maximize revenue, physicians will dutifully click on boxes and comply with the central mandates. Thus will fade the Hippocratic ethic to render their best judgment on behalf of their patients.

Over time, the medical profession will devolve from a science-based art into a trade requiring less training and less experience. Doctors are already being indoctrinated away from a commitment to individual patients and towards allegiance to the state, or to “society.” This should be of grave concern to all of us.

Physicians are down to our last line of defense of the independent practice of medicine. We must get out from under Obamacare, Medicare, Medicaid, and virtually all third party payment contracts.

We must go back to a direct pay model or the profession is doomed. We need to set our own fees, and refuse the price controls. In the long run, this is the only way we will be able to continue to provide individualized, high level care to our patients. Insurance reform might follow based on consumer demand.

This is what AAPS has been advocating for many years. But now there is far greater urgency. We are living under a lawless administration, a gutless, impotent Congress, and a tamed Supreme Court.

What is to prevent the administration from federalizing state medical boards and requiring participation in government medicine as a condition of licensure? Mitch McConnell and John Boehner will be at happy hour somewhere, probably with Nancy Pelosi. A few states may sue, but then what? Can we depend on the Supreme Court? That is a rhetorical question, of course.

We have a limited window of opportunity to establish a critical mass of independent, opted out physicians. We have to do this now, while it is still legal. Doctors should visit our website (aapsonline.org) for practical information on how to opt out. Come to one of our workshops, or to our annual meeting. Join the organization. We need you now more than ever.

Since 1990, Dr. Amerling has been on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel) in New York. He served as director of Outpatient Dialysis from 1995-2012. Amerling is board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology. He also is president of the Association of American Physicians and Surgeons. He has been published in many journals. For more of his reports, Go Here Now.

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As I predicted on this blog back in March, the Supreme Court upheld the Obamacare subsidies flowing through federal exchanges, contradicting the plain statutory language. In so doing, they invented “intent” that was clearly not there.
Obamacare, Supreme Court, Healthcare
Thursday, 25 June 2015 02:17 PM
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