Health Care Alert: Be Careful What You Wish For ... You Just Might Get It!

HEALTH POLITICS--For decades, Democrats and liberal Americans campaigned on universal health coverage ... and after the taking of the Presidency and Congress, they passed it--and lost power in both Congress and the Presidency.  


After seven years of campaigning against "Obamacare", the GOP won both the Presidency and Congress, but now it's clear they had no plan for replacement. 

And while a big hunk of America wants repeal only, most Americans want repeal AND replacement.  

So as evidenced by a Congress laden with politicians and staffers who are happy to have health care, benefits, and pensions that the rest of us "mere mortals" will never have, the most dangerous thing appears to be WINNING the elections, and then being required to DO something about it. 

As in "be careful what you ask for, because you just might get it". 

So for those who danced in the streets when the Affordable Care Act was passed, and for those who danced in the streets when the presidency and Congress were taken away from Democratic power, here are a few very unpleasant-but-probably-true points to consider: 

1) President Obama, regardless of whether you liked him, or whether you liked "Obamacare", will always win the final argument of "we have got to do SOMETHING" to enhance health care access and affordability.  Maybe the ACA was the wrong approach, in that it was a middle-class tax hike of epic proportions...but the era of doing NOTHING is OVER. 

2) The ACA, or "Obamacare" is going DOWN.  Fiscally, and as a matter of policy, it's untenable, is unaffordable to most of the middle class at this time, is appreciated and supported most by people who are NOT on an ACA plan, and requires government subsidization of private health plans which is amazingly still deemed Constitutional. 

3) The individual and employer mandates, no matter how well-intentioned they were, led to a lack of solid employment (WITH benefits) and turned the Bush-era Great Recession into an Obama-era Second Great Depression we STILL are painfully striving to escape from. 

4) President Trump is not nearly as idiotic as his Democratic and Republican detractors proclaim. He's driven, respects only others who are similarly driven, and will NOT stop until the ACA is gone and replaced with a new policy, or set of policies, that is both pro-business and pro-patient.  His style, while bombastic, will be ignored by those who want ACTION, and who don't care about polls. 

5) For anyone who wants to scream, stomp their feet, and threaten to hold their breath until they turn blue, the single payer policy is opposed by most Republicans and Democrats who have ever benefited from private insurance, and failed to take hold in Vermont and California.  

Elements of single payer should be considered, and both health plans and pharmaceutical companies should be excoriated and limit-set whenever possible, but the Charlie Gard case is "Exhibit A" as to the limitations of government-run health care. 

I've had enough experience in medical reviewing and utilization management during my career as a physician, and I assure you that the narrative of greedy health plans and greedy rich Americans is not that simple.  When a private health plan says "no" to a procedure or drug, there are avenues for appeal...but when a government-run health plan says "no" then it's NO!!!  Game over.  

6) For those who rejoicing over the decisions of Senators Murkowski, Collins, and McCain to vote NO on the "skinny repeal" of the ACA, please be informed they didn't like the lack of committee participation and input they got from their constituents.  A few key additions, and an ensured process of future work/fixing American health care, and they'll vote YES on a new repeal/replace bill. 

7) The next election in 2018 is one that does NOT favor Democrats--no mid-term elections have ever recently done so after G.W. Bush left the Presidency, Obamacare passed, and the Blue Dog Democrats were made into a virtually-extinct species in Washington. Democratic senators in Red States are virtually "dead men walking", and now the ACA is STILL a campaign issue for the GOP.

It's up to both Democratic and Republican leaders and politicians and communities to fix our physical, emotional, and financial health--both for ourselves and our children.   

This just isn't over, ladies and gents.  Whether that's a good or bad thing is up for debate, but it's just not over.  Not with this President, this Congress, or this Nation. 

But definitely the old adage still holds true:  Be careful of what you wish for...because, to your horror and chagrin, you just might get it!


(Kenneth S. Alpern, M.D. is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud father and husband to two cherished children and a wonderful wife. He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He was co-chair of the CD11 Transportation Advisory Committee and chaired the nonprofit Transit Coalition, and can be reached at alpern@marvista.org. He also co-chairs the grassroots Friends of the Green Line at www.fogl.us. The views expressed in this article are solely those of Dr. Alpern.)