“A living dog is better than a dead lion.” – Ecclesiastes 9:4

Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

For many, including myself, the political upheaval that has characterized the 2016 campaign and election has been unsettling. Nevertheless, as I write this, we are poised for another bloodless radical change in the American government power structure, a routine achievement that makes our constitutional democracy the envy of the world. I understand the singular importance and significance of this quadrennial change in leadership, and I am proud to count myself among the protectors and defenders of the Constitution that gives rise to this feat of government magic.

Perhaps it is one of the unique attributes of being an American in that you can love and defend the constitutional system with your labors—some with their lives—but not necessarily agree with what that system engenders in either politicians or policy. Even more incredible is that the same Constitution that brings about these political changes protects the individual citizen’s right to protest those changes without fear of reprisal, possibly bringing about favorable change (to that individual’s way of thinking) during the next peaceful exchange of political power. As a student of human nature and history, I find these facts about our society baffling, when viewed through the egocentric and tyrannical lens of the human saga through time, and incredibly fortuitous if you are blessed to call yourself an American today. 

So with that settled, I would like to exercise my First Amendment right to express my concerns over recent congressional actions regarding the Affordable Care Act (colloquially known as Obamacare). Readers of this column will recall that I first commented on Obamacare in a November 2013 editorial1 as I sat in a hospital waiting room while my middle daughter underwent major surgery. Obamacare was new at the time and promised healthcare coverage for an additional 20 million Americans. Since unpaid medical bills are the No. 1 cause of bankruptcies in the United States, I could easily empathize with those going through the same emotional trauma of having a sick child and not having healthcare insurance.

Back in 2013, I could not have predicted (or hardly imagined) the political storms of 2016 or how Obamacare would become a right-wing example of excessive government regulation, as opposed to a plan for getting many uninsured Americans health insurance. So what happened with Obamacare during the past three years to engender such zeal by the current Congress to repeal the law as a first priority with the new administration?

There were plenty of missteps following the enactment of Obamacare into law, with the disastrous Affordable Care Act sign-up website being one of the most visible. To state the Obama administration botched this vital program element would be a classic understatement, and this error certainly did not inspire confidence in the American public or Congress to the new plan. Notwithstanding this miserable start, the fact today is that fewer than 9% of Americans remain uninsured, and an estimated 20 million Americans now have health insurance because of the law. Even more encouraging is that the slope of healthcare cost increases has been at a slower rate since establishment of the program than at any similar time period since 1959, when records of this type started to be collected.2

1 2

Comments (5)

Trackback URL | Comments RSS Feed

  1. Lew Archibeck says:

    All political positions much also be covered by ACA, vs having their own coverage. No exceptions. I have seen that anything the federal government run go belly up broke. I much rather have it privatelize. Most politicians have never run their own business and they pass laws not truly understanding true outcome. I feel that the middle class will again be crushed by current ACA. All must have save insurance plan no carve out. I know many middle class folks that have no insurance

  2. Maria Romanas, MD, PhD says:

    It may be true that the more people are now receiving medical coverage, but I personally know many people who lost all coverage because of the radical increase in insurance premiums. These were mostly people with small businesses or self-employed. They are the entrepreneurs and should not be punished by the presence of Obamacare. Austerity measures need to be taken to cut medical costs, which have been driven up by the takeover of medical care by non-medical administrators, insurance company CEO’s seeking to make a profit and to line their pockets. Personally, I think all hospitals, medical suppliers, and pharmaceutical companies should become non-profits. Radical but would solve a lot of problems.

  3. Seval Gunes, MD says:

    Healthcare is a very complex issue that took other Western nations decades to get right. The biggest obstacle to any reasonable solution is that almost all congress persons and senators are in the pockets of Big Insurance, Big Pharma, ATLA and so on. They will vote with whoever pays them, not what is in the best interest of the citizens.
    Medicare has lower administrative overhead than any other private insurance system.
    1. Allow Medicare to negotiate all services (including durable medical equipment and medications (together with DOD and VA it would be a huge purchasing pool)).
    2. Compete directly with private insurances for customers. As Medicare has the lowest overhead and does not have to make a profit, it should be able to outbid any commercial insurance company.
    3. Expand Medicare incrementally, decreasing eligibility from 60 to 55 to 50 and so on until they become the default (basic) insurer of choice.
    4. Private insurance companies could offer Medicare supplemental insurance (more covered services, bigger formulary …).
    These changes could be phased in over 10 to 15 years and encompass at some point Medicaid, Indian Health Services and all those other disjointed Federal Health Services that are paid for by taxpayers.
    But first, you have to get money out of the political system or generate enough grassroots pressure to force the politician’s hands.

  4. Cathy says:

    Thank you for not throwing the baby out with the bathwater. Big new government programs are never without flaws, some intended, some not. Most programs are adjusted over the years. Unfortunately the biggest problem with the ACA is the power that has been given to the insurance companies who are always out for their own best interests. Some sort of government option should be available to people who need affordable healthcare. It could be an expansion of VA care to spouses or family, an ability to pay into Medicaid or medicare programs, or perhaps a hospital only/emergency or catastrophic coverage plan. If it is left to the insurance companies, we will continue to see what has always happened, a yearly rise in premiums and reduction in services to pad their bottom lines.

  5. Peter Hasby, MD says:

    Dr Buckenmaier hit the nail on the head when he observed that Americans have already decided we are going to take care of each other, nobody confronting the medical system with acute need is turned away; the question is, who pays and how. Hence, the question is immediately political:, will we provide minimal immediate care then bill the patient into bankruptcy, per our recent “system of no-system”, maximal exercise of free market; vs Medicare for all, maximal diffusion of costs with efforts by gov’t to control costs while market forces still operate; vs the politically practicable (barely) compromise of ACA, basically crafted by a conservative think-tank as a way to use private insurers to cover those uncovered by employers, VA, Medicare or Medicaid. True that individual purchasers in the exchanges lost the most in face of limited choices of expensive policies; would have worked much better without politically motivated, proudly admitted sabotage i.e. refusal to expand Medicaid as planned, and blockage of funds intended for risk adjustment for plans with high medical risk. I’m proud that we hold an ideologic belief that nobody dies or gets badly hurt due to withholding available care. An ideologic belief that we have to make that happen in an unregulated market, not so good.

Share Your Thoughts