This Accelerates the Path to a Single-Payer System

Nora Janjan, MD

Nothing is resolved. This just kicks the can to November where the decision will be made by the electorate. The Affordable Care Act (ACA) will impose great regulatory burdens on physicians/health systems. Currently, more than 25% of healthcare costs relate to administrative burdens, and the ACA will only increase the administrative burdens on health systems. It is ironic that the ACA worries about how much insurance companies spend on healthcare delivery but has no limit on how much health care systems spend on the administrative burdens caused by the ACA. Medicare will be decimated. More than 70% of oncology patients are on Medicare. The ACA already cuts $500 million out of Medicare. The ACA shifts funds from Medicare to the young who do not use much healthcare. The sole purpose of the Independent Payment Advisory Board (IPAB) is to cut Medicare costs.  It will literally take an act of Congress in 30 days to oppose the IPAB's cuts.  Already, a lot of physicians are opting out of Medicare. This will significantly affect oncology. With HMOs, the court system and Congress set limits on the cost-benefit ratios that could be imposed. Now it is the government who is imposing cost-benefit ratios on practice.  With the government imposing cost-benefit ratios, there will be no recourse. This also accelerates the path to a single-payer system, as the financials will not work with private payers/private healthcare systems.

The American people will be shocked at how much this is going to cost and how this will impact the deficit.  Also, there is now no limit to how Congress can tax the American people. Congress can now impose taxes on every aspect of life.  This is a huge loss of liberty. Previously, Congress used taxes to put a disincentive on the purchase of something [“sin taxes”]. Now Congress can tax an individual for not purchasing anything [eg solar panels on your house] they choose to mandate. Taken to the extreme, Congress can now control every part of life by taxing people in order to force them to do or not do something. This will have a significant impact on medicine and on the care we will be able to deliver. It has life and death implications. The patients of America, who have enjoyed the best healthcare in the world, have lost. I would implore everyone to follow outcomes and survival rates.

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