Republicans should declare victory on health reform, but they won’t

By Michael J. Pramenko, M.D.

There is no question that my views on health-care reform rank somewhere between a kidney stone and a prostate exam with today’s conservatives. And, the Republican National Committee is surely not going to take any advice from me.

Nevertheless, after more than 8 million Americans have signed up for health care under the Affordable Care Act and millions more covered via Medicaid expansion, here is some salient political advice for Republicans regarding the ongoing debate on health care policy.

Declare victory. 

That’s right. Declare victory on health reform.

Here’s why. The Republican-designed ideas of an insurance exchange and individual mandate are showing signs of success. Remember, these two policy recommendations came from Republicans during the decades-long debate on how to fix our health-care system and cover more Americans. Republicans, believing that these policy recommendations could keep us from moving toward a single-payer system, once openly favored these elements of reform.

Those very same Republican health policy recommendations, voted into law by a Democratic Congress and President Obama, are working. With millions of Americans now signing up for health care and the number of uninsured steadily declining, the likelihood of a single-payer system fades into the political sunset. At the same time, health insurance companies posted one of their better years in the stock market. The same law that conservatives proclaim as moving us toward a single-payer system is clearly doing the exact opposite.

Don’t stop there. There is more political gold worth mining. Over 70 percent of Americans believe that pre-existing health conditions should not preclude people from being able to buy insurance.

The individual mandate is the mechanism in a privately run insurance marketplace that allows for coverage of pre-existing health conditions. Without the enlarged insurance pool of patients created by the mandate, insurance companies would go out of business if they were forced by law to insure everyone with significant health problems. Remember, before the Affordable Care Act, there was no consumer protection regarding this issue. 

What are you waiting for Republicans? Declare victory. You designed a policy recommendation that led to an insurance environment favored by over 70 percent of Americans. Celebrate.

Currently, Republican leaders in Congress are attempting to write replacement legislation for the Affordable Care Act. They are discovering the difficulty of designing a system that isn’t government run but will guarantee coverage for pre-existing health conditions. Watch this closely this year. If alternative legislation is offered and voted on, it likely will only ensure coverage for pre-existing conditions for Americans who already have insurance and not for the uninsured.

So, what are the chances that the old Republican Party can get the new tea party-controlled Republican Party to polish up its political playbook and parlay off practical health care policy?

Furthermore, what are the chances that Republicans will declare victory regarding successful policy recommendations that they designed back in the 1990s?

Probably about the same chance as seeing an elephant fly.

Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is a past president of the Colorado Medical Society.


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Any new medical reform needs to address the deceptive medical coding and billing system by doctors.

I was told that my insurance paid for an annual PREVENTATIVE physical. I got that physical, but my Dr. billed me for an office visit separately which my insurance did not cover. The physical was the reason for the office visit and I think it is wrong to be misled and double billed when I’m told my insurance would cover a physical. If I had known, I would have delayed the physical because I am cash strapped right now and I will have a delinquent bill accruing interest until I can pay. 

I found out that because I discussed a pre-existing condition, It has to be coded differently than preventative, so my Dr. billed me for an office visit to cover what the insurance wouldn’t, even though I explained up front hat I have a $2500. deductible and only want preventative service as anything else would not be covered. I feel cheated.

Dr. Michael Pramenko’s column – “Republicans should declare victory on health reform, but they won’t” – sardonically laments the tragic-comic inconsistency of Republicans’ refusal to take credit for their own “market-based” approach to reforming “our broken health care system”.

On October 1, 1989, with health care costs consuming 11% of our GNP, the Ronald-Reagan-revering Heritage Foundation first advocated the “individual mandate” in a lecture entitled “Assuring Affordable Health Care for All Americans”. 

That proposal was then refined to incorporate insurance exchanges (where private insurers could compete for business), and premium subsidies (to make those competitive premiums even more affordable).

In 2006, these features were successfully implemented by Republican Governor Mitt Romney in Massachusetts (“RomneyCare”), and were endorsed by Club 20 and Colorado’s Republican Governor Bill Owens’ Blue Ribbon Commission in 2008.

By 2008, health care costs consumed 16% of our GDP (the highest of any industrialized nation), health insurance premiums were rising at double-digit annual rates, the health insurance industry was rife with coverage-denial abuses, and middle-class Americans faced the specter of bankruptcy due to uninsured medical expenses.

While “liberals” favored a “public option”, to compete with private insurers, on August 15, 2009 in Grand Junction, President Obama embraced the “conservative” alternative – seeking to gain bipartisan support for health care reform while avoiding disruption of some 1300 private insurers and their 500,000 employees, when the economy was emerging from Bush’s near-Depression. 

Had Nancy Pelosi named it the “Ronald Reagan Memorial Patient Protection and Affordable Health Care Act” (“ReaganCare”), “red state” Republicans might have supported it – rather than wage an incessantly dishonest disinformation campaign against it.

Nevertheless, today, at least 7.5 million have obtained qualifying insurance through federal or state exchanges, 6+ million through Medicaid/CHIP expansion, 1+ million “under26ers” remain covered on parents’ policies, and some 8.2 million have obtained qualifying coverage directly from insurers or through brokers.

PART 1. Swell. “Baghdad Michael” Pramenko is at it again with his anti-logic snark.
Because the ACA is a fraud on its face, once again rebuttal to a painful bore is required.
Let’s start by getting rid of our foolish collective “my doctor said ‘Mylanta’” gullibility and naiveté. Too many people are unaware that allopathic establishment docs – who have a government-granted commercial monopoly on access to meaningful pain control – kill, injure and/or infect some 15 million patients a year without so much as a single OSHA ticket. Another thing too many people are unaware of is that M.D.-prescribed treatments are the third leading cause of death. Also, for four decades, Big Medicine (including Big Pharma) has led inflation by steadily increasing its rates for no other logical reason than they think they can get away with it without losing too many customers. Let’s face reality: there is no money in it for Big Pharma to create cures. What Big Pharma creates is customers, not cures.
Into the middle of this complex problem, the corporate fascists now introduce “Obamacare” named after its racialize-everything constitutionally-ineligible head cheer leader. It’s a toxic mixture which has destroyed the American health care system and replaced it with nothing more than collectivist “freebies-for-votes” fraud.
Contrary to the seemingly regularly scheduled propaganda bulletins by “Baghdad Mike”, clearer and better-informed heads have explained the problem and offered self-evident Economics-101 solutions. For example, former Libertarian presidential candidate Dr. Mary J. Ruwart has explained that healthcare costs could be reduced by some 80% overnight simply by abolishing the FDA, thereby introducing more competition into the marketplace. Others (including me) have proposed Freedom of Self-Medication amendments to the U.S. Constitution as a means of using natural market forces to control prices.
Contrary to Baghdad Mike, the so-called “individual mandate” will only guarantee higher healthcare prices in the end. The only defense any person has against the price of something being to high, and its attendant involuntary indebtedness (and loss of property), is the freedom/right to not buy that item.
At the risk of your own financial well being, do not buy Baghdad Mike’s B.S. Kool-Aid! There ARE vastly better alternatives if humankind can find our way past all the political propaganda B.S.

PART 2. Because my rebuttal is intended for normal intellectually curious individuals, not for propaganda manipulators (to hell with those, especially the race dividers), I say: don’t get me wrong, I don’t believe there are any throw-away people. I am not trying to categorically “diss” in any way the many wonderful folks working in the healthcare industry. We are talking ideas and philosophy here.
Establishment Big Medicine does an excellent job treating trauma. If you’re in a car crash and you have broken bones sticking out through your skin, they do a truly amazing job. The more highly skilled among them can even fix “ugly” for big bucks – sort of. (Although potential customers of artificially created “beauty” should carefully consider the sad fate of one “celebrity star” Michael Jackson before making any hasty irreversible decisions.)
Having said that, cut-burn-poison Big Medicine tends to treat symptoms for big bucks. As I said, they have a commercial monopoly on effective pain control. (That’s why opium products are illegal for anybody but Big Pharma to make.) They are, for the most part, untrained in nutrition, and are therefore painfully weak in recognition, prevention and cure of root causes of disease. It’s a good bet that’s why they tend to disrespect, demonize, and want to legislate out of existence so-called “alternative” medicine along with vitamin and mineral supplements. There is no money for Big Medicine or Big Pharma in good health.
If you want to understand what is going on, remember the old saying, “follow the money.” Not exactly rocket science.
The collectivism of insurance – especially the compulsory kind—is arguably the most destructive thing ever to have happened to the price of automobile repair and healthcare. While superficially seeming to make the financial consequences of our mistakes less painful, by following the inescapable natural laws of economics, they ultimately guarantee that the price of automobile repairs and healthcare will be increased.
There should be food for serious thought in that harsh reality somewhere. Maybe it has something to do with sustainable versus unsustainable human behaviors. And we sure seem to have a lot of the latter.
Let me finish with a little tit-for-tat snark of my own. If there are any people out there ignorant, gullible and naïve enough to believe that there exists any such thing as a liar – er, politician – who is smart enough to coercively “mandate” wages and prices to the benefit of the happiness and prosperity of all of society simultaneously, I consider those wishful thinkers to be too low in basic information to be involved in any serious discussion of the spiritual and intellectual potential of the human species. Besides, lobbyists like “Baghdad Mike” need to make a living, don’t they?

Local Libertarian John Wilkenson “is at it again with his” ad hominum snark-attacks on nationally-recognized health care expert Dr. Michael Pramenko.

Wilkenson offers no facts to support his baseless contention that “the ACA is a fraud on its face”, his painfully boring “rebuttal” is indeed “a fraud on its face”.

Nevertheless, Wilkenson is correct to focus on the flaws in our profit-driven health care system and “Big Pharma”.

However, the ACA shares his concerns and contains multiple provisions intended to address those problems and improve the quality of health care delivered by traditional medicine – including scientifically determining the efficacy of allopathic therapies.

Likewise, the reason Big Pharma remains unchallenged is that – in enacting Medicare Part D – Republicans prohibited Medicare from negotiating prescription drug prices (even though the VA has been successfully doing that for years).

Unfortunately, “in the middle of this complex problem”, Wilkenson introduces obnoxious racist and “birther” insinuations which add nothing to the discussion.

Consequently, what Wilkenson describes as “self-evident Economics 101 solutions”—offered by “clearer and better-informed heads” than Dr. Pramenko and generations of health care experts who have preceded him—is actually sheer nonsense.

Thus, while failed Libertarian political candidate (and child pornography defender) Mary Ruwart may be right in suggesting that pharmaceutical costs could be reduced by 80% (compare Medicare to the VA), it is preposterous to claim that merely abolishing the FDA could reduce overall healthcare costs by 80% “overnight”.

While prescription drugs expenses are a major component of overall health care costs, and while unnecessary profit-driven procedures are an unfortunate reality, Wilkenson (and/or Ruwart) is implying that 80% of medically treatable injuries and illnesses are merely figments of the medical community’s imagination.  There are just too many fully-satisfied and now-healthy former patients to give that proposition any credence.

Even if abolishing the FDA would “introduce more competition into the marketplace”, it would also introduce more socially unacceptable risk and would not improve public health, while reforming and improving it – along with negotiated drug prices – would.

Meanwhile, Wilkenson and others remain free to self-medicate as they wish – but doing so localizes the risk only to themselves and does not generalize it the public as a whole.

Contrary to Wilkenson’s claim, the ACA’ competitive insurance premiums are lower than initially predicted.  While they are likely to rise in the future, the rate of increase will still likely be lower than the double-digit annual rate increases that preceded the ACA.


It is a testament to Wilkenson’s arrogance and society’s ineptitude that no one – not even Wilkenson – has as yet convincingly articulated the “vastly better alternatives” which Wilkenson claims exist.  Why won’t he tell us what they are?

Wilkenson self-servingly claims that his “rebuttal is intended for normal intellectually curious individuals” – but apparently not for critical thinkers capable of applying basic logic to his fallacious reasoning.

Wilkenson focuses exclusively on the defects in our present “system” (without regard for its countervailing benefits) – which are the same defects that the ACA seeks to address.

Wilkinson also ignores the fact the defects he generalizes from are themselves products of the very profit-driven “marketplace” system that he claims will solve those problems –but which an even more laissez faire libertarian approach would likely exacerbate, not ameliorate.

Moreover, Wilkenson fails to explain why “normal intellectually curious individuals” in every other developed nation have rejected the purely market-driven approach to health care that libertarians embrace.

In essence, libertarians like Wilkenson would revert to the pre-ACA system – in which rapidly rising health care costs, health insurance premiums, insurance industry coverage abuses threatened even insured Americans with financial ruin due to uncovered health care costs.

While libertarians like Wilkenson apparently value individual liberty more than good health, most sentient individuals recognize that one’s personal political ideology is worthless without it.  And, libertarians like Wilkenson would impose the costs of their personal irresponsibility on society at large.

Thus, if you “follow the money” (as Wilkenson suggests), you end up with a “single payer” socialist approach, leaving the ACA where it belongs – somewhere in the middle of the ideological spectrum.

Wilkenson’s critique of the “collectivism of insurance” is particularly revealing.  The moral risk of insurance is that people will behave less responsibility when they know that their financial exposure is limited by insurance.

However, Wilkenson confuses the risk of self-insuring for fender-benders with the catastrophic financial consequences of liability for a major accident.  It should be obvious that the “inescapable natural laws of economics” persuade “normal intellectually curious individuals” applying common sense logic to prefer to pay marginally more for relatively minor repairs than assume total financial liability for more catastrophic accidents.

The same “inescapable natural laws of economics” persuade “normal intellectually curious individuals” applying common sense logic to prefer to pay marginally more for health insurances than assume total financial liability for more catastrophic illnesses.

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