W ith Obamacare essentially upheld, including the broccoli of the individual mandate tax, the pressure to repeal and replace it will increase. If it is to be replaced, Republicans and Democrats alike are talking how to keep the popular frosting, which conceals the rotten cake.
Almost everyone mentions being able to stay on your parents' health insurance until you are 26. What could be wrong with that? What will go wrong is that barring catastrophe, next year you will be 27, and you will have had another year in which to develop a pre-existing condition (if it still matters after 2014). Or your parents might become unemployed and lose their insurance. Most won't notice - or won't care - that their employer's insurance premium will go up. If employers eventually stop offering insurance benefits, they - or the big, bad insurance company - will be blamed.
Not so long ago, young people couldn't wait to be out on their own. Of course, then they had a job, rather than a useless academic degree and a pile of debts. But today's young people do have one advantage: the Internet, and sites like eHealthInsurance.com.
A 22-year-old nonsmoking man can get a policy with a $10,000 deductible for as little as $30 a month. He should immediately start putting away money to cover the deductible. He should look for a guaranteed renewable plan, with the idea of keeping it all his life. If he needs help from his parents, they could help him buy his own policy, and cover the deductible if need be, instead of carrying him as a dependent. Good health care reform could assure availability of such plans.
Obamacare promises to end "discrimination" against people with pre-existing conditions, as Donald Berwick, former director of the Centers for Medicare and Medicaid Services, put it in The Washington Post. That means everybody gets to pay the same as the high-risk people, so premiums go up, so more low-risk people drop out. The government slaps on price controls, so insurers leave the market.
There's still discrimination, though. It's been shifted to the level of treatment. There may be no lifetime limit on the amount a third party payer is obligated to cover but coverage isn't care. There might be no care available, or the insurer might deny payment for your case, claiming it to be of insufficient benefit.
But then the problem may be temporary, reformers suggest, since Obamacare offers so much "free" prevention. Like the state, which withers away in the perfect communist society, sickness will be mostly vanquished - later. Obamacare doesn't actually mandate that we buy broccoli and eat it, but would such a mandate be more effective than endless anti-tobacco and anti-obesity counseling? According to all the evidence from demonstration projects, promises of better health and lower costs from screening, counseling, coordinating and different payment methods are like whipped cream - mostly air.
All the frothy, impressive "new" schemes have side effects. It sucks the substance out of our system of sickness care. We pay for it by "saving" money rather than the lives of the seriously sick. Population health statistics may look better when not weighed down by elderly or sick people.
Schemes like Obamacare are not just empty calories. They are more addictive than tobacco or sugar. People become more and more dependent on government for their only source of health care. They'd then need to be doubly sure to eat their vegetables, or use whatever means are still allowed to improve their own health.
Alternately, they can rip out the rest of the Obamacare scheme and the soothing promises it infuses into their veins and seize responsibility for their own medical care.
"Live free or die" is not just a motto. It is reality. Those who do not live free will live at the pleasure of their government - and die when the system decides it is time.
Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons (aapsonline.org).