- - Thursday, September 6, 2012

The Affordable Care Act, commonly known as Obamacare, will function as an entitlement program. People may think they are paying for insurance, but they will be subsidizing an agenda, one unique to a nation already burdened by taxation.

The number of people receiving supplemental nutritional assistance, commonly known as food stamps, is close to 47 million. That is more than the estimated 45 million President Obama insisted were in need of his universal health plan. Even if we ignore the deluge of paper and electronic documentation expected, Obamacare will bring new spice to entitlement programs and the delivery of health care in general.

Affordable Care presumes a patient will be admitted to a hospital, treated and discharged and will not return again until the government thinks it’s necessary. With that reasoning, beginning in October, our hospitals are going to be penalized for readmitting Medicare patients within 30 days of discharge.

The theory here is simple, or simple in the mind of a government bureaucrat: If the patient is readmitted, the hospital didn’t do a good job the first time around. It turns a blind eye to the severity of illness, the brittle nature of many diseases and the vigilance necessary in the Medicare patient group.

The Affordable Care Act wants hospitals and physicians to assume ownership for patients and their illnesses. This fosters an entitlement mentality. Why should I take care of myself if the government is going to take care of me?

Patients will no longer have to assume any responsibility for their own health care. It will be solely up to the hospitals and the physicians, and if they fail, they will be penalized.

This new role for hospitals and physicians will be time-consuming. Hospitals will hire people to track patients, follow them around, hold their hands at the pharmacy to make sure they buy their medications, and call them daily to verify that they have taken the medications. With physicians, it will be more complicated.

The government not only recognizes the entitlement mentality, but encourages it. In our brave new world, the patient is not responsible for anything. James E. Orlikoff, consultant and national adviser on governance and leadership to the American Hospital Association and Health Forum, explained it recently to a pediatrician. During a meeting with Mr. Orlikoff, Dr. Emilia Matos expressed her frustration with a patient’s mother abusing the emergency room in the evening when the child had missed an appointment in the office earlier that day. The mother had chosen to go shopping instead. The child was on a federally subsidized program created to help less fortunate people. Mr. Orlikoff explained to Dr. Matos that she had “failed to educate the mother properly.”

Other patients were delayed in the emergency room that evening because of this unnecessary visit, and taxpayers made up the cost. Dr. Matos had not allotted time on a previous visit to educate the mother because there was no way of knowing she would choose shopping over her child’s medical condition. According to Dr. Matos, “I can’t take care of my sick patients if I’m teaching mothers when to go shopping.”

This raises questions as to how much more time is going to be spent, how many more regulations will be written and what further delays in patient care will occur in the name of improving efficiency in our health care system and keeping the costs of health care down. No one appears to be held responsible except the health care provider.

The escalating numbers participating in government entitlement programs have been the subject of unemployment, tax increases, immigration and health care. Few have approached the sensitive issue of how these entitlement programs actually delay health care, not only for the entitled, but for the privately insured as well. Under a government-controlled system, of course, most people fall into the entitlement category.

The time of bread and circuses has arrived. Medical decision-making has mushroomed into responsibility for all patient outcomes, and that includes, in effect, baby-sitting. Patients will no longer shoulder any responsibility for their own actions or non-actions. People will need to accept much longer waiting times while extensive education and behavior monitoring become the status quo in a society rendered helpless and hopeless by entitlements.

The government is in control, and the government is making the rules. It is no longer about providing actual quality care. It’s about providing what the government perceives to be quality care. As physicians, we receive gratification and a sense of accomplishment for delivering proper care to the seriously ill. Now we will see admonishment and penalties.

The best health care decisions have always been made between a doctor and a patient. I don’t recall ever inviting in the government.

Dr. Constance Uribe is a general surgeon and author of “The Health Care Provider’s Guide to Facing the Malpractice Deposition” (CRC Press, 1999).