I should have know that the answer was the same as always -- money. In particular, who gets what and how much? Screw the patient, screw the employer and screw us the taxpayer. Private profits and political power are as tempting today as they've ever been.
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Recent emails -- uncovered by House Republicans, despite stonewalling by the Obama Administration -- indicate one of the biggest perpetrators was the pharmaceutical industry. Drug companies, through their health-care reform lobby (PhRMA) were brought on board early. In the spring of 2009, they met repeatedly with (Senate Finance Chairman) Max Baucus, (White House Chief of Staff) Jim Messina, (Energy and Commerce Chairman) Henry Waxman, and (Nebraska, D) Ben Nelson to work out favorable treatment for price controls and the removal of "drug re-importation language" being considered by (then candidate) Obama. It was crony capitalism at its worst -- PhRMA understood that this new entitlement would be a windfall to the drug companies as taxpayers bought more and more of their products.
America's Health Insurance Plans (AHIP), a lobbying group for the health insurance industry, also got in on the bidding. Thinking they would craft the legislation for bigger profits, they worked with Democrats to promote the new bill as a way to provide cheaper insurance for everyone. They promised to squeeze $2 trillion in costs out of the system -- in large part by requiring 85% of premiums be associated with care, not administrative costs. This led to basically eliminating insurance agents who sold insurance and a reduction in the number of people working at the home office (underwriting, customer service and marketing). Health insurance "exchanges" are being set up by states (another government agency) to facilitate the sale of whatever health insurance comes out of The Affordable Health Act, starting in 2014.
AHIP believed that in return for its support, the industry would be able to set the terms of reform and be spared the government option (which would decimate the health insurance industry). Despite opposition from many of their own trade groups, AHIP went ahead and backed The Affordable Care Act, with dreams of 30 million uninsured being forced to buy their insurance.
Another group that sold out was the American Association of Retired People (AARP), which -- despite calls from seniors running 14 to 1 against the new law -- announced in 2009 that they would support Obama's new health plan.
On the surface, AARP's backing of the healthcare bill was puzzling, as the bill was designed to cut an estimated $500 billion in benefits for seniors by forcing them from popular Medicare Advantage plans. However, like PhRMA and AHIP, the answer lies in the financial windfall AARP got in return for their support.
Many people mistakenly believe that AARP is just an advocacy group for senior citizens. Over the years, AARP has become a much bigger player as an insurance company, specializing in the sale of Medi-gap insurance policies, which supplement Medicare coverage.
In 2003, President Bush passed the Medicare Advantage program, which offered an alternative to Medi-gap policies offered by AARP (and others). Through this new program, senior citizens got all the extra coverage they needed plus coordinated, well-managed care, usually by the same doctor. And at a much lower cost. The plans were so popular, that more than 10 million seniors went with Medicare Advantage plans. So, AARP saw The Affordable Health Care Act as a way of forcing more seniors to buy their policies by supporting Obama's goal of eliminating subsides for the lower-cost Medicare Advantage plans. Without the subsides, Medicare Advantage plans would no longer be as affordable (with luck, cease to exist) and seniors would be forced to buy AARP supplied plans, boosting their Medi-gap revenues, profits and more importantly, AARP executive salaries.
As a result, AARP has revealed themselves as a profit-motivated organization that put its own goals in front of the needs of its constituents.
Finally, the American Medical Association (AMA), which represents just 17% of American doctors, supported the new act despite the fact that a large majority of doctors opposed it. Why? Because in return for their support, the government would delay implementing something called ICD-10 diagnosis-coding.
Currently, physicians use ICD-9 codes to list patient diagnoses on claims, while hospitals use them for diagnoses and procedures. Under ICD-9 there are 12,000 diagnoses being used. ICD-10 would increase this number to more than 140,000 codes. The thinking is that with more codes, doctors would be able to provide government with better information that could be used in managing health care payment. Opponents, however, believe it will be used by Washington to micromanage and ration health care dollars.
Under AMA's cooperation, the new health care bill would delay implementation of the new ICD-10 codes to allow enough time for hospitals and doctors to upgrade practices and billing systems, saving them millions of dollars in the near term. However, the bill only allows for a delay, not removal. So, AMA succumbed to Washington's power for a few more years of ICD-9 coding without regard for the more damaging aspects of the law, including less pay for doctors and more interference by the Department of Health and Human Services in providing proper care to their patients.
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I mention all of the deals made by hospitals, drug companies, trade associations and doctors to point out the irony of them NOW WANTING TO GET OUT. The bill, in its final form (which according to Obama is still being worked on) isn't what these groups thought they were getting. The agreements reached in 2009 and 2010 are being modified (in some cases receiving outright denials that any agreement was ever made).
I'm sorry, but the bill is already beyond repair.
So the bill that was passed with the help of a powerful few -- despite the majority of America against it -- has now received the approval of the United States Supreme Court. The Affordable Health Care Act, our nation's newest entitlement program, is here to stay despite the political rhetoric being used by Mitt Romney and the rest trying to fundraise off its survival.
Did these medical trade associations and CEOs really think Washington was going to play fair? Come on -- since when? I've always wondered how some of our brightest medical minds can be so naive and gullible. I guess they think they're so smart that they can out-maneuver the politicians in Washington.
It didn't happen in 2010 and it won't happen now. It's already too late for the taxpayers in America; it's about to become too late for the rest of them.
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