One Perspective: When progress is complete

By Michael Giuliano
The Daily Record Newswire

It was 2015.

Everything had been made nearly perfect. The People’s representatives in Congress, leveraging the full weight of their collective 11 percent approval rating, had made it so. Many accepted the decisions of their leaders as a reflection of the leaders’ great omniscience.

The thousands of pages of laws and rules added to the federal code by 2010’s Patient Protection and Affordable Care Act had left health care, such as it was, accessible to all. Some Americans embraced the new, fully bureaucratic health care system with near-religious fervor; others just accepted it. Few openly spoke negatively of it.
Health care freedom had arrived; the expansion of the IRS was designed to bring this to fruition. A colorful chart, displaying graphically the statutory framework of all the existing health laws, was considered a thing of beauty by the many government office managers who displayed it proudly in their expanded waiting areas.

Of course, by 2015, the system did have its necessary evils. “You can come in and see the aide to the nurse practitioner’s assistant on Dec. 18” was not an unheard of response to a patient phone call to a primary care physician’s office following a tofu-turkey induced illness in November.

Low government reimbursement rates had driven uncooperative doctors into early retirement. Insurance companies, however, were rather pleased with the earnings they could report to shareholders and the bonuses that could be paid to executives.

Some doctors, concerned about the diminished quality of care that began long before 2010, eliminated their 10 or 15 paper-pushing staffers and refused to accept Medicare, Medicaid or private insurance whatsoever. They enjoyed a less stressful, even if relatively modest existence.

Upon an uninsured patient’s arrival at a medical office, the patient would be provided with IRS Form PX1040, which would be forwarded to report the patient’s failure to purchase health insurance. By law, the medical office had no choice but to make the report. It was easy enough, though. One didn’t want to be labeled an uncooperative patient.

A call to the IRS Health Care Hotline would answer all patient questions while the patient waited to see the doctor. The classier physicians’ offices would even prepare the fine payment forms for the patient as a delightful courtesy. Some would offer financing to those who couldn’t afford the fine.

There would be a remembrance that summer for Patient Protection Act advocate Sen. Robert Byrd, now dead five years. The newspapers and his colleagues on the Senate floor spoke at length of the great tragedy that Byrd did not live to see the law carried into full effect — or even any effect at all.

Also, now 79, Sen. John McCain is “reinvigorated” according to news reports. He is riding high and not only from the HGH shots he recently received during a recess (only the congressional health plan paid for such injections).

You see, McCain is also rather ebullient on the cable television circuit. He is celebrating the passage of his Vitamin Quality Improvement Act, which imposes a prescription requirement upon the purchase of vitamins and supplements.

The now highly-regulated vitamin manufacturers enjoyed the new monopoly prices they could charge. It was a bipartisan effort widely praised as a courageous reform. It was a summer of celebrations for McCain who, in July, had led an Independence Day celebration in Arizona, where he was praised for his career defending freedom.

The vitamin law would have the effect of further crowding medical offices and pharmacies although doctors rather liked being paid for these vitamin visits; their new vitamin-prescribing business was more profitable than visits ostensibly focusing on true patient care. The pharmacists also benefited, enjoying an average salary, in highly-inflated dollars, of $223,000. Although, the public was skeptical of the legislation, it was of no consequence. Now, the average worker would pay 37 percent of his or her salary in premiums.

By this time, a patient dated herself terribly if she recalled the obsolete notion of a doctor-patient relationship while expressing frustration over the triplicate government compliance forms that had to be filled out before and after each doctor’s visit. You see, several “2010 bill fixes” had been enacted since 2010 with the intent tying up regulatory loose ends in the original act.

Legislatures also had toughened the drug and prescription laws and doctors were very frequently prosecuted for prescribing certain drugs unless “extraordinary cause” could be shown. Doctors simply stopped prescribing them altogether. That many of the costs the health care laws were designed to reign in could be eliminated or reduced by ending the prescription and dispensing monopolies granted to pharmacists and doctors was a point occasionally raised but always rejected as “dangerous” and “risky.”

In any case, the licensed professionals and the law enforcement bureaucracy lobbied heavily to keep the status quo. The status quo was lucrative.

One of the 2010 act’s committees had declared that the treatment of pain or anxiety and other maladies were unnecessary “tertiary treatments.” It was assumed a patient could get along without certain types of care. These were now classified as “quality of life” treatments and only served as unnecessary encouragement to patients.

Restrictions were put on the fat and sugar content of foods to deal with the obesity epidemic that was adding greatly to the government’s health care costs. Dessert manufacturers were sued for misleading consumers about their addictive potential and harmful side effects.

Seventeen percent of the public is chronically unemployed. Some had accepted the “opportunity jobs” in India and China but most refused. Higher unemployment taxes had to be implemented, thereby adding another 2 percent burden to payroll costs. A veterans’ medical tax was also added to the roster of payroll taxes; the five separate wars and occupations for peace in the Middle East had taken their toll on the Treasury.

Permanent unemployment benefits are the new “third rail” of politics; most were resigned to the fact that Social Security would soon be terminated as the federal debt had passed $23 trillion, and the Treasury auctions were going without foreign bidders. Some had been on unemployment since 2008 and magazines ran articles on the new class of dejected non-workers.

In March 2015, the economists lauded the economic recovery; the unemployment rate had risen only two points in the last six months. Many small employers closed shop subsumed by taxes, 1099s and the burdens of bureaucracy. They attempted to become employees. However, Wal-Mart and other retailers were not hiring since fewer people could afford the expensive imports resulting from the dollar’s demise.

Many doctors employed the same strategy but they were usually successful in attaining employment directly with the insurance carriers. With the convenience of having the carrier on-site, many patients could be turned away immediately. Many doctors did not see patients until late afternoon. Medical ethics commissions and medical associations dismissed the conflict of interest as a small price to pay for “sensibly regulated” health care. The insurers praised the efficiency of the arrangement.

The average emergency room wait is now 17 hours; the average wait for an appointment with a specialist is 40 weeks. Some doctors have gone into the private “emergency care” field providing emergency services for circumstances where 17 hours may be too long to wait. Patients are often willing to pay whatever they have for such services.

By 2015, starting salaries for doctors are extremely low and Congress takes notice, rising to the occasion of its towering responsibility for everything. Although there was some contrived controversy, in the end Congress passes, 240 to 175, a bill supplementing physician salaries to deal with the massive shortage of physicians. The wheel of the perfected health care system was now complete and the economy, with its 27 percent unemployment rate, was “recovering.”

Michael Giuliano is a New York-based freelance writer and an attorney editor at Thomson Reuters.