With Healthcare Reform, Be Careful What You Wish For

February 1, 2011

For those who want to overturn the law, the real risk is that in the longer term it sets up the likelihood of a single-payer system. In my opinion, by making the fines less than the cost of the insurance, it leaves a way for companies to not insure their employees. So it automatically ensures that businesses will take the cheaper way out, driving all of those individuals into the state pools for their required coverage.

The U.S. district court judge in Florida tossed Obamacare on the basis of the individual mandate. The logic the judge used was fine; the Supreme Court will ultimately review it and it will likely be a five-four decision, although I don’t know which direction. There are at least a solid four against, and now at least a solid three and likely four in favor. I still could be surprised. 

But for those folks who are desirous of an overturn of the law, the real risk is that in the longer term it sets up the likelihood of a single-payer system. In my opinion, the law was set up to ensure failure of the insurance companies. By making the fines less than the cost of the insurance, it leaves a way for companies to not insure their employees. So it automatically ensures that businesses will take the cheaper way out, driving all of those individuals into the state pools for their required coverage.

The insurer of last resort will be the feds and the states through Medicaid. Or, they could have a raft of part-time employees and avoid the mandate entirely. Those not covered could save the money in the short term and then buy into the system when sick. Again, those folks end up in the Medicaid pool.

The GOP says they will use the marketplace to provide coverage. Could be. However, nothing will happen until after the 2012 elections. One day, when the Democrats once again find themselves in power, possibly holding both houses and the White House, then there will be a push for the single-payer system, funded by taxes (and which, unless they write something else incorrectly, not as readily reviewable by the courts). That will likely be irrespective of the Republicans getting a voucher-type system in place in the interim.

Either way, at the end of the day, we - physicians and patients alike - will end up paying for it all.

John Lohnes, MD, FACR, is a radiologist at the Wichita Radiological Group and clinical assistant professor at the University of Kansas School of Medicine in Wichita. He serves on several local and state committees and is a self-proclaimed serial entrepreneur.