ObamaCare contributed to the murder of health care, but it’s not the only culprit

Health care is a little like Agatha Christie’s “Murder on the Orient Express” — a new version, directed by and starring Kenneth Branagh, is now in theaters, and, as in the film, there are many suspects.

Who murdered the U.S. health care system? The most obvious suspect — ObamaCare — isn’t the real killer, it’s merely one of them.

So, who is to blame? As detective Hercule Poirot says, “I suspect everybody till the last minute.” Let’s examine the crime scene.

{mosads}The evidence for the death of health care is clear. Average wait time to see a family doctor is more than four months. Health insurance premiums now average $18,764 per year for a family of four. The national debt, driven higher in large part by government health care spending, has doubled in eight years to $20 trillion. Based on the facts, health care is dying and taking both the American people and our country with it. 

The Affordable Care Act — colloquially ObamaCare — is not the culprit, or more accurately, not the sole perpetrator. It’s merely the latest (and possibly the biggest) felon, that killed health care by expanding federal bureaucratic cost so much that there is not enough money to pay for care.

And worse, neither you nor your doctor can decide what care you get. Washington mandates the care you receive and how much providers are paid for that care. The federal government even requires your health care providers to give away their services without compensation.

Did you know that most of this was true before ObamaCare? It’s largely because of Medicaid. Created in 1965, Medicaid was a relatively modest program with about 4 million enrollees and a budget of about $1 billion. By 2015 it had more than 70 million enrollees and cost $545 billion.  Medicaid was supposed to be a safety net for those who had “any medically determinable physical or mental impairment which can be expected to result in death,” not the default insurer for the nation’s lower income citizens. And, it was intended to be administered by the states, not the federal government.

Over the years, Washington has subverted those original guidelines for both eligibility and administration.

Medicaid eligibility was expanded in legislation including the Social Security Amendments of 1967 and the Omnibus Budget Reconciliation Acts (OBRA) of 1981, 1985, 1989 and 1990. The Balanced Budget Act of 1997 added the Children’s Health Insurance Program (CHIP) to the mix. 

Medicaid benefits were expanded in legislation such as the Deficit Reduction Act of 1984, OBRA of 1987, the Medicare Catastrophic Coverage Act of 1988 (repealed in 1989), OBRA of 1990, OBRA of 1993, the Breast and Cervical Cancer Treatment and Prevention Act of 2000, and the Deficit Reduction Act of 2005.

States protested the fiscal impact of the many mandates the Congress enacted in a letter from the National Governors Association dated Aug. 1, 1989. It called “on Congress and the White House to adopt a two-year freeze on the enactment of further Medicaid mandates.” Congress responded by further expanding eligibility and adding medical screening mandates for enrollees that same year.

So, who killed the U.S. health care system by weighing it down and throwing it in the river? Spoiler warning: If you haven’t read Agatha Christie’s 1934 novel (or seen any of its adaptations), you might want to stop reading now.

Everyone did it. Every one of those mandates played a part. Every expansion of Medicaid put further stress on the system making it harder to care for the truly vulnerable.

That means, of course, that simply repealing the ObamaCare mandates won’t fix the health care system, because it won’t address the problems created by mandates enacted before 2010. It also means what Congress is discussing now won’t work. You can’t fix having too many mandates by creating new mandates. In fact, expecting Washington to fix health care is akin to expecting the murderer to bring his victim back to life.

The right approach is for Congress to start repealing those mandates. It can begin with ObamaCare, but it must not stop there. It is the sum of all the federal mandates that has murdered health care.

Dr. Deane Waldman (@SystemMD), MD, MBA, is a retired pediatric cardiologist and director of the Center for Health Care Policy at the Texas Public Policy Foundation. He serves on the board of directors of the New Mexico Health Insurance Exchange and is the author of The Cancer in the American Healthcare System.