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Obamacare and the aims of progressivism

Obamacare and the aims of progressivism

This article originally appeared on heartland.org.

Greg Scandlen notes the provision of health care, historically, has been an arena populated in America by a host of civil society institutions. These institutions were purposefully displaced by government over the course of the past century:

These associations were formed by working class men and women from all ethnic groups. In some cases they owned and operated their own hospitals. They also provided schools and orphanages for the children of deceased members, sickness funds for members who were unable to work, relocation assistance to help workers go where the jobs were, and moral support to families in times of trouble.

In the early 20th Century, these organizations came under attack by the Progressive Movement, which opposed self-help as interfering with the preferred dependency on and loyalty to the State. The Progressives also disparaged traditional values such as thrift, which got in the way of an economy ever more dependent on consumer spending. One leader of the Progressives is quoted as arguing in 1916 that, “Democracy is the progress of all, through all, under the leadership of the wisest.” The idea that common workmen could provide for their own needs was offensive to those who thought only an educated elite could order the affairs of society.

Greg writes at length about this subject in a new paper from the Citizens’ Council for Health Freedom.The widespread provision of charity care and service was also a major factor – which has again beencrowded out by government in the form of Obamacare:

As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.

The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage.

If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.

Most hospitals are still wrestling with that question, but a few have gone ahead and changed their programs, Cunningham says.

The online charity care policy at Southern New Hampshire Medical Center in Nashua, for example, now states that “applicants who refuse to purchase federally-mandated health insurance when they are eligible to do so will not be awarded charitable care.”

The same rule disqualifies aid to those who refuse to apply for expanded Medicaid, which New Hampshire lawmakers voted to extend, beginning Aug. 15.

Little wonder that, given this type of crackdown on the charity care side of things and the expanded promise of coverage to new Medicaid recipients, hospitals are seeing another Emergency Room spike:

Experts thought if people bought health insurance through the Affordable Care Act, they would find a private doctor and stop using hospital emergency rooms for their primary care.

Well, more people have health insurance. But they are still crowding into emergency departments across the nation.

An online study by the American College of Emergency Room Physicians found that nearly half of its members have seen a rise in visits since Jan. 1 when ACA coverage began. A resounding 86 percent of the physicians said they expect that number to continue growing.

In Philadelphia, emergency room visits were 8 percent higher in June than in November 2013, according to the Delaware Valley Healthcare Council, which collects data from 70 percent of the region’s hospitals.

“We find that when people don’t have health care, there is a degree of pent-up demand,” said Alex Rosenau, the ER physicians’ group and an ER doctor in Allentown. “People finally feel like they can go get medical care once they have some insurance.”

The spike in emergency room visits isn’t totally surprising. Rosenau said when Massachusetts enacted its own health care reform in 2006, everyone predicted the newly insured would find a private doctor. Instead, emergency departments saw a 3 to 7 percent increase in volume.

“Insurance does not equal access,” said Rosenau, adding that his group believes everyone should have access to care. “They know when they go to the emergency department, they are going to be seen.”

Complicating the matter is the growing shortage of primary care physicians. People who have never had a private doctor may have trouble finding one. So they continue to rely on emergency rooms.

It’s almost as if the crowding-out effects of government can have negative or unanticipated ramifications, particularly when they impact and warp the decisions people make about their lives.

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