How the ACA Can Be Abolished

Policy, Politics and Global Health Trends

The Affordable Care Act

The Affordable Care Act (ACA) was recently signed into law in America. This public policy impacts all citizens of the U.S.A. And has been controversial from its inception, not only because many people, who were promised by the President that if they liked their plan they could keep it, ended up having to get a new plan at a higher rate, but also because the very individuals who promoted the policy demonstrated a clear conflict of interest in doing so (Cesca, 2010).

The financial impact of the policy has been a serious one: rates have increased and people who cannot afford to buy health coverage are to be taxed if they do not buy it. Moreover the Act asserts that "healthcare is a right, not a privilege" (Rak, Coffin, 2014, p. 317). However, by "enforcing" everyone to exercise that "right," it stops being one and instead becomes a "tax" burden on American families, who may have reasons for not wishing to purchase health insurance. At the same time, it has been shown that the ACA does little to reinforce the practice of primary care physicians and instead only directs more money to specialized care, further destroying the pool of and accessibility to primary care physicians (Goodson, 2010). This essentially means that more people seeking health care will be required to pay more for "specialized" care. The ACA has, in effect, "scam" written all over it.

As Rosenbaum (2011) indicates, the Affordable Care Act (ACA) was a "watershed in U.S. public health policy" because of its aim to reduce the total number of uninsured citizens by over 50% -- resulting in coverage (whether through insurance or Medicaid) for 94% of all Americans (p. 130). Through this Act, touted by supporters as a reform, health care providers are guaranteed payments that before were simply not available for 25% of municipal hospitals "which handle mostly the poor" (Schorn, 2006). Thus, for both non-profit and for-profit hospitals, the ACA has guaranteed a better consistency with regards to client payment fulfillment. Understanding how the ACA came into being reveals even more clearly the driving motive behind the "reform."

Matthews and McGinty (2010) are quite explicit in their description of how health care services has become a profit driven arena, directed by secret panels (the cartel) which provide guidance for groups like The Centers for Medicare and Medicaid Services: "Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars" (Matthews, McGinty, 2010). This panel operates under the title of Relative Value Scale Update Committee (RUC) and essentially sets the "pricing" of health care services, indicating how much health care providers should be compensated for their work. This means they oversee the half a trillion dollars worth of Medicare money in the sense that they determine who gets a significant cut. RUC, states DeBronkart (2013), is nothing more than a "giant cabal" under directorship of the American Medical Association (AMA). And as Dr. Lee Hieb (2012), former president of the Association of American Physicians and Surgeons, has reported, the AMA has not only openly endorsed the ACA, it is "firmly behind this egregious bit of expensive and health killing legislation." Hieb notes how the AMA has become firmly embedded in the formation of government policies, providing since the 1980s an ever-increasingly complex coding system which health care providers are "required" to use when they bill insurance companies or government agencies. The AMA, essentially, has total control over how physicians interact (financially) with their clients -- which is precisely what the ACA reinforces in an even more stringently codified way.

Because RUC has advised allocating more government money to medical "specialists," Medicare coffers have been emptied (Sanghavi, 2009). Thus, the effect of collusion between AMA and government is, ultimately, exploitation of government's pocketbook. But exploiting the pocketbook to the extent that the pocketbook is completely emptied does not help anyone in the services industry. What is wanted are perpetual profits at perpetually increasing rates -- in short, a "fix" (Sanghavi, 2009). Since the "fix" only exacerbates the problem, a "patch" is needed. The answer to this exploitation? More collusion: the ACA is a law that now requires everyone to "pay into" the system -- meaning, the pocketbook, which is then raided and divided by RUC. That pocketbook is now being reloaded annually with more money than ever before. People who did not want or need health coverage have no choice but either to buy in or pay the penalty "tax" for not buying in.

My values prompt me to be critical of the policy not only because it is the work of a health care cartel out to squeeze ordinary citizens by "getting them into their system" but also because it was touted as something that in reality it was far from being.

The ethical principle that underpins my perspective is that of justice: justice demands that the Affordable Care Act be exposed for what it is and that it be overturned or vastly overhauled so as to allow individuals who do not want to purchase health insurance to opt out without fee or penalty.

B.

The decision maker who will receive this policy brief is Senator Rand Paul, possible future Presidential Candidate and supporter of Libertarian ideals.

The policy requires the attention of the Paul camp because it illegitimatizes the health care industry as a whole by exposing it to charges of extortion, hypocrisy, and strong-arming. Nursing is about helping people at an affordable cost, not at a cost that will make them wish they could receive care in another country. The ACA not only hurts patients, it also hurts nurses and doctors, who act as primary care givers, as they are also targets of the AMA, which wants to replenish the government's wallet and then divvy out more funds for "specialized" care givers.

As an after effect, the law, which is said to be helpful to the average American, because it provides "better" care at lower cost (Rosenbaum, 2011), actually only gives the health insurance cartel an excuse to raise rates (since it now has to cover more liabilities). This in turn prompts government to "overhaul" the legislation in an attempt to pacify the insurance lobby (the famous promise of the President to citizens that they could "keep their plan" if they liked it was quickly broken precisely for this reason). Any way one looks at it, government has become the vassal or servant of special interest groups -- in this case, the health care cartel and the health insurance cartel. What government does not serve in any sense of the word is the working class citizen it purportedly aims to "protect."

Thus, citizens feel themselves caught in the middle of a health care "crisis," as they are the ones least represented in this tug-of-war. To make matters worse, the 1945 McCarran-Ferguson Act is a virtual shield for the health care cartel, in that it exempts it from antitrust laws. Theodore Roosevelt, the famous "trust buster" in U.S. history would be hard-pressed to break the trust that the health care cartel has developed -- so entwined is it with the body of government off which it feeds. The system is essentially that of a host with an ineradicable parasite attached deep down in its intestines. To break this trust would require a complete amputation -- a potentially life-threatening operation for big government.

Add to this the fact that "price-fixing," which is essentially what RUC does for the health care services industry is illegal in America (Kurt Eichenwald (2000) described in detail the extent to which FBI agents will go to "nab" price-fixers in his book The Informant) and one can only surmise that the current system of government in the U.S. is operated by individuals who are openly breaking the law and not being punished for it. The cartels appear to understand that the "law" proper does not apply to them, since they are so entwined with the executive, legislative and judicial branches of government -- branches which oversee, craft and enforce the law. At least, that is what they are supposed to do.

What the health care "crisis" is, in the end, is a crisis of will -- all concept of justice is lost in this crisis, because the very seat of justice panders to the wills of two competing cartels, both of which, in the long run, benefit immensely from the ACA. Meanwhile, the pocketbook of the average American is depleted.

The ACA only serves to demonstrate that nothing has changed in America in the past hundred years. The Federal Reserve Act of 1913, which gave the power to print the nation's money, to a small, private cartel of bankers, showed how powerful a group of focused and determined people can be when they unite themselves with persons of authority in government. The Affordable Care Act, which is said to protect citizens just as the Federal Reserve Act was said to do (both have done nothing but rob citizens of their wealth and their freedom of choice), has ushered in a new era of cartel dominance -- only this time, it is not one but two groups (health care and health insurance) vying for the hard-earned dollars of Americans.

For the above-stated reasons, this policy requires the attention of Paul. A number of nurses, doctors and primary care physicians have brought the issue to light, as can be seen above. All agree that the influence of the AMA in the health care industry has been extremely detrimental to the industry overall. In fact, wherever business and government are intertwined, one can see corruption. Another good example of this is with the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). DSM-V has been highly influenced by Big Pharma to expand and broaden its definitions of mental disorders and to include in its recommended treatments the usage of drugs manufactured by Big Pharma. Many physicians, psychologists, and psychiatrists have challenged the DSM-V in public, calling for an investigation into or "outside review" of its formulations, arguing that there is too little evidence to support its broadened definitions and new treatments (Coalition for DSM-5 Reform, 2012). In general, the health care industry has been fatally underserved and corrupted by its alliance with corporate America, and corporate America's alliance with government. The ACA represents merely the tip of the iceberg, but by steering clear at least of this tip, we may be serving up the first and much needed blow against the cartel currently in control of the health care system.

The main challenges of addressing this issue are that it will pit Paul, conservatives and Libertarians, against a powerful health care cartel, which does not want anyone to rock its boat. The cartel is elitist, wealthy, and influential. Targeting them the way that Teddy Roosevelt targeted the major trusts (to become known as the "trust buster") will likely have political consequences -- good, if the busting of the cartel is successful; bad, if the bust is a bust. Garnering support from constituents may be easier than the actual contest that awaits Paul in Congress or from the cartel, which has powerful influences in and around the White House. Depending on how effective Paul and the Libertarians are at redirecting the current two-party system to a system more inclusive of alternative, grassroots perspective, the challenges will change from time to time. Overall, the biggest challenge is to make a big, bold political statement in which Paul "calls out" the fascistic nature of today's government. The state-controlled, mainstream media will brand him as a "nut" but alternative media may rally behind him. He will become the enemy of corporate shills like McCain and Graham, but there is no avoiding this if one is going to take on the health care cartel. This issue will ultimately shed light on the wedge between the profit-driven demands of Big Business and the concerns of middle America, whom Paul represents.

The primary options/interventions for Paul are the following: first, he should run for President and win the election; second, once in Office, he should suspend the ACA immediately and allow citizens to make up their own minds in a free society what they wish to do regarding health care. Third, he might consider nationalizing the insurance industry. If insurance companies do not want to cover specific types of individuals because such types are precisely the ones who are likely to need coverage, matters must be taken in hand and the insurance companies taken over by a government committed to helping others rather than to making profit, hand over fist, for itself. If that option is not viable, an alternative may be to oblige insurance companies and health care agencies to lower their rates all the way across the board. This would undoubtedly set off a chain reaction of necessary rate lowering in all industries as the market is so interconnected, if one trust is busted they all must be. Education, health care, insurance -- all would be affected. The very value of the dollar itself will be impacted, as the issue of trusts will inevitably lead one to consider the ultimate cartel, which is the Federal Reserve and its harmful impact on the dollar.

The best course of action would be for Paul to be elected President in 2016 and for him then to issue an Executive Order. This will allow Paul to bypass Congress and the lobbies which control it. Americans will thank him even though he will make enemies of some powerful organizations. There is certainly precedent for issuing an Executive Order to overhaul an unjust system. President Obama has issued several Executive Orders, all designed to curb the rights and liberties of American citizens (such as the signing of the NDAA) or to declare war on countries (a right supposedly reserved for Congress alone). If President Obama can issue Executive Orders that are harmful to the ideals of America, there is no reason Paul could not issue a massive Executive Order that would help to dissolve the corruption within the health care industry.

This course of action relies upon an overwhelming grassroots support and massive electoral base. If Paul can manage to make the overhauling or abolishment of the ACA as his main platform, it is possible that he could ride a tidal wave of support into the White House. Establishing such a platform would be key to initiating a plan to take back America's health care industry from the cartel that presently controls it. The platform would appeal to the many Americans dissatisfied with the ACA and the rising rates that have accompanied it. It would appeal to all those disillusioned with the fascistic government that cares more about business profits for giant corporations than it does for the families of citizens who serve as the backbone of this country. Such a platform would require fundraising and a substantial marketing campaign in order to attract as much support as possible. The singularity of the issue should serve as the main focus of Paul's campaign so that there is as little distraction as possible. Fixing America's problems at home would serve as the focal point.

The success of this policy can be ultimately evaluated by the extent to which the AMA is dissolved and the ACA abolished or reformed. Health care costs should not be influenced by individuals who stand to benefit from raising rates or arbitrarily obliging all citizens to purchase coverage whether they like it or not. However, throughout the incremental stages of the policy, evaluations will be necessary. From the top-down approach, this evaluation would start with Paul himself: is he serious about taking on the cartel? Is he serious about running for President and making this the basis of his platform? Once he has committed to this course of action, the next steps are to gather good men/advisors around him, who can help to organize the campaign. Evaluating their success would mean keeping track of the "on the ground" campaigners, the rallies held to draw support, gathering of statistics via polls, questionnaires, etc. All of this information would then be "fed" to those on the ground who can in turn use it to swell their numbers even more. Success breeds success, and if the head is moving in the right direction, the body will follow.

C.

An organization that has expressed interest in the ACA is the Libertarian Party.

Libertarians have expressed interest in this issue because it directly affects individuals' liberty regarding whether or not they want to purchase heath care coverage. Libertarian leader Ron Paul, father of Rand Paul, has proven himself to be a strong advocate of libertarianism and with his support his son could achieve success as the primary reformer the ACA and "buster" of the health care cartel.

CBPR recognizes that community 1) unites us under a shared identity, that 2) it affords us strengths and resources that individuals need to unite and be successful, and 3) promotes a long-term vision and the means to sustain itself.

The goal of the Libertarian Party is to decrease the role of Big Government in the lives of ordinary Americans. To this end, the Party aligns with the aims of this policy issue, which is to eliminate the fascistic influence of the heath care cartel on public health care policy. It is this cartel that hold government in its back pocket. By using government to break the trust and then using government to limit the reach of government, the Party and the policy can unite to achieve simultaneous and mutually benefitting objectives.