Disappointed in Gruber comments on Obamacare

After reading “Leveraging Your Value: how to negotiate narrow networks (June 10, 2016),” I have yet to wrap my head around the fact that you quoted Jonathan Gruber from MIT. As it appears, the author of the article and the Medical Economics editorial team have short-term memory issues and have forgotten who Jonathan Gruber is and what he has said about the passing of the ACA*.  Let me refresh your memories.

Jonathan Gruber was one of the architects of Obamacare.  In 2013, he discussed how the ACA came to pass by stating (and I am quoting from “The Hill”): “Lack of transparency is a huge political advantage.  And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass.” 

He suggested voters would have rejected Obamacare if the penalties for going without health insurance were interpreted as taxes, either by budget analysts or the public. He went on to say: “If you had a law that made it explicit that healthy people are going to pay in and sick people are going to get subsidies, it would not have passed.”

The irony here is not that you quoted an “expert” who publicly referred to the American people as stupid, it’s that the very deceptive law he helped craft is now in many respects responsible for the narrow networks that your article discusses! Amazing.

I’ve been reading Medical Economics for many years and I find it a helpful, informative publication. This article lost all credibility with the Gruber quote and I ask that in future issues, please carefully screen your subject matter experts rather than banking on the short term memory of your customers.  

Joseph Badolato, DO

Camas, Washinton

*Editor’s note: Jonathan Gruber apologized for his November 2014 comments.

Next: â€‹Disturbing technology advances are turning doctors into robots

Disturbing technology advances are turning doctors into robots

I am a 65-year-old family physician working with 2 internists in a small independent adult medicine practice serving a relatively sophisticated population. I see medical care becoming more impersonal and relying on “clinical guidelines” instead of looking at the individual patient. 

The use of extenders by specialists who directly see patients independently clearly demonstrates a decrease in care. Many of my patients complain that the specialist stares at the computer and has to click boxes instead of looking at them and listening. 

The hospital systems are buying practices and controlling more and more physicians, and destroying their autonomy. Guidelines are being produced whose results are intended to serve the population as a whole to reduce costs but I fear the individual can fall through the cracks. I see more and more insurance companies dictating what I can order and what treatment it will pay for patients. 

Newer technologies and medications are unaffordable to most patients. I can’t order a nuclear stress test unless certain criteria are met. Our practice spends time fighting  insurance companies to get medications and tests approved for our patients and don’t get paid for our efforts. The Medicare advantage programs are a good example of what I perceive is our future, and that is healthcare rationing.

As a patient seeing physicians that don’t know me, I find these big offices to be impersonal and the physician rushed. I have observed poor care at large institutions when the main physician relies too heavily on his supportive team.  I do treat other physicians who are in these institutions and they appreciate the kind, individual attention our practice provides. 

When a patient calls, a real human being answers the phone. When a patient comes into the office, they are treated in a more personal and caring manner. It’s too bad that this so called “progress” is resulting in impersonal care regulated by the government, institutions like hospitals and insurance companies. 

I see a disturbing trend of stricter control of physicians, loss of autonomy, and gradual increased care rationing, all designed to cut costs. 

Robert Sacks, DO

Marlton, New Jersey