ObamaCare is broken and we should fix it

Should ObamaCare be thrown out like the Trump administration is currently proposing to the U.S. Court of Appeals for the Fifth Circuit in New Orleans?

The answer is no. Revising, reforming, and adding more choices at a lower cost is a better, more workable approach than starting from scratch. But ObamaCare is an enormously expensive one-size-fits-all insurance with high deductibles and narrow provider networks that frequently don't provide the actual service ObamaCare promises.


Big changes are needed to provide coverage that fits better with the emerging personalized medical technologies of the near future. The Trump administration has already taken steps in this direction by introducing skinny plans, national association plans, greater price transparency, cheaper generic drug and, as Medicare Administrator Seema Verma told me, new systems of payment for powerful individualized bioengineered immunotherapy treatments for cancer.

The argument against the Affordable Care Act from a legal perspective is that the law is unconstitutional, built on an individual mandate, deemed by the U.S. Supreme Court to be collectable as a tax penalty, which is now gone. But the medical argument against compelling people to buy clunky, overstuffed, dysfunctional coverage they don’t need is even stronger.

Policy makers — and big insurers who they have made deals with — have taken over the health-care system based on the concept that health care is a right, but ask a doctor if health care is a right and he or she will probably say, "A right to what?"

A right to emergency care if you are having a heart attack? Yes — in fact, current federal law demands that you not be denied emergency care at any emergency room, with or without ObamaCare.

Now we need a government-provided catastrophic insurance (not ObamaCare), which ensures that no one goes bankrupt from a sudden health emergency. That’s where ObamaCare should have started and ended.

But a healthy 27-year-old non-smoker shouldn’t have to pay towards cancer treatments for all smokers via an exorbitant premium that the federal government then has to subsidize down to near-affordability. A much more practical approach is an individualized policy based on risk that the government could subsidize when needed so that all with pre-existing conditions are covered.

ObamaCare mandated an insurance model that is obsolete. This concept is based on the fear of illness. Namely, that since we are all going to be sick one day if we aren’t already, then we must all pay a hefty price to make sure that everyone has hefty coverage (again, coverage is not the same thing as care) for all the tests and services they or others might potentially need. But this socialized medicine concept doesn’t work. Why? Because most of the health expenses are gobbled up in the last few years of life and by those few with severe chronic illnesses. We can’t in good conscience ask everyone to share the costs of this without either charging exorbitant premiums or rationing care.

So what are your health care rights? Beyond the right to basic lifesaving care, you have the right to know how much your procedure or medication cost. You also have the right to choose the health-care coverage that works for you and the doctor or hospital that can best provide it.

I believe you should also have the right to pay the same or less than foreign countries do for prescription drugs that were invented, developed and marketed here in the U.S.

These are all rights that the Trump administration through Health and Human Services Secretary Azar are working at ensuring.

You also have the right to public health. The government has an obligation to provide vaccines and sanitation, for example. But arguing that maternity or mental health and other “essential benefits” such as a copay on a colonoscopy have to be mandated in all insurance policies is part of why the Affordable Care Act is so unaffordable.

Keep in mind that the federal government already offers these services directly through Federally Qualified Health Centers and the National Health Services Corp, which provide care for over 20 million people.

The Medicaid expansion, which is one of the best parts of ObamaCare, helps provide the funding through individual patients that helps keep these essential clinics going.

There is no need to obliterate ObamaCare, but there is a need to work around it rather than expand it. We need to provide more choice outside of it, while changing the system to make it more affordable.

Finally, your doctor has rights, too. He or she has the right— after many years of specialized training — to be well reimbursed and not have to spend several hours per day in mandatory rote computer documentation (another Obama-era law). Under ObamaCare, patients come to see us with heightened expectations that we doctors just can’t deliver because of regulated time constraints. Many doctors are burned out and considering quitting. Now that’s one outcome that will not ensure your “right” to basic care.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent.