The Patient Protection and Affordable Care Act (PPACA) was passed by Congress and signed by President Obama in 2010. The constitutionality of this law is being questioned in the courts. Most people, including myself, do not understand it, and some in the current Congress are trying to repeal it, or, at least, keep its unpopularity as a major issue for the 2012 presidential election. My view is that the PPACA accomplishes a couple of agendas for the current administration: It expands the Medicaid entitlement population thus potentially expanding a Democratic Party voting bloc, and it accomplishes redistribution of wealth. The effect for people, who actually purchase health insurance (on their own or via employer) and who also pay taxes, is an expansion of both payments. It did not accomplish perhaps the most important mechanism for true healthcare reform, i.e., the public option. I wonder why. In effect, the health insurance carriers remain unchallenged despite all the rhetoric to the contrary. (http://www.equalhealthcare.org/2010/health-insurance-rate-hikes-and-the-affordable-care-act ) (http://tucsoncitizen.com/medicare/2011/01/18/health-care-reform-and-medicare-in-2011/ Comment by R. Garth Kirkwood, MD)

Congressman Paul Ryan (R-WI) has proposed A Roadmap for America’s Future (http://www.roadmap.republicans.budget.house.gov/). This plan ensures universal access to affordable health insurance by restructuring the tax code, allowing all Americans to secure affordable health plans that best suit their needs, and shifting the ownership of health coverage away from the government and employers to individuals (http://www.roadmap.republicans.budget.house.gov/Issues/Issue/?IssueID=8516). I agree that financing one’s own health care is a personal responsibilty and that employers should be completely alleviated of responsibility in this regard. Does the roadmap accomplish this? Moreover, just how is it that one can predict his/her healthcare needs? I guess those, who can, have a crystal ball. Will the inexorable premium and deductible increases, co-pays, restrictions on what is covered and what percentage of it is covered remain? This is not healthcare reform. It is rhetoric labeled as healthcare reform, which will keep the insurance companies in their primary position of directing American health care. In effect, it socializes American healthcare. My book, Socialized Health Care Reform (ISBN: 978-0-9829947-0-2) copyright 2010, explains how this is so. And don’t forget the monthly management fees for all those health savings accounts (HSAs). Paul Ryan is being referred to as a Tea Party Masquerader. (http://www.chicagonow.com/blogs/chicago-political-commentary/2011/04/paul-ryan-tea-party-masquerader-distorting-intent-with-path-to-prosperity.html) If the shoe fits, wear it.

Why the politicians continue to vomit their manipulations onto us is clear: To do the bidding of the people and businesses that financed their campaigns and to promote ideologies designed to expand voting blocs. Accomplishing their self-serving designs in the arena of health care requires their insistence that the business of medicine is synonymous with health care and that the medicine of medicine provide structure and support for this distortion. Politicians participating fully in the orchestration of moneyed politics forces the dollar bill to be the primary goal of our healthcare system, thus leaving the doctorpatient relationship as some sort of wistful idea of the inconsequential people of America, i.e., anyone who doesn’t swamp dive in Washington, DC.

The need for true healthcare reform is still with us. The above plans won’t accomplish it.

R. Garth Kirkwood, MD