Fact-checking Dr. David Janda: Why Obamacare isn’t fascist


A cousin just sent a link to the above video, featuring the controversial orthopedic surgeon David Janda, to a list of recipients on which I was included. “I thought it was very eye-opening about Obamacare,” she writes. “I am trying to understand this, but I am very concerned if Obama gets reelected.”

After watching the video and doing a bit of research, I sent this reply:

“I think you and I have political differences that are not apt to be reconciled, but this guy—M.D. or not—does not seem to be the most reliable source of accurate information on the Obama Administration’s health care policies.

“The medical treatment comparison that was included in the stimulus bill was indeed controversial; I found a range of perspectives, both pro and con, in this New York Times article. The speaker in this video focuses on his concern that care will be rationed by the government; that has not happened, and this speaker seems to dismiss the cost-saving and potentially life-saving benefits of sharing information about best practices.

“He also seems to wildly misstate the role of the National Coordinator for Health Information Technology. Dr. Janda describes the office as exercising veto power over physicians’ treatment decisions. Rather, the office promotes the implementation of current health care technology—and that’s not an Orwellian euphemism, it actually refers to computer systems—again with the goal of reducing costs, improving reliability, and saving lives. I can find no confirmation of Janda’s claim that this office does or will limit treatments in the manner he describes. The closest I can find is the possibility that newly adopted technology may suggest treatments in some cases, but I can’t find evidence of any penalties for not taking those suggestions beyond the necessity for providers to get prior approval for certain procedures undertaken for people covered by Medicare and Medicaid.

“This is comparable to the oversight that private insurers exercise over patients covered by private insurance plans. As has been widely pointed out in response to criticisms of the seeming possibility that the Obama Administration’s policies will increase the government’s role in health care ‘rationing,’ there is no health care system in the world—public or private—that lets you have what you want, for free, whenever you want it. Any insurance system—again, public or private—entails some form of regulation of benefits. Many have observed that a major reason for the vast amount of money the U.S. spends on health care compared to other developed nations—with worse results—is that physicians currently overprescribe costly and ineffective treatments. The health information technology promoted by this legislation is designed to help providers make smart choices about treatments that work.

“As for the charge that Obama ‘cut’ Medicare by $500 billion, that has become an issue in the current presidential campaign as Mitt Romney and Paul Ryan have repeated it—and increased the number to $716 billion. As has been widely pointed out, though, the exact same ‘cut’ appears in the House Republicans’ 2013 budget, authored by Ryan and endorsed by Romney. It’s not a cut in benefits, but a savings achieved by reducing provider reimbursements and cutting waste. When this was pointed out, Ryan and Romney first said that the difference between their plan and Obama’s is that they would use that savings toward deficit reduction rather than the Affordable Care Act (‘Obamacare’); now, Romney has said he differs from Paul Ryan on this matter and would reverse the policy that created those savings, which he continues to call ‘cuts.'”

Regarding Janda’s concern that half the country’s physicans will quit their professions when the Affordable Care Act is fully enacted, it’s true that a physician shortage is a problem in the U.S., and one that’s going to get worse before it gets better. Cuts in provider reimbursements might be contributing to this shortage, particularly among primary care physicians in areas where many patients receive government aid. Is the way out of this dilemma, though, perpetuating a privately-run system where physicians flock to the specialties where they can make twice as much as the average $200,000 a primary care physician makes? We need to train more doctors, and make primary care a more attractive option for them. Though the Affordable Care Act doesn’t solve this problem, the pre-Obamacare health care industry wasn’t solving it either.