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Obamacare 2.0: What Are Healthcare Practitioners Thinking?

The opinions expressed by columnists are their own and do not necessarily represent the views of

As the battle rages-on over the implementation of the federal “Obamacare” law, there is an important question that rarely ever gets asked: What do actual health care practitioners think of it? Without the practitioners themselves, there would be no healthcare. Yet politicians, government bureaucrats, insurance executives and healthcare administrators have so thoroughly co-opted any discussion on the subject that actual healthcare professionals – doctors, nurses, physician’s assistants and the like – often appear as mere pawns in a big government game.


One might think that the American Medical Association (“AMA”) would have something coherent to say about the present state of things, or that they might even have some ideas about healthcare that are better than those being pushed by politicians. I’ll have more to say about the AMA in a moment, but first, here’s a name with which we should all become acquainted: the Citizens’ Council For Health Freedom.

Advocating for a private sector, free-market approach to healthcare, the CCHF has quite a bit to say about the practice of medicine, as does the organization’s President and Co-Founder, Twila Brase.

“We’re moving away from the mission of medicine and more towards the business of healthcare, and these two endeavors are not the same thing,” Brase claims. “We’re moving in the wrong direction.”

Brase, who by profession is a Registered Nurse, notes that CCHF’s beginnings date back to 1994. “At that time, Bill and Hillary Clinton were in the White House and the threat of a government take-over of the medical profession was becoming apparent. I began holding meetings and speaking about the issue, and in 1995 we officially incorporated. The interest in what we propose has become even greater since President Obama’s healthcare law has come in to existence.”


Brase believes that one of the greatest weaknesses of the Obamacare agenda is the state-by-state insurance exchange set-ups that are intended to be used as regional Obamacare implementation mechanisms.

“If people refuse to participate in these things and there aren’t enough young healthy people who are willing to pay the increasing insurance rates, then there won’t be enough paying customers in the exchanges to financially support people who aren’t paying for their insurance at all, or who have medical conditions and who consume lots of healthcare and drive up the expenses of the exchange,” she notes. “I suspect that some of these state exchanges are going to financially collapse, all on their own.”

As an alternative means of taking care of those who can’t afford healthcare all on their own, Brase recommends private sector charitable organizations that are supported by tax incentives. “But we need to discourage people from enrolling in the exchanges. People need to understand that the exchanges are intrusive and all they offer is government coverage. We call it Medicaid for the middle class.”

Contrast the CCHF’s vision, with the ever-changing vision of the much-older American Medical Association. The AMA’s stated mission is to promote the art and science of medicine for the betterment of the public health; to advance the interests of physicians and their patients; to promote public health; to lobby for legislation favorable to physicians and patients; and to raise money for medical education. Given their stated commitments to these high-minded ideals, back in the 1960’s the AMA originally opposed Medicare, the government healthcare program for senior adults, fearing undue government intrusion in the medical profession.


But soon after Medicare’s beginnings, the A.M.A. changed their position – presumably they realized that government-funded health care through Medicare produced a steady revenue stream of payments going from the federal government to individual practitioners, and it seemed like a beneficial thing at the time. Thus for all of my lifetime, the A.M.A. has aggressively opposed any cuts at all in Medicare funding.

By mid-2009 the A.M.A. reverted back to being skeptical of government power again, and publicly opposed President Obama’s healthcare “reforms”. The Obama Administration then countered the A.M.A.’s opposition with a pro-Obama political group calling themselves “Doctors For America,” and essentially took the public spotlight away from the AMA, in terms of their influence over the public policy debate.

Compared to the nearly 1 million M.D.’s practicing in the United States, D.F.A.’s approximate membership of 10,000 is tiny. Yet the pro Obama MD group made a huge public relations impact in 2009 and 2010, complete with photo-ops of “Doctors” dressed in white lab coats and wearing stethoscopes standing beside the President at his podium. The D.F.A. was also able to get the A.M.A. to hedge a bit back in 2010, as the AMA announced that they changed their position again and supported Obama’s reforms “in principle.”


But then in June of 2012, A.M.A. President Dr. Peter Carmel announced at the Association’s annual convention their renewed opposition to Obamacare. He declared what many of us have been concerned about for quite some time – that the law doesn’t address the greatest problems with healthcare in America, and in a variety of ways makes matters worse.

So what is the biggest difference between the wisdom of the AMA and the CCHF? While the AMA has had an on-again off-again relationship with big government, Brase and the other members of the CCHF understand the basic economics of their own profession. They are also wise enough to understand the threat of third-party intrusions in the practitioner-patient relationship, and ethical enough to care about that threat.

“When other people hold the dollars, the mission of medicine is compromised,” Brase reminds people frequently. “Whether it’s the government, or an insurance company, the agendas of the people with the money ultimately take precedence over the needs of the patient.”

Are practitioners beginning to see the light as Brase and her associates do, or are they still inclined to play the “pawn” role in the government’s agenda?

“I’m hopeful that more of my fellow practitioners are seeing things more clearly” Brase notes, “but I think the loudest demands for change in the practice of medicine are going to come from the patients, first.”


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