President Obama and the Irony of his African Trip

Is the President just using the American people for unabashed self interest? The issue has more than simply crossed people’s minds in many quarters, and now, to me, seems to have passed any reasonable level of doubt. The President is using his office and power largely independent of the real-world experience of the American people.

The recent trip to Africa, a family vacation costing millions of dollars, highlights both the President’s disconnect with the nation, in my opinion, as well as an arrogance that leaves his conduct inconsistent with what he’s done in our nation.

First, the widening gap between rich and poor in our nation under Obama’s leadership is pretty much beyond dispute and has been noted from reports from the Global Post, quoted by the Huffington Post on 1/22/2013, to the NY Times, 2/9/2012, to Bloomberg.com 10/13/11, to name just a few.

[For formerly middle class Americans, this is no surprise as Obama has used the middle class to support and finance his follies from achieving his desired increase in the numbers of young adults covered by health insurance by making their parents the source for insurance coverage, to the increased payroll tax, to making sure that young, college educated Americans have to compete with illegal immigrants given amnesty maintaining a stubborn unemployment rate, to the sequestration raise in amounts required to be spent for the medical expense deduction to over 10 percent.]

Amidst his preaching and coaching about “doing the right thing,” the President took a family trip to Africa, best put in the headline of the Huffington Post of 6/27/13, “President Travels to South Africa with Hopes of Seeing Nelson Mandela,” which by now, everyone knows is not happening.

But the irony and arrogance of the President, who has defined himself by Obamacare is most starkly offensive to me in this trip to see Nelson Mandela, a man whose life is a testament to the pursuit of fairness and equality, on a much more basic level, since not only has the President worsened the living status of the middle class, but under Obamacare has and will force Americans to face the challenge of decreased ability to be able to afford life sustaining services, such as the life support upon which Nelson Mandela relies today.

The widening gap between rich and poor will undoubtedly extend to the ability of Americans to obtain life sustaining services at the end of their lives, even as health insurers and states and hospitals seek to address the costs of end of life care, including life support.

It’s important to understand the goals of legislation, this was, in my opinion one of the biggest mistakes we made in our consideration of Obamacare, which first and foremost was and is designed to get people to buy insurance and have insurance. The law was created to address a specific issue, the large numbers of people who did not have insurance.

Obamacare’s emphasis on saving costs, euphemistically described in terms of streamlining, efficiency, et cetera, will influence end of life sustaining services, such as life support.

Today, 47 states have a version of a POLST, Physician Orders for Life Sustaining Treatments, or MOLST (Medical Orders for Life Sustaining Treatment). These forms, described frequently as supplemental to living wills or advance directives, carry the force of a physician list of orders regarding care that an individual will receive who is facing end of life. The forms must be signed by patients or their representatives, and usually must be renewed each year, though you should absolutely check on the duration of such order if you have one.

While the pitch is one that provides the patients with a say, and more control, and blah, blah, blah, it is not coincidental that both the idea and the forms are inspired by efforts to reduce the COSTS associated with life sustaining services at the end of life. Since COSTS are a MAJOR concern of Obamacare, and insurers, it was only natural that these costs be tackled.

The forms are issued by healthcare providers, and the consultation is conducted by healthcare providers. There is no requirement that patients sign the form, but ultimately, other factors in the healthcare world will likely step in to accomplish the cost-saving goals of the forms.

For instance, many hospitals already have ways of getting around living wills, advance directives where they determine according to a specific process that the care or service is essentially, useless.

What I anticipate is that insurance companies will hone in on life sustaining services as a means of preserving their profits in an age where they’re mandated to provide certain care (essential health benefits) as well as the removal of lifetime limits.

This assumption is based on the insurance industry itself, its typical way of handling increased costs, raise patient contributions, or limit coverage. If lifetime limits are removed, does that mean that insurers will pay for life support indefinitely? You can count on that not being the case, but it’s worth asking your insurer each year when you renew.

That leaves individuals with the ability to pay out of pocket for such costs largely unaffected. But of course, since the gap between rich and poor has increased, you’ll have to determine where you think you are in terms of your ability to pay a larger share of those costs.

Regardless of your willingness to pay, or your willingness to leave behind medical bills because, after all, after clearing out your estate, there’s no place else for the medical business to go to take your money, in my opinion, the emphasis on cost controls will increase another pressure, and that is for physicians to more readily withhold life sustaining treatments, which can OVERRIDE patient requests in circumstances that meet the criteria of the hospitals they work with.

Under Obamacare which has raised the idea of outcome-based care to a virtue, the trend, in my opinion will be to opt for withholding life-sustaining treatments, eg life support.

So this trip to Africa, is symptomatic to me, of a President whose arrogance and self-interest has elevated itself to the ironic, honoring someone who has devoted a life to raising the situation of the mere ordinary people in society, versus his own destruction of the middle class, and taking for himself the opportunity to see someone sustained on life support services, that are likely to be less used in our country in the near and ongoing future.