In this morning’s paper, I reported on how Republican U.S. Senate candidate is focusing on her medical background as she runs against two rivals with more political experience.
The story was introduced by an event Bosworth held this past week, where she invited a dozen local doctors over to her medical office to discuss the Patient Protection and Affordable Care Act. But ironically, there wasn’t enough room in the paper to actually describe what happened at that meeting.
Every one of the doctors at the meeting was against the Affordable Care Act. Some, like Dr. Paul Amundson, the chief medical officer for Dakotacare (which is participating in the ACA’s exchanges), had fairly nuanced takes, arguing the confrontational law was simply poorly conceived and would be counter-productive.
"That’s one of the fallacies of the Affordable Care Act… as we all know, you’ve got to have a lot of healthy people paying in money to pay for the people who cost a lot of money — in general the older people," Amundson said.
He noted that young people on the individual market might pay 50 percent more for their insurance before government subsidies, while the story was different for older people.
"Take DakotaCare for example — a lot of our individual members are in their 60s… those people, their rates will go down, significantly, but somebody’s got to pay for it," Amundson said. "I don’t think there’s going to be that many young, healhy people adults who are going to jump on (to balance that)."
Other doctors present were fiercer in their opposition to the law.
"In this mechanism that’s involved with the ACA… we no longer have the control," said Dr. David Auch, an internist at the Veterans Affairs hospital in Sioux Falls. "We no longer have the ability to say this is good, this is bad, this is not."
Other attendees at Bosworth’s meeting painted darker pictures.
"The goal is to federalize medical care, and eventually end up in a single-payer system, or just frankly a socialist government-run system," said Dr. John Oliphant, a plastic surgeon. "They want to abolish private medicine altogether."
On that point, Bosworth agreed. “It will be,” she said.
But she said she was most impressed with the arguments made by Dr. Oleg Georgiev, a doctor who defected from communist-controlled Bulgaria in 1984. Georgiev said the Affordable Care Act reminded him of what he had seen growing up.
"This is collectivism, communism, socialism, fascism — call it whatever you want to call it. I’m from a communist country, I know how the system is," Georgiev said.
"Physicians who’ve seen other programs, and that have been a part of this… have the more engaged answers because they’ve been through these lessons," Bosworth said after her roundtable finished.
Though the dozen doctors gathered at Bosworth’s event varied only in the intensity of their opposition to the Affordable Care Act, the wider medical community has a much broader range of opinions on the controversial law.
The South Dakota State Medical Association’s official position is that the Affordable Care Act is a mixed bag but with “more positive than negative,” said SDSMA president Dr. Daniel Heinemann.
"Physicians have long known, and we’ve been telling anyone who listens to us, that… people who have health coverage live longer and live healthier. Anything we can do to increase that is a positive," he said.
But “we’re finding little things that were unintended consequences that need to be reviewed,” Heinemann said, pointing to its formula for paying physicians and its Independent Payment Advisory Board.
Some South Dakota doctors passionately support the Affordable Care Act, while others see it as a catastrophe. Plenty more are in between.
"When you look at things like the Affordable Care Act, it comes down to political ideologies for physicians, just like it does for everybody," Heinemann said.
Bosworth said she hosted the meeting, which was promoted by her Senate campaign, in part to foster a public discussion in the medical community about the Affordable Care Act.
"You’ve got every other news program saying, defund Obamacare. Where are the discussions in my community?" Bosworth said. "If not me to lead it, then who would? And what would their agendas be? When you get the discussions led by… insurance companies, led by private citizens, led by physicians, led by hospitals, each one of them has an agenda. What if you just bring them together and say, ‘Let’s talk about this.’"
She said hearing the doctors criticize the Affordable Care Act Tuesday night reinforced her beliefs about the law.
"The better question is, will what I’ve learned change my thoughts? The answer is no," Bosworth said. "I heard in a public forum what I’ve been hearing from one physician at a time, which is, the closer they are to seeing what this law unfolds, the less they see it improving the health of the patients in front of them."