Defensive medicine: How to survive Obamacare

10:08 am by | 7 Comments

It’s been a horrible year for individual liberty. First, John Roberts re-writes the Obamacare legislation in order to side with the four liberals on the U.S. Supreme Court to uphold the constitutionality of the individual mandate. Then Mitt Romney, a moderate technocrat, failed to make the case to change course with the electorate, in my view largely because he was unable to effectively challenge Obamacare. The federal noose is tightening inexorably around our collective neck! How can we, as individuals, defend our families and ourselves? These are desperate times and require desperate measures. Allow me to suggest a few.

There is simply no way that greatly expanded federal control over medicine will be anything but a disaster. Central planners will tighten their grip using price controls and other heavy-handed means of “cost control” that will inevitably mean shortages and rationing. To understand how this happens, look no further than hours-long lines to get gasoline in New York and New Jersey. These are a direct result, not of Hurricane Sandy, but of the strict “anti-gouging” laws in these states that prevent retailers from raising prices in response to scarcity. Higher prices will signal suppliers to overcome barriers to delivering more supply. Gas lines would vanish overnight with suspension of price controls. In medicine, price controls on doctors and hospitals will mean shortages of both.

Take complete control of your personal health

To assure continued access to a personal physician, concerned Americans should immediately seek out and contract with a direct-pay or concierge doctor. This is even more important if you have significant medical problems. You will not get the care you need in Medicaid, or an “Accountable Care Organization,” the latest version of managed care.


Doctors should strongly consider opting out of Medicare and other major third-party payers, as our practices will increasingly be under their direct control. If a critical mass of physicians opt out, it will be difficult for the federal government to compel participation.

Under your doctor’s guidance, wean yourselves off expensive drugs by adopting a healthy lifestyle. Don’t take illicit drugs or tobacco, and limit alcohol. Avoid processed carbohydrates and high-fructose corn syrup. Exercise regularly and maintain ideal body weight. Most medications for hypertension, type 2 diabetes, high cholesterol, and osteoporosis are toxic, and don’t address the underlying problem.

To pay for care, consider setting up a Health Savings Account, which somehow survived Obamacare, albeit with some restrictions. The HSA can be used to pay for routine care, such as office visits and tests. Get used to the idea of paying directly for your routine care. An HSA should be coupled with a catastrophic insurance policy with a high deductible. These too are still available. The Association of American Physicians and Surgeons has information on all of the above, and frequently sends updates on Twitter.


This leads to my final recommendation: If you live in a blue state, consider relocating to a red state, particularly one that is not complying with Obamacare. According to Twila Brase, we can add Montana, Alabama, and Wyoming to the list of states refusing to set up the Obamacare state insurance “exchanges.” The U.S. Supreme Court ruled that the federal government couldn’t force states to expand Medicaid, or set up exchanges. States that opt out effectively defend their citizens from some of the more objectionable aspects of Obamacare.

There are other major advantages for conservatives who move from a blue to a red state. Your vote will suddenly count, and over time, the Electoral College and Congress will shift to favor red states. You will also enjoy lower taxes and cost of living, and if moving from the northeast, a better climate! Many of the blue states, such as California, New York, Illinois, and Michigan, are in dire financial straits due to high taxes, public sector unionism, and overspending on welfare programs, including Medicaid. If millions of productive conservatives (i.e., taxpayers) bail out, the fiscal picture worsens considerably and these states will either collapse or reform. Long term, this is the only way to win the non-shooting civil war that is raging between those who favor expanding the welfare state and those who desire a return to our founding principles of a limited federal government and maximal personal freedom.

Copyright 2015 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Richard Amerling

By Richard Amerling

Richard Amerling, MD (New York City) is an Associate Professor of Clinical Medicine and an academic nephrologist at Mount Sinai Beth Israel in New York. Dr. Amerling received an MD from the Catholic University of Louvain in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence and is a seasoned speaker and on-air contributor.
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This is an encouraging letter to all the kids out there who think it is too hard to become a doctor. If this guy can get an MD, all you need to do is get a scholarship for undergrad and you'll be fine. Seriously, anti-gouging is your first argument? Classic monopolistic economic thinking by someone who currently holds a monopoly on the services he provides.


"If millions of productive conservatives i.e. taxpayers..." What about the millions of unproductive conservatives? Or do they make up the entire population of American non-voters. What a waste of KB.


What I love most about the "personal freedom/responsibility" argument is that conveniently forgets to include the fact that the children of the productive/free/responsible are literally enjoying a welfare life as a result of the parents they were lucky enough to be born/adopted to. What did the 14 year-old with a trust fund do to inherit a clear path to the top, aside from nursing from the golden bosom?


Exactly. The author only feels so entitled because he probably drank golden milk as a baby himself.


Good article. To "Chach" who said it was "terribly written": you're wrong. It was well-written. You just don't like that it was an opinion piece. It's sort of like declaring that all the fiction books at Barnes & Noble are poorly written because you're looking for a history book with lots of facts. Not a fair analysis. Everyone - both Democrats and Republicans - recognize that arbitrary taxation to subsidize an otherwise unaffordable plan invariably has unintended consequences. The unintended consequences here are loss of jobs (fact: Stryker has already laid off over 1,000 employees as a direct result of the Affordable Care Act), and higher prices for medical devices. Those two things don't help anyone or any industry. There is strong bipartisan support for repealing the medical device tax. Fact: Democrat Senators Amy klobuchar and Al Franken both oppose the tax. Fact: Democrate Representative Keith Ellison opposes the tax. Instead of saying we should sign the bill and read it later, Nancy Pelosi should have said we can't afford the Affordable Care Act so we're not going to implement it right now. Watch out, they might start taxing t-shirts, Christmas trees, car tires, and grass on your front lawn to pay for this really expensive idea.


This article was terribly written and takes away from the legitimacy of healthcare without obamacare because the author was too lazy to research and instead simply wrote down opinions without facts to back up the claims. Protectionism against price gouging is not a bad thing especially in a time of natural disaster, and simply moving is not really an option for most people. Being and eating healthy should be a priority regardless of the insurance situation. This article was silly and a waste of 5 minutes of my time.


Absolutely the best article I have read so far.  Thank you for giving us some VERY useful advise. We are already doing some of this and look forward to moving from the horrible blue state of WA to a red state.  Can't wait to start the journey. Together we will survive this and hopefully save our great country from socialism or worse.



Personal insults:  Check.

Ad hominem attack:  Check.

Can't refute the information so the writer must be silenced:  Check.


Dr. Amerling, you touched a nerve.


Why is MedCity deigning to publish the ravings of acephalic individuals like this Amerling person? 


I mean, really:


"This leads to my final recommendation: If you live in a blue state, consider relocating to a red state, particularly one that is not complying with Obamacare"


Here's a tip, Dr. Amerling: skip moving to another part of the US based on your deranged political views and fly directly to Moonbase Alpha.



Personal attacks attacks and invective, such as "civisisus" writes above,  don't constitute a compelling retort to any argument.