If you don’t like Obamacare, can you opt out?

3:40 pm by | 5 Comments

Dr. Keith SmithAt a physician’s roundtable years ago, I asked Senator Orrin Hatch why I couldn’t punch out of Social Security, happy to leave all that I had paid “into the system” on the table. Why couldn’t anyone, I asked, willing to leave behind all they had paid in, be allowed to walk away from these entitlements, as long as they were willing to forgo a future claim to these “benefits?”

He wouldn’t answer me. The answer is obvious, though, isn’t it? Without the current “contributions” of the young (and yes, draws on the credit line of the unborn), the current beneficiaries would discover that these programs were bankrupt.

Virtually all of the legislators that brought us Medicare are dead and gone now. All of the legislators who brought us Social Security are dead and gone. This is no coincidence, for these men realized that it was politically much more popular to give away government goodies paid for by the young and unborn than to tax the very same people who were to “benefit” from their “ideas” and “programs.”

Dead now, these criminal politicians have largely escaped the harsh judgment they deserve for buying votes with property that would belong to future generations. Currency depreciation (“inflation”—the current political class’s favorite way to rob the young for the benefit of their current constituents) has the same effect on future generations.

This is the essence of a Ponzi scheme. That is a fraudulent investment scheme that pays investors not out of profits but out of money paid in by later investors.

If you think about it, all government programs are Ponzi schemes. It is becoming increasingly clear that the same can be said about the [Un]Affordable Care Act. I call it the UCA, instead of the ACA.

UCA can’t let young people out for the same reason that Social Security can’t. Young workers aren’t paying or saving for their own benefits, but for older, sicker people.

UCA rules force insurers to charge them more than they actually cost to help offset the higher cost of insuring older and sicker people. If the young don’t sign up, premiums for everyone in the insurance pool will dramatically increase, as will the cost to the government.

People generally don’t volunteer to be overcharged so that strangers can be undercharged. Hence the individual mandate, and tax penalties.

Young adults are beginning to see the reality as the UCA takes shape, and understand how they wind up losing from every angle. Hence the $600 million advertising campaign and multimillion dollar Navigator program to steer people into the program as quickly as possible. UCA promoters know how hard it is to take away an entitlement once people are trapped in it.

The idea is to entice people with subsidies so they won’t notice how outrageous the premiums are. When enough are lured away from private insurance—the “crowding out” effect shown so well with the Children’s Health Insurance Program (CHIP)—private insurance will collapse. Like Medicare beneficiaries now, all Americans will be without options for major medical insurance.

The success of the UCA hinges on the successful fleecing of the young people. This is the same immoral basis for Medicare and Social Security, “programs” that are still alive because participation in these Ponzi schemes is involuntary. With Bernie Madoff, at least people could take their lumps, having learned their lesson and move on. They didn’t have to continue to give him money after they learned what he was up to.

I am optimistic that today’s young people will reject the shackles that many of their elders have embraced.



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Keith Smith MD

By Keith Smith MD

Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.
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Finally! A column and a doctor willing to call Obummercare what it is: theft. Indeed, he applies that to the entire government! 

Thank you so much for your morality, Dr. Smith. I hope others in your profession learn from and emulate you.


As an MD, it is astounding that this author has completely missed the point of the ACA.  The U.S. spends twice as much as any other country on health care, and has health care outcomes that are the worst of any developed country, even worse than some third world nations.  Why?  We spend the vast majority of funding on tertiary care.  We do not detect disease until it is difficult and very expensive to treat.  Yes, anyone can go to the emergency room, but by that time care is expensive and too late, and this pattern creates a huge burden of uncompensated care that the government ends up paying for.  The ACA emphasizes prevention, and even provides free preventive care on all plans.  If we can obtain better primary care and/or eliminate uncompensated tertiary care, the government can save enough to pay for the subsidies that are reducing  premiums.  The "young and healthy" are not exempt from health care tragedies, as evidenced by the fact that health care bills are the primary cause of bankruptcy in this country.  So the ACA offers bargains to the young and low income to bring them into the care system, provide preventive care, and serve both the individuals and the national goal of better health outcomes. And the young are seeing through the misleading political hype and signing up. I have seen premiums for fully employed applicants of under $10 per month after subsidies - much less than the cost of an annual checkup and lab tests.   The solutions offered by people like Smith and the Republicans - higher deductibles, medical saving accounts - simply missrepresent the nature of the problem and compound our difficulties.  The same is true of those who counsel that the young reject the insurance offered.  Where will these pundits be when the bike accident, hiking accident, melanoma or mental health conditions impose a $50-100,000 bill on the young who take their advice? 


Maybe I'm missing something, but the reason is the same for both. Young people will eventually become old, and start to benefit from both programs. 

The key is that even if you "opt out" of social security, you will still externalize your health care costs because our cultural sense of ethics will not deny you emergency care if and when you need it. So no, you do not have the option to opt out of the contributions, then benefit from the unwillingness of doctors to let you die due to a lack of insurance (which was a direct consequence of your decision to opt out). 

The cost of aging, and the inability of most people to predict and adequately plan for the associated costs is the entire reason why these systems were put in place in the first place. 



Don't confuse Social Security with Medicare.  They are separate programs with separate tax structures.  So focusing on Social Security, it is a Ponzi scheme where recipients have historically received much more than they put in.  Now that the ratio recipients to tax payers, is is a massive burden and unsustainable.  Young people need to be prepared to save for their own retirement and social security needs to be drawn down to basically welfare for the elderly poor.

The problem with making it sustainable is the root of all the controversy around ObamaCare.  The US has never and likely will never turn off an entitlement program.  So no matter how bad, costly and unsustainable it is, once it takes root, we are stuck with it forever.


@DanielBerman1 So we force people to join a Ponzi scheme knowing full well that at some point it will collapse. This is why people  are not allowed to put 5% of their social security into a private account. I will collect my SS while I can as I was forced to pay into it but young people need to plan for the system collapse. Politicians added eligibility to the system years ago knowing full well they would be gone before it failed.