obama care...

Don't say I didn't warn ya , when your train gets lost. B Dylan

This article was written by Marc Siegel in the NY Post Oct 26th

I Can feel ObamaCare closing in.

It starts with small things. Consider a patient I'll call Jane, a corporate executive in her mid 40s. She's happy with her current health coverage -- a high-deductible policy paired with a Flexible Spending Account that can cover up to $3,000 a year in routine expenses, which she uses to pay for much of her medical care.

Other than her yearly screening check-up, Jane doesn't come in to see me unless she's really sick. An occasional bout of bronchitis prompts a brief visit, where I prescribe her a short course of antibiotics. Otherwise she uses her FSA to buy Tylenol and Advil over-the-counter for an occasional headache, insect repellant for summers in her backyard and Prevacid for an infrequent case of heartburn.

But, starting Jan. 1, Jane won't be able to use her flex-spend account to cover OTC remedies without getting a prescription first. That's right: She'll need a prescription for non-prescription drugs -- a waste of her time, and mine. Otherwise, she has to pay a 20 percent penalty for using the account to buy exactly the sort of things it was designed to cover.

She's not alone: I have 20-plus patients facing this pointless restriction on their flex-spend or Health Savings accounts. Nationwide, more than 30 million workers with FSAs and 10 million others with HSAs are all in the same boat.

Do the congressmen who passed the health-reform law seriously expect me to somehow find the time to prescribe laxatives, antacids, creams for insect bites and hemorrhoids and so on for these patients? Or are they just looking to render that coverage worthless?

There's much worse to come. Also on Jan. 1, the cuts to Medicare Advantage start kicking in -- $140 billion in lost federal funding. I don't yet know how many of my patients will lose the dental, eye and comprehensive prescription-drug coverage that these policies provide.

The burdens keep piling up, bit by bit, over the next three years. I'm really worried about 2014: That's when the new Independent Medicare Advisory Board starts restricting the essential services I can provide the more than half my patients who have Medicare. Since the "reform" cut hundreds of billions from Medicare, something's going to have to give.

Then there's the issue Dr. Scott Gottlieb pointed out recently on these pages ("Killing Marcus Welby," Oct. 18): The reform law is also designed to push my patients -- and me -- into an HMO-style arrangement, even if they've renamed these behemoths "Accountable Care Organizations." We're not supposed to find a way around all the restrictions -- we're supposed to give up, and start following the orders of the president's preferred experts.

As more of the "reform" law takes hold, the daily practice of medicine will grow more and more difficult for both doctors and patients. Premiums are already rising and services are diminishing.

Several of my patients have found that their policies are changing and no longer cover their medications. Their referrals are restricted to narrow networks of specialists even as their co-pays and deductibles rise.

Others have lost their jobs but still have too much income to qualify for Medicaid and don't yet qualify for the high-risk pools. I see many of these patients for free, but they can't afford the tests I want to order.

It's hard for me to believe that President Obama has spent any time in a real doctor's office. He can claim that he hasn't succeeded in getting his message across, or that fear clouds our thinking -- but when it comes to health care, most Americans understand his message and just don't agree with it.

And, having written a book on fear, I can tell you that fear is an appropriate response to ObamaCare as it plays out in my examination room.

Marc Siegel is a practicing internist in New York and a Fox News medical contributor.