Tuesday, November 20, 2012

Post ObamaCare: The Brave New World


It is an inviolable fact of nature that in every contest, there are winners and there are losers. While Mitt Romney, Super PACs and big coal were thumped in the recent elections, that same rencounter delivered resounding wins, not only for Barack Obama, but also for "green energy", marijuana fans and Big Bird.

As the dust begins to settle, we are already seeing the negative repercussions of the wet-blanket legislation known as ObamaCare.

In order to escape the mandate to provide expensive healthcare insurance for workers, many companies have already decided to drop the benefit entirely and opt to pay the fine of roughly $2,200 per employee.

Others, particularly those in the hotel and restaurant business, are moving to increase part-time employees for whom they bear no benefit responsibilities. The CEOs of both Papa John’s and Applebee’s have launched plans to cut workers hours and institute a hiring freeze to reduce spiking healthcare costs under the new legislation.

In response to ObamaCare’s 2.3% tax on medical devices, multiple large device companies, including Medtronic, Welch Allyn, Boston Scientific and Stryker intend drastic employee layoffs. These companies will also move jobs overseas where they will be less expensive to fill. Furthermore, they plan to pass the increased tax burden on to consumers in the form of higher device pricing. Of note, Stryker owner and CEO, billionaire Jon Stryker, was one of Obama’s top five contributors. But this is real business with real impact, and the company is slated to close multiple facilities and slash 5% of its workforce as a result of ObamaCare. In the words of Barack Obama, "Elections have consequences."

Likewise, Boeing, PepsiCo and Dana Holding Corp. have announced plans for major layoffs in an attempt to stem the financial crush of ObamaCare’s employee mandate.

This "blowback" – to coin an espionage term used to define the unintended consequences of a covert operation that are suffered by the civil population -- is anticipated to have continued and wide-reaching repercussions on American businesses and the economy. Entire companies may dissolve and reconstitute as a series of smaller subsidiaries, each with less than 50 full-time employees, in order to avoid the onerous requirements of employee health insurance.

Unfortunately, what every good parent understands, but clearly Democrats in Congress fail to grasp, is the concept that we should subsidize those things we hope to promote, and tax those things we wish to suppress. Research, medical devices and jobs are prime examples of the former. This is not politics; it’s economics.

While many have focused on the negative consequences or blowback of ObamaCare’s stay-of-execution, the fundamental truth of the "winners and losers" adage remains. Americans are a highly entrepreneurial and resourceful bunch, and many opportunities will ultimately be borne of ObamaCare.

In passing the legislation in 2010, Congress virtually guaranteed total government control of healthcare by rationing care, setting fee schedules, mandating coverage of services and limiting access to treatments that citizens may wish to buy. In addition, they laid the groundwork for the federal government – that tightly run ship -- to serve as the ultimate "competition" for fat, greedy private insurance companies.

After a year or so of denials for hip replacements, annual mammograms, pap smears, dialysis and cataract surgery, many Americans will look to alternative options for care; the treatment and services they obtain may not be legal, but they will be available. In the words of Winston Churchill, "If you destroy a free market, you create a black market."

Americans with financial resources will seek – and industrious practitioners will provide -- under-the-table healthcare services. Cost for this care will be layered on top of the guaranteed higher taxes that are part and parcel with ObamaCare, but American consumers with means will not sit back and accept the lowest common denominator when it comes to healthcare.

There will likely be an explosion of "health spas" and "wellness retreats" that will advertise a vague range of services, with the covert understanding that an active senior can easily obtain that desired knee replacement or government-denied pacemaker. The surfeit of disenfranchised and disgusted healthcare providers will be more than eager to reinvent their practices geared toward this private-pay and highly motivated consumer class.

The medical version of "speakeasies", mobile surgical hospitals, and an underground railway for medical supplies will be created within less than a year. These sorts of entrepreneurial endeavors require minimal up-front capital and insignificant lead-time. More energetic groups of investors will look to create full service, floating hospitals on refurbished cruise ships that can be anchored in international waters off the coast of Miami or elsewhere. These "off-shore" medical centers will offer convenient helicopter service to world-class care, free from the constraints of an over-zealous and increasingly socialistic government. As an additional plus, they will have no risk of running into an offshore oil rig, as these are prohibited by the current administration.

Major U.S. based medical centers such as the Cleveland Clinic have been several years in the process of building huge medical megalopolises in the United Arab Emirates, Singapore and elsewhere in Asia. While originally conceived to tap into the expansive wealth and vast patient populations of these foreign nations, these international hubs for healthcare will thrive with the influx of Americans seeking care out of the control of the U.S. government, where they can still buy the best healthcare services in the world.

Then there’s the opportunity presented by the recognized "sovereign status" of Native American reservations. It is this designation that has allowed various Indian tribes across the country to operate casinos, even in states that prohibit gambling establishments. If their sovereign status justifies casinos that promote gambling, dancing girls and rampant alcohol consumption, certainly one can imagine that a medical facility offering high-quality, elective healthcare procedures would stake a strong argument. State-of-the-art hospitals and clinics with associated luxury hotels and fine restaurants could turn vast swaths of Native American-owned property into a veritable medical Disneyland. In a somewhat ironic twist, Native American tribes may take advantage of the opportunity to gain control of a significant portion of the U.S. economy via healthcare.

Medical tourism will certainly extend across our southern border to clinics and hospitals that will spring up in Mexico, catering to those unwilling to accept denial of treatments on their home turf. As an incidental consequence, this trend could potentially reverse the flow of illicit border crossings, as both Americans and Canadians travel south to obtain healthcare services no longer allowed in the U.S., and Mexico subsequently enjoys a significant uptick in jobs that will keep their residents put.

Companies that are inclined to remain within the confines of the U.S. and have latitude with regard to geography will gravitate to states that for one reason or another have a "bye" for ObamaCare. Some of those states have achieved their coveted waiver status as a result of filing a formal lawsuit against the federal government. Others received special dispensation by executive fiat. Regardless, in an extension of the law of unintended consequences, states that eschew ObamaCare will doubly benefit by an influx of revenues from companies that seek safe haven there.

Before ObamaCare was conceived, there were a number of initiatives to "privatize" other scientific and technology sectors, including the space program. As a result, large numbers of specialists in esoteric fields such as nanotechnology are free from their previous government commitments and anxious to continue their work. Much of this applied science, particularly microchip technology, has potential application in the healthcare arena. It is likely that we will see a wave of new entrepreneurial endeavors aimed at developing and selling these technologies – pre-revenue -- to European or Asian countries where they will be further developed and commercialized.

It is virtually a given that some version of a black market in healthcare will arise as a direct result of ObamaCare. Given that by definition, black markets exist outside the law, the question remains how it all will be regulated, and by whom. The probable answer is by no one. The promise of obtaining services and treatments no longer conventionally available, however, may well be enough for Americans to assume the risk, and forego the right or ability to sue for medical liability.

Ironically, one additional unintended consequence of all of this will be a drastic widening of healthcare disparities between the "haves" and the "have-nots"; precisely the divide Democrats claimed to be narrowing when they conceived the healthcare reform bill.

Economists and business owners alike warned that ObamaCare would cost billions and billions of dollars and implored Congress to carefully consider its potential fall-out on jobs and the economy. Little attention has so far been paid, however, to the potential opportunities, legal and otherwise, that would inevitably emerge if ObamaCare marched forward. Americans are an industrious group – and the blowback from ObamaCare may well be the birth of a brave new world.