There are only so many Obamacare supporters that can hide under a rock. After the four years of foot-shooting we’ve seen so far with this rollout, I suspect all those spots are taken.

There are only so many Obamacare supporters that can hide under a rock. After the four years of foot-shooting we’ve seen so far with this rollout, I suspect all those spots are taken.

Space here doesn’t allow me to review all the Obamacare miscues (so far). Instead, let me point out some gaping potholes on the road ahead.

Three pillars of the argument for Obamacare have recently suffered crippling blows. They are: having insurance saves money by reducing emergency room visits, use of quality measures in a healthcare setting reduces the cost of care and having insurance improves disease outcomes.

A Harvard study published in the journal Science now reports that emergency room visits increased 40 percent among Oregon patients enrolled in Medicaid programs like those offered with Obamacare. So much for the theory that Obamacare will lower costs by reducing visits to the ER.

Right now, 32 Iowa hospitals are participating in a pilot program designed to test the theory that providing better quality care cuts costs. This program is being conducted beyond the scope of public review. It has not been publicized because the idea you can improve quality and cut cost is just a theory at this point. Well, guess what? Over half the hospitals are reporting the opposite. That is, complying with government-mandated measures designed to improve quality drives costs up. So much for the second pillar of the Obamacare foundation.

And finally, the Oregon study referenced above also showed no improvement in blood pressure, cholesterol or blood sugar two years after patients enrolled in Medicaid.

These three arguments are the foundation on which support for Obamacare has been based. Now, evidence demonstrates that all three arguments are wrong.

One of the strongest arguments against Obamacare is that it does nothing to address the critical shortage of physicians in America. Seventy percent of California physicians are choosing not to see Obamacare patients due to low reimbursement. That’s in California, for crying out loud, which is already one of the states with the lowest insurance reimbursement in the country! So it now appears, although millions of Californians will have insurance by way of Obamacare, they aren’t going to be able to find a doctor to accept it. This is a pattern you will see repeated in state after state in 2014.

But the worst is yet to come.

Now, patients are supposed to be enrolled in Obamacare plans. Now, patients are supposed to be paying their Obamacare premiums. Now, people who have never had insurance are supposed to learn the financial realities of co-pays and deductibles. Now, there are suppose to be doctors willing and waiting to accept the patients covered under Obamacare. And now, those doctors are supposed to be able to confirm through the usual channels that individual patients actually have benefits under Obamacare.

Last week, my office spent in excess of six hour (yes, six hours) trying to confirm benefits of my first Obamacare patient. Three separate employees (a quarter of my entire staff) made nearly a dozen phone calls (remaining on hold up to two hours in one instance) and were never successful in confirming benefits. Ultimately, a resourceful employee of mine actually called the insurance company and pretended to be the patient. After another extended wait and numerous transfers of her call, she was finally able to get a confirmation that benefits were in place.

The next obstacle will come when I have to explain to the patient he has a $2,500 deductible that he will have to pay towards the cost of his cancer surgery and that he will have a $50 co-pay to make when he is seen for an office visit. These patients have no idea that they are going to have out-of-pocket expenses that they can’t afford. It’s like giving someone a million dollars worth of Confederate money and they don’t understand that it has no value.

Many will stop paying their premiums. That’s when the fun will begin.

The present system has no provision in place to inform physicians if these patients’ premiums are paid up. The best information they can provide is whether the patient is enrolled in the Obamacare plan or not. What that means, is that physicians gamble every time they see an Obamacare patient that the patient has paid his premiums. And guess what? If the premiums are delinquent, the insurance company doesn’t have to pay the claim.

Now how many of you believe a patient is going to pay a past due doctor bill when he can’t even pay his health insurance premium? Please crawl out from under your rock and raise your hand where we can all see you. This Obamacare disaster is just getting started.

Dr. STEVE JOHNSON has been in private practice in Sherman for 17 years. He can be reached at