Wednesday, February 20, 2013

Doubts about Obamacare As Major Issue During Second Term Erased
If a man will begin  with certainties, he shall end in doubts, but if he will be content to begin with doubts he shall end in certainties.
Francis Bacon (1561-1626), The Advancement  of Learning
Any doubt  I had about Obamacare being a major issue during President Obama’s second term  were erased when I received today’s Wall Street Journal. The Journal  has the largest circulation of any American newspaper.  It does not publish things with considering the impact of its reporting.
In today’s edition,  the Journal has a special report, a six page spread on “Squaring Off on Health Care, “ on five issues it considers “big issues.”

One, Should all women over 40 get annual mammograms?
YES: Catching early improves odds of  beating it.
NO:  The benefits are small, but the costs can be high.
MY COMMENT : Obamacare’s proposed comparative outcome studies  are likely to side with the “NO” side because of the statistically insignificant outcome gains.   Women do not think of themselves are “statistics.”

Two, Should medical residents be required to work shorter hours?
YES: Long hours are harmful to both patients and doctors.
NO: More work hours mean more opportunities to learn.
MY COMMENT:  Shorter work hours mean more costs for hospitals, who may have a tough time paying because of the 40% reduction in  Medicare reimibursements over the next 10 years.

Three, Should states opt out of the health law’s Medicaid expansion?
YES:  It represents bad welfare – and health – policy.
NO:  It offers cost-efficient care for the most needy.
MY COMMENT :  This is huge issue,  literally a make-or-break issue for Obamacare,  for states who say they can’t afford Medicaid expansion.   and for patients who will have a hard time finding physicians who accept Medicaid patients.

Four, Should employees get insurance discounts for completing wellness programs?
YES:  Financial incentives can be a good motivational too.
NO:  It could lead to higher costs for all.
MY COMMENT:  Wellness programs will lead to higher premiums for those at-risk, who are already seeing health premiums rapidly increase because of provisions in Obamacare.

Five: Should healthy people have their genomes sequenced online at this time?
YES: For patients, knowledge can be a powerful tool.
NO:  The information is too difficult to interpret  - for now.
MY COMMENT:  This is not, to my knowledge, an Obamacare issue because gene sequencing comes out of  patients’ pockets. However, at this stage of the genome art,  a little knowledge can be a dangerous thing.

OP-ED: “Coming Failure of Accountable Care”

The  three Harvard-based authors of this piece  argue that Accountable Care Organizations, the centerpiece of Obamzcare's efforts to “save” Medicare money by herding doctors into common organizations that bundle billing, as administered by government, are unrealistic and destined to fail  because of three flawed assumptions.

One , ACOs will succeed.
They won’t  because they require a major change in doctors’ behaviors, which they are unlikely to make.

Two, ACOs will succeed.
They won’t  because they require a major change in patients’ behavior  which patents are unlikely to understand or appreciate.
Three, ACOs will “save” money. 
The Congressional Business Office estimates ACOs will “save” $1.1 billion in first five years. This is unproven and speculative. Further, it is  insignificant in face of current Medicare budget of $468 billion due to increase each year for next 5 years to over $1 trillion by 2018/

The authors’ conclusion:

Accountable Care Organizations over the long haul may ease the path to slightly lower reimbursements or redistribute physician compensation among specialties. But what ACOS most assuredly will not do is deliver the disruptive innovation that the U>S. health-care system urgently needs.
Tweet: ACOs  are likely to fail. They require major changes in physician and patient behavior and will not save a significant among money

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