Monday, March 25, 2013

What Are Limits to Obamacare?
No limits but the sky.
Cervantes (1547-1616), Don Quixote de la Mancha
Climb high
Climb far
Your goal is the sky
Inscription on Hopkins Memorial Steps
Williams College, Williamstown, Massachusetts
After scanning this morning’s health care news, this question sprang (after all, it is Spring) to mind, what are the limits of Obamacare? Obama seems to think the sky is the limit, and there is no budget deficit problem.  Others  see clouds and limits on the horizon.

These are questions that arise when thinking about limits.
·         Will  it be  the magnitude of the national budget deficit?  That is the crux of the dispute between our two political parties. The deficit  will likely exceed $20 trillion in Obama’s 2nd term,  and the big drivers are Medicare and Medicaid.  Senior fellows at the Hoover Institute think we have gone beyond that limit, “Many current government policies are going well beyond such limits, as shown by excessive spending and taxes, growing debt, intervention government policy, and burdensome regulations that shave slowed growth and job creation)”A Better Strategy for Faster Growth, “ WSJ, March 25, 2013.   

·         Will it be the cost of health exchanges?   I read in Robert Laszewski’s piece in The Healthcare Blog, it will be $935 billion in California alone,  the federal government will be running 33 of these exchanges? 17 states will set up their own exchanges, with financial aid from Washington, including $124 million for Vermont, $253 million for Kentucky, and $252 million for Kentucky. The other 33 states will have to find their onw money.  What will be the limits for federal and state largess, and where will the money come from?   More taxes, most likely.
·         Will it be doctors willingly participating in Accountable Care organizations?       No one knows for sure, but a piece in HealthLeaders Media indicates doctors await proof of ACO performance in achieving the magic thing called “care coordination” before jumping the private practice ship.  Why leap before Accountable Care Organizations  have proven their worth? Primary care physicians are keeping an open-mind on the matter, with a poll indicating 70% are willing to wait and see if ACOs deliver on what CMS projects.

·         Will it be the 2014 elections?   Betsy McCaughey, the former lieutenant governor of New York and author of a new book, Beating Obamacare, says the 2014 elections will set the limit because  ordinary citizens  will vote to retain the GOP majority in the House and will win back the Senate. In “Disaster for Dems” Obamacare; the 2014 Vote,” she reasons as follows: young people (19% of those who voted for Obama) will revolt when their premiums double; middle-class folks will shudder with 20% to 30% premium hikes; workers in the retail, fast food, and hospitality industries won’t like losing health coverage, experiencing premium increases, and being reduced to part-time status; senior will be shocked by cutbacks and loss of benefits.  Chaos will reign in 2014, and the people will vote  for a GOP House and Senate, who will overturn or defund Obamacare.
We shall see if Obamacare has limits and, if so,  who and what  will set these limits?
Tweet: Converging forces will limit Obamacare - budget deficits, health exchange costs,  physician ACO responses,, and 2014 midterm elections.


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