Sunday, July 28, 2013

Obamacare – Will It Collapse of Its Own Weight?
Now in building of chaises, I tell you what,
There is always a weakest spot, –
In hub, tire, felloe, in spring or thill,
In panel or crossbar, or floor, or sill,
In screw, bolt, throughbrace, — lurking still,
Find it somewhere you must and will, –
Above or below, or within or without, –
And that’s the reason, beyond a doubt,
That a chaise breaks down, but doesn’t wear out.

All at once the horse stood still,
Close by the meet’n'-house on the hill.
First a shiver, and then a thrill,
Then something decidedly like a spill, –
And the parson was sitting upon a rock,
At half past nine by the meet’n'-house clock, –
Just the hour of the earthquake shock!

What do you think the parson found,
When he got up and stared around?
The poor old chaise in a heap or mound,
As if it had been to the mill and ground!
You see, of course, if you’re not a dunce,
How it went to pieces all at once, –
All at once, and nothing first, –
Just as bubbles do when they burst.

Oliver Wendell Holmes (1809-1894),  The Deason’s Masterpiece The Wonderful One-Hoss Shay
Critics of Obamacare are betting that it will collapse of its weight into a heap and a mound because of  imperfections in its structure.  Its wheels, they assert, are already coming off – the abandoning of its long-term care CLASS program,  demise of the medical-device tax,  imminent  death of the Medicare Independent Advisory Board (IPAB), revolt of the unions(AFL-CIO, Teamsters, IRS, et al), opting out of states from Medicaid expansion, and delay of the employer mandate for a year.  

The final wheel,  lack of ability to sign up enough young uninsured to bring down premiums for the rest of us,  may come off by January 1, 2014.
Predictions of a sudden collapse are wishful thinking. Obama and the Democrats have too much political capital invested to let that happen.
But Obamacare is in trouble  because of doubts on these fronts.
Does the Obama administration have:
·         The technologic competence  to put together a “hub” linking 7 federal agencies to  judge  who should qualify for federal subsidies?  Despite assurances by Obama and  Kathleen Sibelius that all systems will be ready by October 1, 2013,   doubts exist in all quarters – federal and private - that the administration can meet the October deadline. 

·         The necessary collaboration among those entities – states who have  chosen to opt out and let the feds do it,  health plans who must participate to offer choices, and  uninsured and underinsured who must sign up in adequate numbers to make the whole thing work? 

·          Sufficient  capital  to fund the implementation of health exhanges in face of Republican plans to defund Obamacare, i.e., where will it get the money to put Obamacare in motion?   HHS estimates it will cost $4.4 billion to help states set up exchanges, more than twice the original estimate because 34 states have to let the federal government do the job.  HHS  does not have the money. It  has asked Congress for $1.5 billion more , but may not even get even that.

Should Obamacare falter and collapse, comes the ultimate question:  what are the alternatives for health reform? 
Tweet:   Does Obamacare have technologic competence, enough collaboration among participating entities, and capital to implement the health law?

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