Wednesday, October 9, 2013

On Health Law Hassles and Regulations
The best we get from government in the welfare states is competent mediocrity.  What is impressive is the administrative incompetence. Every country reports the same confusion, the same lack of incompetence, the same proliferation of agencies, of programs, of forms, and the same triumph of accounting rules over results.
Peter F. Drucker (1909-2006), The Age of Discontinuity
The U.S. health care system is rapidly evolving into a two-tier system with equal numbers currently in each part of the system.
One is Medicare, Medicaid,  and Medicaid + subsidies,  which now  covers roughly 160 million Americans.   Individuals making up to $45,000 will qualify for subsidies.
Two, the other also covers 160 million and  consists of Americans covered by their employers.
With the health law, the first population  shows every sign of growing as the law proposes to dump some 20 million on the Medicaid rolls,  and add  perhaps 20 million  more on federal subsidies. 
The second is shrinking as employers drop health plans,  transfer retirees and spouses to health exchanges,  and shrink full-time workers to part-time employees to avoid health law penalties.
Medicaid + subsidies group  are  most likely to gain members  Medicaid already covers 1 of 5 Americans,   pays for 2 of 5 births, and pays for 60% of  nursing home expenses.   Add to these 10 million Americans now received disability benefits, and you have a real federal tsunami threatening to engulf American society.
One big population group standing in the way of this wave are the American people, 57% of whom disapprove of the health law, and citizens of  26 states who are resisting Medicaid expansion.   These states   are able to resist because of a 7-2 Supreme Court decision ( part of the same law’s decision declaring ObamaCare “ constitutional”). The Court ruled that expanding Medicare constituted coercion exceeding the government’s  constitution spending power. The Court noted Medicare is increasingly a program for the middle class.
Another thing standing in the way is the “workability” of the health law.   The hassles and red tape embedded in the law hamper its performance,  productivity, and efficiency.  EHRs are great for documenting  and providing data for government accountants, but poor for doctoring and  improving health care.
A good example is the push to enforce and reward the use of electronic medical records in physicians’ offices.  
Although most physicians  who use EHRs would not return to paper records,  these same physicians  say EHRs are overly expensive,  overly bureaucratic, do not communicate with other systems, i.e. lack “interoperability,” interfere  with work flow, are not adapted to specialty care,  decrease productivity by 30% or more,  serve as impersonal barriers to direct patient care, and  distract from time spent with patients (for details on RAND study reporting these findings,  see “EHRs. Red Tape Eroding Physician Job Satisfaction,” Health Leaders Media, October 8, 2013).
Tweet:   Affordable Care Act is creating 2- tier system: 1) Medicare, Medicaid, and Medicaid + Subsidies plans; and 2) Employer-based coverage plans.



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