Tuesday, November 19, 2013

The first and great commandment is: Don’t let them scare you.
Elmer Davis (1890-1958), Director of the United States Office of War Information in World War II
A war is going on out there.  It focuses on ObamaCare and its survival.  Its combatants are those who pray it succeeds and those preying upon who hope it fails.  Both are trying to scare the public by predicting apocalyptic outcomes if the other side wins.
Many in the public are reacting by not doing anything, by waiting until the smoke clears, by sitting on their digital finger to see if the healthcare.gov fix is for real. 

They have questions.  Will I be able to keep my plan, my doctor, my hospital? And, if I can, what will the whole kit and caboodle cost? 
They are anxious and scared.  They are playing the waiting game, to see what this ObamaCare access mess is all about.  
Because of clear evidence that President Obama knew that plan cancellations would occur and that the health care website might fail,  many of the  public feel Obama  misled them by hiding that evidence.   His approval rating  has plummeted, along with certainty about  the future of his and thieir health plan. 
The situation is dire because of deadlines to meet, November 1 to see if the website is functioning.    December 15 to enroll. January 1 to have a plan or face a penalty.  March 31  to see if 2.3 million young and healthy “invincibles”   sign onto avoid an actuarial death spiral precipitated by unaffordable “sticker shock”, with often shockingly high premiums and deductibles for new plans   for the older and sicker and vulnerable  among us.
Others among us are running scared – self-insured and employer-generated policy holders, retirees, and spouses who may lose their coverage, health insurers who may be forced to reinstate cancelled policies, physicians and hospitals who accept Medicare Advantage patients who are being arbitrarily cut out of insurer networks on short notice, and Democratic politicians who voted for ObamaCare and are up for re-election. 
Among the  paradoxes for the scared is this  – how to create address the doctor shortage , by recruiting or creating  primary care physicians,  while  cutting doctors out of the system, and while more and more doctors choose specialties  over primary care (Barbara Sadick, “In Search of More Primary-Care Doctors,” Wall Street Journal,  November 17, 2013).
Doctors are running scared to hospitals for protections against lower reimbursements and high expenses from installing electronic health records systems and coping with compliance regulations. 
Hospitals are trying to become leaner and more efficient by solving the quandary of paying doctors for “value” rather than “volume.” The dilemma?  Hospitals depend on volume to pay the bills and and “value” is an abstraction. difficult to define and often at odds with reality.  
Physicians, who generate roughly 80% of health costs through strokes of their pen or computer clicks, are paranoid – caught between a rock and a hard place, criticism of being “greedy” and fear of malpractice suits for not doing enough. They, too, are frightened about the fuure.
Tweet:  Malfunctioning healthcare.gov website, health plan cancellations, and loss of confidence in President Obama’s veracity, scare Americans.

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