Thursday, January 9, 2014

What We Do Not  Know About ObamaCare

What is past I know. But what is for to come I know not.

The Apocrypha (The Hidden Books), Greek Scripture

What the future holds for ObamaCare,  I know not. It is all Greek to me.  But here is what I think we do not know.

·         We do not know if Obama’s $1 million public relations  campaign, with its parade of ObamaCare feel-good stories, will succeed in reselling the unpopular and controversial  health law. 

·         We do not know if the demographic split among the old and young among those enrolling will result in a “death spiral” of the law  because government says it does not know the true numbers.  

·         We do not know as a nation  how to redistribute costs across the broad population, by taxation,  penalties, fees, or mandates, or God Forbid, by market competition. 

·         We do not know if ObamaCare or economic conditions, is responsible for the overall slowing of total health care costs, to 1.8%, over the last four  years.  

·         We do not know if  government control of the health system will work in the U.S. The  eight-of-center US culture rejects “socialized medicine,” with limited choices, rationing, and bureaucratic versus clinician-patient decision making.  

·         We do not know if reform-driven initiatives focusing on accountable care organizations,   value versus volume health care, bundled payments, pay for “physician performance,”   and ending of fee-for-service are workable or viable  concepts.

·         We do not know if  trends toward direct payment (concierge or retainer medicine)  without 3rd party involvement will reach enough critical mass to change US health care into a two-system, i.e, private pay for some versus government dependency or others.  

·         We do not know if government-selected “navigator” beginners  can effectively replace experienced  health care agents  to  increase the number of ObamaCare health exchange enrollees. 

·         We do not know if ObamaCare will ultimately deliver on its promises of reduced costs,  expanded access, increased efficiency, and enhanced quality.

·         We do not know if a GOP sweep in 2014 and 2016 would lead to repeal  or radical restructuring  of ObamaCare.  

·         We do not know if doctor shortages on non-acceptance of  recipients of those on government programs will drive up emergency room visits and waiting lines to see doctors to politically intolerable levels.

·         We do not know if the current unpopularity of the health law (56% against, 38% for) will grow or diminish once ObamaCare begins in earnest.  
T   Tweet:  We do not know what the future holds for ObamaCare. It involves the unknowable  and  one cannot judge the future by the past.

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