ObamaCare’s Fourth  Birthday

Would ye both eat your cake and have your cake.

John Heywood (c.1497-c.1587), Proverbs 

Sunday March 23, 2014 marks the fourth birthday of ObamaCare.  And what a four years it has been, marked by unilateral political decisions,  partisan controversies, public skepticism, business uncertainties,  broken presidential  promises,  arbitrary economic burdens,  a vast healthcare experiment, and dueling points of view.

In the Sunday Wall Street Journal, these dueling points of view are in full display. 

·         John C. Goodman, PhD, president of the National Center of Policy Analysis and author of  Priceless: Curing the Healthcare Crisis  (Independent Institute, 2012), takes his shot by calling ObamaCare a “Costly Failed Experiment.”

·         Ekekiel Emanuel, MD,vice provost for global initiatives at the University of Pennsylvania and former health-policy advisor at the White House budget office during passage of the Affordable Care Act, and author of  Reinventing American Healthcare (Public Affairs, 2014) fires back with “Progress, with Caveats.”

Goodman says ObamaCare has three huge problems that won’t go away: 

·         An impossible mandate: limiting government’s share of costs while doing nothing to protect individuals or their employers.

·         Unworkable subsidies: An $8000 gift to a family of four at 138% of poverty and a $10,000 burden on businesses for each employee with no government support.

·         Perverse incentives in the exchanges:  Insurers are required to charge everybody the same premium, regardless of health status, and they are required to accept anyone who applies, which means they must overcharge the healthy and undercharge the sick.  Result?  Rising premiums and deductibles, and a race to the bottom in access and quality,  as health plans narrow networks to cheaper doctors and  as employers, striving to meet compliance standards, decide  not to hire or reduce hours.

Goodman says a good start to turn the situation around would be to reduce costs and to improve care would be to get rid of the mandates, let people choose their own plans,  give universal tax credits, and make access to health savings accounts with high deductibles widely available.

Doctor Emanuel unloads  his smoking dueling pistol by saying the number of uninsured have declined from 18% to 16%, 3.1 million of young adults are now covered under their parents’ plas, 4.5 million are now eligible for Medicaid, and five million are now insured on the exchanges, and cost growth of health care has declined.   

Progress will continue, Emanuel contends, when health plans compete for exchange business on a cutting edge e-commerce site,  when a team of tech-savvy management specialists run the whole operation, and when payment is shifted from fee-for-service to bundled payments for entire episodes of care.   

The good doctor concludes, “ Conservative fear-mongering and predictions of calamity notwithstanding the Affordable Care Act is moving  American healthcare in the right direction.”  Perhaps left direction wuld be more accurate.

Emanuel  goes on: enhance the exchanges,  adopt  bundled alternatives to fee-for-service,  cooperate, coordinate,  and collaborate with government  and  pray for reign  for  ObamaCare to go on “autopilot,’ whatever that means  That  seems to be Emanuel's message.

In my opinion,  Goodman’s pistol is fully-loaded and Emanuel’s pistol is mostly bellowing, blowing, and belching  smoke.

Tweet:  ObamaCare’s fourth birthday is upon us, and dueling gurus are lighting and snuffing candles on the birthday cake.