Saturday, August 9, 2014

Sixteen Doubts About ObamaCare

To know much is often the cause of doubting more.

Montaigne (1533-1592), Essays

Doubt is not a pleasant condition, but certainty is an absurd o

Voltaire (1694-1778), Letter to Frederick the Great

“I doubt it ,” said the carpenter, and shed a bitter tear.

Lewis Carroll (1832-1898), Through the Looking Glass

Over the last 7 years, I have received 1.6 million page views on this blog. I have now reached 8000 page views each day. If this pace continues, I shall receive 3 million more “hits” within the next year.

What are my doubts about the health law at this juncture?

1. The health law remains even more deeply unpopular ( today’s polls - 38% favoring, 59% opposing) than it was on passage on March 23, 2010.

2. The law is hopelessly complex, all 2700 pages of it, perhaps even more so since President Obama keeps changing and delaying its provisions. The current problem, deciphering whether its authors meant what they said only states could subsidize subsidies, illustrates the obfuscuity of the text of the law.

3. The law favors the low income uninsured population, disfavors the middle class, and has little effect on the upper 1%.

4. The law harms the economy, slows economic growth, and produces part-time employment, often for low income workers who receive no health benefit health plans.

5. The future of the law is uncertain, and its fate may depend on the Supreme Court and the outcome of the Senate vote in November 2014.

6. Overall health costs are coming down, no one knows why for certain, but not for the middle class health plan premiums, which are up an average of 49% but vary by state and demographic category.

7. The law is said to be data- and value-driven, but what this means on the ground remains shrouded in mystery.

8. More doctors have electronic health records but hospital are digital laggards, and many of the EHRs still do not communicate with each other.

9. Young doctors are adapting to the new practice environment, but middle aged and older doctors are looking for escapes, most often through hospital employment.

10. Misdiagnosis is said to be rampant, with 12 million diagnostic errors per year, mostly due to the rushed practice environment in which doctors must “process” a patient each 7 to 10 minutes to make ends meet.

11. The direct pay movement, concierge medicine, cash-only ambulatory care centers, and cash-driven urgent care and walk-in centers are thriving, partly because one in five patients has no health plan, and many do not desire a plan because of costs and bureaucratic obstacles.

12 Confusion still reigns because of health law complexities, the bust and “back-end” failures of the system, and legal challenges whose outcomes remain in doubt.

12. Government is proving to be inefficient and even incompetent at managing innovation, implementing pay-for-performance and “savings” concepts, and organizing doctors into accountable care organizations.

13. The health law is at odds with the traditional American culture of self-reliance, self-empowerment, individual choice , and distrust of big government. The lastest polls indicate only 13% trust big government.

14. Numerous physician survey show profound feeling of despair over loss of autonomy, hopelessness at being pawns of government and top-down management and , frustrations over spending 25% of their time on paperwork.

15. The effects of ObamaCare cuts on Medicare have yet to be felt, except perhaps on Medicare Advantage plans, but the changes are coming, and they will not be pleasant. Of that I am certain.

16. The war between the states and the federal government continues unabated, and may intensify as millions more join the Medicaid ranks, and government budgets sink more deeply in debt.

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