Twelve ObamaCare Certainties

Certainty is an illusion.

Oliver Wendell Holmes, Jr, , The Path of the Law

There is no such thing as absolute certainty.

John Stuart Mill (1806-1873), On Liberty

I can’t say with certainty, but I foresee these certainties ahead for ObamaCare.

1. Health care will never be the same again. The reform dye has been cast, and it will never go away.

2. The Internet and the social media has changed everything and will transform health care.

3. The Medicaid rolls will continue to grow as a proportion of the population and will be reined in through health savings accounts and private cost restraints.

4. Health care reimbursements will be data-driven, and data scientists will be in great demand.

5. Government will impose more regulations to control costs, but these regulations will fail because humans, being human, will find ways around and away from them.

6. Hospitals will gain revenues through government subsidies of the uninsured, but will lose revenues through penalties for poor outcomes.

7. Hospitals will charge more for services of hospital-owned medical practices to make up for losses in money losing services such as psychiatry, burns, and trauma.

8. Government will continue to offer waivers as political expediencies to keep political allies and stay in power.

9. There will be continuing constant chatter about value-based reimbursement, bundled services savings, doing away with fee-for-service, and care coordination.

10. A combination of high health care premiums, anecdotal complaints about being forced to switch plans and doctors, a weak economy, and foreign policy debacles will determine the outcome of who wins the Senate.

11. Market-based forces - Health Savings Accounts with lower premiums, high deductibles, and catastrophic insurance; cash-only practices and cash-only procedures; urgent care and walk-in clinics, nurse-based clinics based at Walmart and other retail outlets, will prove more powerful than ObamaCare in lowering costs of care.

12. The November 4 midterm elections will be a referendum on the state of the economy and the state of ObamaCare and their interrelationships.