Wednesday, November 5, 2014

ObamaCare: Dead or Alive?

Oh, the days dwindle down
To a precious few…

Maxwell Anderson (1888-1959)

Will ObamaCare survive results of the midterm elections,which was disastrous for President Obama and the Democrats?

That is a question I keep asking myself.

And it a question I address in my forthcoming triology of books on the history of ObamaCare – the first leading up to the October 2013, the second on results of the first launch, and the third on events from the end of the launch to the midterms. The title of my third book will be ObamaCare: Dead or Alive?

Midterms exit polls after the Republican sweep of state legislatures, governorships, House, and Senate races indicate the three major issues were the economy, ObamaCare, and immigration. The three are interrelated. ObamaCare is perceived as a drag on the economy, people are having a hard time paying for rising health costs, and recent immigrants, legal and illegal comprise a big chunk of the uninsured.

What are the prospects for ObamaCare over the next two years of the Obama presidency?

First, the health law and the President will face incremental challenges on taxes on medical innovation companies, on employer mandates and penalties for covering employees, on the expense of one-size-fits-all benefits for everyone, on subsidies and Medicare expansion to all states, on the roles, rules, and legalities of state and federal exchanges, and a host of other issues, large and small.

Second, some of the more popular ObamaCare provisions – covering young adults under their parents’ policies, those with pre-existing illnesses, many of the disenfranchised receiving subsidies, seniors falling into the donut hole – are likely to be retained.

Third, ObamaCare has set in motion a number of irreversible forces - young physicians seeking security in hospital employment, hospital consolidation with higher prices from dominant systems, electronic health records and big data as a basis for physician performance and payment, and a two-tier system – with one tier covered by government and health plans, and a another tier dominated by physicians, physician organizations, and private organizations offering health care services in retail and online settings.

Two things are self-evident.

One, health care, its structure and its services, will never be the same again.

Two, ObamaCare, as it is currently structured, will dwindle. Its excesses will be excised. It will become more market-based. It will be more consumer-directed with more price transparency, more online information about quality and outcomes, and more reliance of self-care and self-choice.

Three. ObamaCare will live. It will not die completely. It will not be totally repealed but it will be commonsensically transformed to make it more consumer friendly and less costly, for that is what American voters will demand.

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