Thursday, December 10, 2015

3 Ms of ObamaCare – Mindset, Mistakes, and Middle Class Angst

When the Affordable Care Act passed on March 23, 2010, the Obama administration's mindset was that the law was needed to cover 50 million uninsured, even if the price was higher taxation, more regulations, federal mandates, and income redistribution.

Transformational reform was necessary to fulfill the progressive dream of universal coverage no matter what disruption was required . This mindset has led to fundamental miscalculations, leading to 10 mistakes.

Mistake #1 - The President and his party did not bother to consult or engage the GOP, who won the 2012 and 2014 midterms by 60/40 margins, in writing a law that effected the entire population, not just Democrats. As a result, Obama and Democrats own the law lock-stock-and-barrel, and have nobody to blame but themselves for its shortcomings.

Mistake #2 – In passing the law, Obama and his followers showed a profound ignorance of and utter disdain for America’s center-right, free-enterprise culture, whose members are more interested in economic growth and prosperity than in health reform. Before the law passed, 85% said they were satisfied with their health plans. Today that percentage is down to 67%, according to Gallup.

Mistake #3
– A third fundamental mistake was thinking that middle class working Americans, who comprise most American voters, would sit back and passively accept the notion that health and wealth redistribution with equality of outcomes was necessary in a free-enterprise culture where many have the dream and opportunity of becoming rich.

Mistake # 4 – A fourth mistake was making promises the architects of the law knew they could not keep - lowering premiums, keeping your doctor and your health plan- and by presenting and writing and delaying the law to obfuscate its contents so the average “stupid” American would not be aware of its ultimate consequences once it was fully implemented.

Mistake #5
– A fifth mistake was engaging in political warfare with the states, the majority controlled by Republican governors and legislatures, and in which, Medicaid was the number one, fastest growing budget item. Medicaid threatened to crowd out other state government programs. ObamaCare depended on the states to set up their own health exchanges, but only 13 initially did. Medicaid has added 9.7 million people in the last year, thanks to ObamaCare's health exchanges/.

Mistake #6
- A sixth mistake was honestly believing and grossly overestimating the ability of the top-down federal bureaucracy to micro- manage transactions and clinical behaviors of bottom-up patient-physician relationships at the local point of care level. All of these relationships, like all politics, are local.

Mistake #7 – A seventh mistake was the notion that the federal government could standardize and homogenize individual care through uniform health plans administered through government by providing ten essential benefits for all plans, regardless if patients wanted or needed these benefits. All-for-one, one-for-all, and one-size-fits-all, is not a good fit for heterogeneous, freedom-seeking-and loving, and multicultural society.

Mistake #8 – An eighth mistake was trying to reform the health system without thinking through or paying attention to how the reform would lower costs or provide more benefits for the typical worker, how much he or she would have to pay out-of-pocket, and how their choices of plans and providers would be narrowed.

Mistake #9 - A ninth mistake was going to philosophical and ideological war with the small and medium-sized business community, private physician practices, and start-up companies. Small businesses supplies 80% of the jobs in the U.S, and to make such statements as “You didn’t build that,” or “Anybody who thinks businesses or corporations create jobs is crazy,” is absurd and shows an anti-business and anti-private practice bias.

Mistake #10
- A tenth mistake was the fantasy that reform would result in more coverage and more access even if the law was designed to drive more doctors out of business with burdensome regulations but instead increased premiums and narrowed choices of access to doctors and health plans and hospitals of their choice.

During the nearly 6 years since ObamaCare’s passage, the middle class has experienced income declines of roughly 5%, joblessness (94 million Americans have given up looking for work), reduction of roughly 30% of their wealth, loss of their minority status to less than 50%, and erosion of their traditional values on issues like gay marriage and marijuana legality.

They do not like being called bigots, right wing nuts, white supremicists, evangelical zealots, or dismissed as mere Team Party conservatives. They consider themselves patriots and the backbone of America. In their minds, political correctness has run amuck.

Despite landslide wins in midterms in 2010 and 2014, nothing has happened to Washington to reverse middle class angst. The middle class is angry. They're embracing straight-talking politicians like Trump, Cruz, and Rubio who they believe are free of liberal euphemisms. The middle class is mad as hell, and they’re saying they’re not going to take it anymore.

No comments: