Thursday, January 28, 2016

The Future of ObamaCare
The future of ObamaCare may not be what it was cracked up to be -  upwardly mobile, virtually connected,  increasingly digitally and data-driven,  interconnected and interoperable,  more collaborative and cooperative,  less and less costly,  more and more efficient and effective,  and generally, better and better in every way.  At least, the future  hasn’t worked out that well  so far. Maybe, given more time, it will.
What follows are 11 assessments of how well ObamaCare is working out 7 years after its passage and implementation.
One,   insurers are taking heavy losses from the 13 million who have signed up for the health exchanges.  UnitedHealth, the biggest of them all,  is pulling out of the exchanges after losing $450 billion last year.  Other major insurers may follow,   and more than half of the insurance co-op have failed.
Two,  premiums and deductibles are spiking,   often as much as 30% to 40%,  though the increases are variable and average about 10%.
Three,  the number signing up on health exchanges have gone up by 13 million,  40% less than the originally projected 20 million,  at the cost of $56 billon, expected to double  this decade, and   11 million of the 13 million are subsidized and are sicker than anticipated, driving up costs even faster than anticipated.
Four,  the United States continues to spend 40% to 50% more than other developed nations,  We  lag behind them in longevity and infant mortality rates, but we are ahead of them in access and results of diabetes,  cardiovascular, and cancer treatments.
Five,  the skeptical American public opposes ObamaCare  by consistent margins of  5% to 10%, with a slight majority favoring a fix rather than repeal and replacement, depending how the question is asked in polls.
Six ,  a clear majority of physicians look with disfavor upon ObamaCare, with 26% giving it a D or F grade.  Physician morale is low, physician engagement with the system and patients is declining,  and physician shortages are growing.  Many physicians feel they are not part of the health reform conversation, and significant numbers are leaving traditional practices or are not accepting patients covered by  3rd party insurance to participate in “direct” or “cash-only” arrangements .
Seven,   the nation’s health care information system is faulty, clunky,  and inadequate. Despite widespread  physician and hospital adoption of electronic health records,  information systems  are not interoperative,  not user-friendly,  not effective in advancing quality, and are either counter-productive or distracting  in patient-physician relationships.
Eight,  ObamaCare has not lived up to its promises of lower premiums, higher quality,  and patient retention of their doctors,  health plans, and hospitals.
Nine,  the American middleclass is particularly unhappy with the health care system because of a variety of factors, - affordability,   accessibility,  unpredictability , and complexity.
Ten,  partisanship  and disagreements among  the major politic parties   cast a pall over the future of ObamaCare and how to fix its problems.  Repeal, replacement,  elimination of individual and employer mandates, and reduction of regulations are possible and may to imminent.
Eleven,  the  technological innovations  being offered by the Centers of Medicare and Medicare Innovation -  data-based algorithms to guide care,  a shift to  value, evidence-based  reimbursements, physician-hospital bundled capitated payments  rather than individual  fee-for-service are on the horizon but are controversial  and do not sit well with providers.




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