Thursday, August 11, 2016

ObamaCare in Abeyance- The Big Picture
Everybody knows ObamaCare is in a state of suspension.   Nothing much is being said about it because other issues -  Hillary Clinton’s  emails,   Donald Trump’s misstatements, the differing economic plans of the two – have taken center stage.
But everybody knows ObamaCare’s future hinges on the election.  And everybody knows on November 1, big  premium increases ranging from 10%  to 50%,  will be announced, and the fourth signup for health exchanges begins.   If not enough of the young and healthy sign on,  an ObamaCare meltdown looms,  and it will up to the new President to clean up the mess and prevent a death spiral.
The Nation’s Biggest Business
Why is ObamaCare reform so difficult?
In my opinion,  the main reason, is only partly  ideological but mostly  because health care is the nation’s biggest business, soon to consume 20% of the GNP and still relentlessly expanding.    Health care reform depends on transforming am embedded system that has grown from 5% of GNP to where it is today
In any given city,  such as New York City,  Boston, or Minneapolis,   or any given geographic region,  health care is likely to be the single biggest employer and the single biggest revenue center,  outstripping manufacturing  or service industries like finance. 
Fiendishly Complicated
Furthermore, health reform is “fiendishly complicated,” pitting the government’s bureaucracy, which cannot go out of business, and CMS against entrenched for-profit, medical industrial complex, that complicated network of physicians,  hospitals, drug companies,  chains of suppliers,  nursing and  rehabilitation facilities.
Lack  of Compromise
To complicate matters,  a spirit of compromise is lacking between the forces of government and the forces of commerce.  President Obama has mastered the art of executive actions,  and the Congress has responded in kind  with legal actions and political blockades.    Much of the political conflict  revolves around the U.S. Constitution ,  possibly the world’s  best example  of  high level compromise,  and the Constitution’s   immutability, what the founders intended,         and what flexibility and change is possible .
Unanswered Questions
Several reform questions remain unanswered.  
Does ObamaCare  increase quality?   
Do its countless regulations impair economic growth, or cripple small business startups? 
Does it contribute to exploding physician shortages? 
Who should make decisions at the point of care – government or clinicians? 
Do government reforms, aimed at using data to determine”value, ”in part by herding doctors into integrated large groups and networks, making them easier to control, work or simply make care impersonal and bureaucratic?  
Do these reform spell the death knell of autonomous private practice,  or open the flood gates for concierge and other forms of direct cash medicine? 
Can consumers afford to keep their private physicians?  
Will the present problems and the attendant frustrations cause voters to throw up their hands in despair and opt for government –controlled universal health care?

November 1 and Ensuing Three Months Will Rouse Sleeping Dogs
For now,  these questions and the other issues of health reform,  are sleeping dogs in the presidential campaign.    Premiums increases on November 1, the week before the election,  and failure to sign up enough of the young and healthy over the three months of the fourth exchange signup,  will rouse the sleeping dogs.

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