Friday, October 7, 2016

ObamaCare Chaos
In Minnesota,  Oklahoma, and Tennessee,  three states in which I have lived or practiced,  ObamaCare premium rates are skyrocketing into the 50% to 67% range,  insurers are pulling out and citizens are losing plans and choices, and chaos reigns.
What does it all mean?   I was speaking to Dave Racer, a conservative publisher in Minnesota.  He says ObamaCare is unstable there, and major insurers are either increasing premiums,  capping enrollment,  or pulling out of health exchange markets.    He says if the Democratic Farmer Labor Market wins the next election there,   a universal coverage plan will be on the horizon within 18 months.
ObamaCare Alternatives
If ObamaCare health exchange markets fail, and ObamaCare goes down the tube, these options remain.
·         Universal single payer,  unlikely no matter who wins the presidency

·         A public option, if Clinton wins, with other fixes, such as ending  individual and employer options, moving the 55 to 65 crowd into Medicare, raising taxes for everyone. 

·         ObamaCare repeal, if Trump wins, with a market-based plan – competition across state line,  expansion of health saving accounts,  management of Medicaid by states – and God knows what else. 

·         Management of clinical medicine by machines and algorithms,  if progressively minded government experts have their way (Z, OBermeyer,M.D. and E.J. Emanuel , MD. of Harvard and Wharton (“Predicting the Future – Big Data, Machine Learning and Clinical Medicine, NEJM. September 29.”  

       Ekekial Emaneul Opinions
Ekekiel  Emanuel is one of the principle architects of ObamaCare.  He blames the Republicans for the health law’s problems and says with more government money poured into  “risk corridors,”  the health exchanges could be stabilized and insurer death spirals could be prevented,
Emanuel and co-author argue, that given time and money could solve complex clinical problems and “open up vast new possibilities in medicine.”  Machine learning will one, “dramatically improve the ability of professionals to establish a prognosis,” two,” displace much of the work of radiologists and anatomical pathologists,” three, “improve diagnostic accuracy.”
My Opinion
In my opinion, the health law’s travails result from the ACA being   passed without a single Republican vote, thereby triggering partisan opposition,  and from ignorance of the concept of insurance risk  by not allowing insurers to ask about pre-existing conditions.   
As far as “machine learning” goes,  I would point out that electronic medical records, have been a bust in the medical marketing space,  neither increasing efficiency, or improving quality in terms of diagnosis and prognosis.   I doubt that diagnostic  algorithms will significant displace radiologists or pathologists.   Data has a place as a supplement, but not as a replacement of these specialties.

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