Saturday, July 30, 2011

Obamacare: How Many More Things Can Go Wrong?

Never very popular to begin with, Obamacare continues to face strong opposition from millions of Americans who are indignant that Congress passed it over strong and vocal opposition. They know it is wrong for America. Obamacare is wrong for families, wrong for patients, wrong for business, and wrong for our children’s futures.

Grace-Marie Turner, James C. Capretta, Thomas P. Miller, Robert Moffit, Why Obamacare Is Wrong for America(Broadside, An Imprint for HarperCollinsPublishers), 2011

Anything that can go wrong will go wrong.

Murphy’s Law, saying, 1950s

July 30, 2011
- The past week was a bad week for Obamacare because of two major negative developments.

ONE, Thomas P. Weil, PhD, has written a paper, bearing the title “ACOs Doomed for Failure.”

ACOs, the organizational foundation of the Obama plan to reduce costs and improve outcomes, are slated to begin operation on January 1, 2012.

Weil says ACOs will fail for five reasons: 1) they over-estimate physicians‘ capacities to motivate patients with chronic disease to change their behavior, which has been established over a lifetime and which is unlikely to be altered enough to change the course of their diseases; 2) ACOs require a nearby well functioning multispecialty group; 3) a fully-functioning EHR system linking all parties is necessary; 4) resolving nitty-gritty operational issues – calibrating quality goals, adhering to burdensome rules, being proactive and competitive, implementing a physician reporting system, and resolving anti-trust issues – have a long way to go; and 5) ACOs may anger the public because their major priority is to limit utilization of services desired by the public and physician alike.

TWO, The National Federation of Independent Businesses (NFIB) have just released an extensive survey indicating 57% of small businesses are either likely or somewhat likely to drop coverage for employees when the law takes effect in 2014. Since the health law passed, 12% of small businesses have already terminated coverage. A year from now, 55% says they are “not too likely” (18%) or “not at all likely” (37%) to offer coverage. Finally, 57% say they would likely continue coverage if they had the option of giving employees a “tax-excluded contribution,” an HSA or its equivalent, which would give employees more control over choice of coverage, ownership of a portable policy not dependent on jobs, and incentives to shop for better value.

Two Questions

These two developments raise two questions: How many things have to go wrong before we consider scrapping or severely modifying Obamacare? How long must we wait before Obamacare cuts costs and expands access?

So far what’s gone wrong includes: sharply rising costs and declining access since passage, threats of multinational corporations to drop drug coverage for retirees, issuance of over 1500 waivers to unions and small businesses and some States bypassing Obamacare to avoid its regulatory burdens and expenses; dropping of the audit of business expenses over $600, continuing disapproval of the health law by 55% to 60% of Americans; rejection of the idea of ACOs by most major physician organizations; a survey by McKinsey and associates of American businesses indicating 30% plan to drop coverage in 2014 when Obamacare kicks in in earnest.

Everybody , including critics of the new law, agrees reform is necessary to reduce costs and expand coverage, the twin goals of Obamacare. Of good intentions toward achieving these goals, Obama and the Democrats are right; on opposing the results, higher costs and lowered access for the insured and previously insured with unforeseen consequences. Republicans are right.

I’m reminded of the story of the Blind Men and the Elephant , which might now be modified to read.

And so these men of health reform
Disputed loud and long.

Each in his own opinion
Exceedingly stiff and stern.

And each was partly in the right,
And all in part were wrong.


John Nail said...

You forgot to mention that "Obamacare Brought us the Awful Smurfs Movie" to your biased misrepresentations, esp on the NFIB study.

If you read the study - which you clearly did not - your main point - that 55% would not be adding coverage in the next year is the only true statement. Why?

Only 42% (314) of the 750 small employers (<50 employees)provider coverage today so 55% not is correct.

The other 2 stats are misrepresentations as well.

12% of those with coverage report that their insurers have or will drops their plans. In this small market this happens all the time even before the wicked "Obamacare".

The 57% you reference is the real story. That many of the 314 with coverage said they would consider dropping their plans IF employees left their plans for the subsidies in the exchanges in part or in total.

But 57% of all 750 (428) reported they would like to be able to contribute to their employees coverage if they bought it in the exchange. This is called "defined contribution" like a 401K plan.

That means that instead of the 42% today that provide coverage 61% could provide or help provide coverge to their employees, a 50% increase, even higher than CBO estimated would occur.

Anonymous said...

As the case in most if not all Republican statements.
"Republicans are right" no elaboration. As Niki, " Just say NO". Nothing is perfect. Of course all Congress has insurance. My suggestion: Give all members of Congress, Executive Branch, and Supreme Court a vouch for Health Insurance and let them buy their own like the rest of the country. How many will be unable to be insured..many. John Schorsch MD

Anonymous said...

John Schorsch MD:

Richard L. Reece, MD said...

Your name, John Nail,and your trenchant comment bring to mind a tenet of great writing, "If you have a nail to hit, hit it on the head." Sad to say, in this case, the head in question is my head.