Saturday, May 5, 2012

Hollow Health Reform Promises

We are the hollow men
We are the stuffed men
Learning together
Hairpieces filled with straw. Alas!

T.S. Eliot (1888-1965), The Hollow Men (1925)

May 5, 2012 -  “Hollow,” according to my dictionary, means having an empty space, or only air within it, having a cavity inside, not solid.

At this point,  the promises of the Patient Protection and Affordable Care Act, seem hollow.   

The promises await Supreme Court decisions in late June and the election in early November.

The big promises, as implied in the name of the Act are:

  •   Patient protection 
  • Affordable care

More specifically, the promises, some immediate, some delayed until 2014 and beyond,  were:

  • P{remium   Cost savings of $2500 per family by 2016
  • 32  million more uninsured covered through  Medicaid in 2014
  • Coverage for children under 26 under their patients’ policies
  • Federal subsidies for those falling below poverty line after 2014
  • Discounts for seniors falling into the Donut Hole
  • ·Coverage for those with pre-existing illness
  •   Coverage for all but 23 million Americans
  • ·         All for $940 billion through 2020
Some of these promises, called "sweeteners" by critics,  have been fulfilled. Others await 2014 and beyond.   

What promises are hollow?  Some fall short of reform goals, as articulated by then-senator Barack Obama in 2008, “ Here are my goals – reduce costs, increase quality, coverage for everybody.”  

To date, the ACA does not do any of these things, at least not  in the 2 years since passage of the ACA.  

Costs are rising,  quality in the eyes of patients and doctors is failing,  and people are losing coverage as employers drop coverage.

·          The  overall costs, as estimated by the government itself, are likely to be $1.76 trillion to $2.3 trillion from 2014-2024.

·         It was based on the promise that the government would spend $940 billion  on vast new entitlements and save the taxpayers money.

·         It will collect more than $500 billion in new taxes and take $575 billion out of Medicare to pay for Medicaid expansion.

·         It fails on the promise made by President Obama in a speech before the AMA on June 15, 2009, “No matter how we reform health care, we will keep his promise: If you like your doctor, you will be able to keep your doctor, Period. If you like health plan, you will be able to keep your health plan. Period. No one will take it away. No matter what.”

“No matter what” is happening.   More doctors no longer accept Medicare or Medicaid patients, and more businesses, large and small, are dropping or thinking of dropping coverage because of bureaucratic costs and uncertainties of government-approved plans.

Am I saying President Obama made hollow promises or is an hollow man?    

Of course not.   President Obama undoubtedly  thought government, under his leadership,  could fulfill his promises.  He simply misunderstood or misread the American culture in a center-right nation.  At his core, which is not hollow, he has said, “If I were designing a system from scratch, I would probably go ahead with a single-payer system.” 

Single-payer was not to  be, so he did the next best thinghelped Congress . He pressed  a government-controlled centralized system under questionable circumstances  with parliamentary gimmickry without a single Republican vote in the House or Senate.  

Unfortunately, by doing so,  he poisoned the political process- created the Tea Party,  animosity among suspicious  seniors,   and opposition among the American people and  the other two branches of government,  who distrust  overly ambitious executive branch.

TweetHealth reform goals - lower costs, higher quality, expanded access – look hollow but 2014  is 2 years away when they were to become reality.

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