Thursday, January 24, 2013

Book Review:  Obamacare Survival Guide- The Affordable Care Act and What It Means For You and Your Family, by Nick J. Tate, Paperback, $19.95, 226 pages, Humanix Books, 2013
January 24, 2013 -  This book has been heavily promoted on national TV.  When I saw the ads, I thought it would be a conservative screed against Obamacare.  It is not that.  Instead, it is  a balanced, pragmatic, fact-filled, well-written review of what Obamacare means to every American – and every subgroup of Americans. Its author is Nick J. Tate, a veteran journalist from Florida who has written extensively about health and consumer affairs, and who had a fellowship at the Harvard School of Public Health.
The book is not about “Will America survive Obamacare?” Indeed, Tate believes Obamacare will “endure.” His reasoning “With the individual mandate upheld as constitutional by the Supreme Court , Obamacare was given the green light. The law is moving forward. Albeit slowed somewhat by the new power given to the states  to opt out of expansion of Medicaid if they choose. But this is a road bump rather than a stop sign and in the long run will not prevent the new healthcare system from becoming fully operational.”
Tate believes the states now opposing health exchanges will cave because they will be unable to resist the lure of federal Medicaid subsidies.  He  believes the winners will be the uninsured and some in the private market who will be able to buy insurance with the same advantage that employer-based plans enjoy.
The losers?   They include 10% to 30% of employees, 15 million to 30 million poeple or more,  who will be dropped by businesses. The biggest loser will be Medicare recipients, who can expect billions of dollars of budget cuts over the next decade.  Another big loser will be physicians.  Obamacare reduces their earning potential and represents “an ideological assault on the current fee-for-service system – the foundation of most doctors earnings.” Accountable Care Organizations may further hurt doctors financially.  If these factors lead to 40% of doctors who say they will retire, seek a non-clinical job in healthcare or seek a job unrelated to health care in the next three years, the ensuring doctor shortage could be a disaster for Obamacare.   The Association of American Medical Colleges predicts a shortage of 60,000 doctors by 2015, and Investor’s Business Daily estimates as many as 360,000 doctors will leave the profession.
There are many features of the book I like -  a list of dates for  implementation events, the good news and the bad news of impact of different groups(those on Medicare, Medicaid, employer-based insurance private insurance), the “Did You Know” outtakes summarizing what is being said,   statistical tables showing where the money for Obamacare goes ($465 billion for health insurance exchanges, $434 billion  for Medicaid expansion/CHIP,$176 billion for risk adjustment, small employment tax credits); and where the revenue comes from to support Obamacare ($455 billion from Medicare spending cuts, $414 billion from new taxes and fees. $349 billion from all other revenue sources).
I do not agree with everything in the book, e.g. “Obamacare is, on the whole, great news for those who work for small business.” He also says it is great news for small business  because of tax credits.  Small businesses and their organizations have not gotten the message.  They are four-square opposed to Obamacare, and are not hiring because of the uncertainties and costs of the law.  I also think Tate underestimates the cost of the law, which according to Congressional Business Office, may balloon to $2.6 trillion by 2024. 
On the whole, however, I recommend the book.  The author is plain-spoken and clear.  He outlines the impact on every segment of the population.   His facts are correct.    He is nonpartisan and nonpolitical, although he acknowledges politics makes a difference. He is realistic “Although ObamaCare is rooted in the idea that overutilization drives up medical costs (and defensive medicine practices indisputably add fuel to the fire), the new law does almost nothing in area of tort reform.”
If you are concerned about what Obamacare portends for  you in your particular situation and how you best survive or thrive  its impact, buy the book. You will not be disappointed.

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