Monday, August 4, 2014

ObamaCare Is Complicated

Life is really simple, but we insist on making it complicated.

Confucius (551-479 B.C.)

Even Confucius would be confused.

Health reform ought to be about making health care simple. Instead it is just the opposite.

Health reform makes health care even more complicated.

To many simple-minded observers, health care and health reform ought to be simple. You have coverage. You get sick or have a pain, you go see a doctor, he or she diagnoses your problem, you get treated, you get better or your pain goes away. Someone else pays for it.

But health reform in its present form does not work that way.

It ought to be good enough to do these things, but it is not. As Amy Goodnough (What an appropriate name) so beautifully describes in a New York Times piece, “Newly Insured Face Steep Learning Curve”, August 1, 2014.

She writes that most of the newly insured 8 million have never had health insurance before and do not its language, e.g. “premiums,” “co-pays,” “networks,” and so forth. 90% end up by asking questions how to access care. So CMS had launched a new government program, "From Coverage to Care."

Health reform, the newly insured learn, is complicated. A new patient may have to navigate three “tiers” of health care, each with its own set or rules and regulations, each with its own list of doctors and hospitals, to pick from.

Getting covered by government, whether it be in private ObamaCare approved plans or by Medicaid is one thing, understanding how the coverage works is quite another.

Health care is complicated enough already.

How complicated is it?

Well, there are already 142,000 pages of Medicare regulations, which require 4500 federal employees to administer, with rules and regulations covering roughly 115 million people. Now, of course, the government elite dream of covering all 315 million of us, give or take 30 million or so who fall through the cracks.

Add to this complexity with all those government regulations and complications that would bewilder a Byzantine monk, just as it has already confounded policy experts, politicians, physicians, consumers, health plans, and employers and workers.

Now add these complications.

• 25,000 new regulations under ObamaCare.

• The fact that the average physician needs to know about 700 different conditions and will need to interpret 7000 new ICD-10 codes come September 2014.

• The typical physician needs 2 or 3 extra employees needed just to cope with coding and meet the regulations required to bill a patient covered and be paid for by a 3rd party.

• Computers are supposed to make complicated things simple, but computers must be fed data to make them work, but data feeding sessions require nearly 22% of the physician’s time.

•, whose computers are still wholly unable to implement ObamaCare, who is eligible and who is not, what physicians to go to, what hospitals are approved to deliver care, how much providers should be paid, what physicians will accept those on health exchange plans, and how much each new enrollee ought to be subsidized and indeed, whether it is even legal to subsidize them on federal health exchanges.

• With bureaucracies of government and private health plans representing HMOs and PPOs, there’s no limit to how complicated things can get, on account of one thing always leading to another.

Government , the master, and its loyal private servants, say their mission is to make the complicated simple, e.g. provide affordable health coverage for all, but too often, they end up making simple things complicated and health care unaffordable for most. It’s complicated.

Perhaps that is why many consumers and many businesses are turning to direct pay for doctors in concierge practices and surgeons at ambulatory care centers . There’s a place for care provided as simple, direct, transparent transactions between consumers and physicians.

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