Sunday, March 29, 2015

The Final Health Reform Four

ObamaCare has been five years in the making, and it’s come down to the final four. The final game will be in Late June in Washington, D.C. with the Supreme Court making the call.

The final four are:

-- Universal Health Care - This is the favorite among liberals, but it was out of the running early. Even its supporters knew it would not win among Americans, who had no wish to emulate the European or Canadian systems. Some thought, hope against hope, we follow the British, Switzerland, German, or even the Singapore models, but that was not to be. Our system had been in place for 70 years . It dated back to World War II when employers were giving tax deductions for covering health care for employees. When Medicare and Medicaid were introduced in 1965, it experienced budget overruns of 9 to 10 times original estimates, and when the medical industrial complex devoured 1/6 of the U.S. economy and was not to be displaced. All of these things were barriers to a winning entry in the reform sweepstakes.

-- ObamaCare - Then in 2010 came the Patient Protection and Affordability Act, renamed Obamacare by critics and embraced by the President because, he said, “It shows I c care.” It is one of the co-favorites because it under its aegis, overall health care spending has slowed and the number of uninsured Americans has declined by over 11.6 million. But it has its liabilities. Americans disapprove of it by 52% to 42%. It did not fulfill its misleading promises – to increase quality, decrease individual costs, and lower premiums for most Americans. Its launch in October 2013 was badly bungled. Among doctors, 46% gave it a D or F grade, and 25% said they would not accept plan patients. It was passed secretly in the dead of night against unanimous political opposition. The majority of states choose not accept federal Medicaid funds. And it ran into an electoral buzzsaw in the 2012 and 2014 midterms and lost its majorities in the House and Senate. Its survival depends on the kindness of strangers – conservatives on the Supreme Court.

-- GOP Care - This is currently being developed by three man Republican committees in the House and Senate. It is one of the co-favorites. But it has problems. The final versions have yet to see the light of day. It is unlikely to withstand a certain Presidential veto. It promises to be patient-centric, to offer competition, to foster patient choice and freedom to select their own plans, and to lower costs while expanding service and coverage. And it may never see the light of day if the Supreme Court declares federal subsidies to be legal in the context but not the wording of the health law.

-- Free Market Care - Policy markets say this alternative is least likely to succeed. It is a return to the bad old days of unregulated care. It trusts doctors to do what is best for their patients, not their pocketbooks. It assumes patients are well-informed about what is good and bad for their health. Its advocates believe employers will do what is good for their workers. It relies on doctors and patients rather than government and management experts. It has no real base, no rooting section. According to the government, less than 5% of doctors currently participate in free market, i.e., cash-only or concierge, care. It has no structure – no overarching national strategy to guide and regulatory safeguards. But it seems to be catching on – largely because of the complexities, bureaucratic barriers, physician shortages, and high costs of ObamaCare for middle class Americans. A growing tide of consumers are going to urgent care centers, retail clinics, concierge physicians, and to self-care or home care options.

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