ObamaCare Legacy: The Good, The Bad, and the Ugly

This is a must read collection of essays that gives the good, the bad, and the ugly of the new health care law.

Jacket blurb on my 2011 book,The Health Reform Maze,  by Donald J. Palmisano, MD, former president of American Medical Association and author of On Leadership

The Good, the Bad, and the Ugly was the title of 1966 movie starring Clint Eastwood and Eli Wallach.   The film was called a Spaghetti Western, or Macaroni  Western because  it was produced, directed, and put to music by Italians.  The flick  had good guys, bad guys, and ugly guys, often acting out of character.   The good guys had noble intentions but were cunning, deceitful, and acted unexpectedly: the bad guys had their good sides; and the ugly guys did brutal things against defenseless people.  

In any event,  in my 2011 book, published the year after ObamaCare was passed,  I predicted 8 trends :  1) the rise and possible fall  of ACOs; 2) consolidation  at every level of the health system; 3) bundled payments between hospitals and doctors; 4) decline of private practice; 5) decentralization of care with dominance of local markets; 6) evolution of  concierge medicine; 7) the electronic revolution ; 8) patient involvement in care,

ObamaCare triggered these trends.   Now the time has come to evaluate the good, the bad, and the ugly effects of the health care law.

The Good -   20 million people have been removed from the number of insured – 12.7 million in health exchanges and 7.3 million in Medicaid, reducing the percent of uninsured from 15% to 10%;  coverage of those with preexisting conditions and  young adults on their parents’ plans has been assured.

The Bad -  The cost, roughly $ 1 trillion has exceeded estimates  and raised taxes for all;  the administration has failed to deliver on its promises of cutting premiums,  increasing quality, and improving outcomes;  premiums will soar 20% or more in 2017 and quality and outcomes have not significantly changed; 13 to 23 co-ops established by the administration have failed with more to come;  major insurers, led by UnitedHealth have pulled out  of health exchange markets;  widespread physician shortages have intensified with decreased access to doctors and narrowing of choices of doctors; somewhere between 10% to 50% of  doctors are not accepting Medicare, Medicaid, and ObamaCare patients. 

The Ugly  - Increasing numbers of middle income people can no longer afford  premiums, deductibles, and co-payments; Jonathan Gruber, an MIT economist said by many to be architect of ObamaCare,  has revealed that the Obama administration knew from the start people would be unable to keep their doctors and health plans;   The VA system, though not part of ObamaCare,  has besmirched the reputation of government as a competent health care manager  of large populations of needy people;   despite two Supreme Court decisions upholding the constitutionality of ObamaCare  recent lower court decisions questioning the legality of  hospitals that participate in ACOs to continue to be charitable institutions  and the legality of unilateral  subsidies for health exchange  without House approval has cast a cloud over the future  of ObamaCare. Good, bad, and ugly weather lies ahead.