Thursday, May 5, 2016

 Prospectively,  ObamaCare Sounded Good, in Retrospect Not So Good
In retrospect,
Seven years ago,
ObamaCare’s big idea  sounded simple.
Cover everybody.

Regulate the doctors.
Cut their fees.
Put them on salary.
Organize them.
Herd them into organizations,
Where they didn't  want to go.
Make them provide better more accessible care
at lower costs.
Guide, direct, and control
all aspects of care,
health plans, hospitals, and medical practices.
Minimize  doctor  independence.
Maximize  doctor dependence.
Think big.
Think oxymoronically.
Increase coverage.
Decrease costs.
Cut Medicare by $575 billion
Promise to save money
Promise to reduce premiums
By $2500 per family.
Promise you can keep your doctor
and your health plan.
Think systematically.
Think in terms of big systems.
Think about what you know patients need.
Develop systems for them.
Launch big new programs in name of innovation,
with impressive sounding acronyms,
CMMI(Centers of Medicare and Medicaid Innovation),
ACOs (Accountable Care Organizations),
BPCI (Bundled Payments for Care Improvement -BPCI ),
APMs  (Alternative Payment Models).
MWV (Medicare Wellness Visits),
MACRA (Medicare Access and CHIP Reauthorization Act).
Promise more care at  lower costs.
Think as a team.
Stress  improvement.
Involve everybody, cover everybody.
Convince the public the old ways were bad,
and unfair.
Remind them where you’re going.
Set goals.
Give reasons when you miss your targets.
Think about the big picture.
Think about how the big problems.
Organize to solve them in  big ways.
Think about what kills people too soon.
Prevent what kills them prematurely,
through Medicare Wellness visits.
Think how to minimize complications.
Promise to save Medicare money.
Give doctors the electronic tools,
You think they will need at site of care,
even if the tools  costs $29 billion.
Give patients information they need -
at home, at work, and at sites of care.
Invest heavily in electronic health records.
Say we’re all  in this together
Broadcast your accomplishments.
Rationalize  your shortfalls,
Never admit your failures.
Minimize the information gap
between caregivers and patients,
and sooner or latter,
everybody  will recognize,
where you’ve been
and where you’re going,
and what it all means.
Your chief information officer, Philip Fasano
will be quoted in
“The Face of Future Health Care”
(New York Times, March 20, 2013),
as saying.
“We have all the pieces,
Anything a patient needs,
You can  get in the four walls of our offices”
The article will also quote,
George Halvorson,  CEO of  Kaiser Permanente,
He will sum it up simply,
“All of this adds up to better care and cheaper care."
The future prospects of health care
sounded simple prospectively.
But in retrospect,
realities kept getting  in the way,
costs rocketed  higher,
doctors choose to see fewer Medicare and Medicaid patients,
access became difficult,
choices narrowed,
insurers revolted,
they exited exchange markets.
raised  premiums,
deductibles made care unaffordable.
Unpopularity of your health  law grew.
Millenials complained and did not join exchanges,
Older folk who joined were sicker.
and left exchanges after being treated.
The middle class groused about  low wages and high health costs.
Patients chose direct care without 3rd party coverage.
ObamaCare  paved the way for concierge medicine.
and became its best salesman.

In retrospect,
As poet Robert Burns said,
“The best laid schemes o’ mice and men
Gang aft a-gley.”
Translated, this means:
In retrospect, foresight is never 20/20:
hindsight always is.






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