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.

• Healthcare.gov, 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.

Video Link to my May 9 talk Before the American Association of Physicians and Surgeons in Minneapolis can be viewed at:

http://youtu.be/Vleb1kuBn3o

The talk, entitled “Direct Pay Independent Practice: Remnant of the Past and Wave of the Future,” is 20 minutes long. The talk is reprinted in a new Kindle book, which also contains 12 interviews with direct pay/concierge and direct pay ambulatory surgery center representative. The book is now available on Amazon.com for $9.97
___________________

My new E-book Understanding ObamaCare: Travails of Implementation: Notes of a Health Reform Watcher is now on Amazon. The Kindle edition sells for $3.99. You may be interested in reading it since ObamaCare may determine the outcome of the November midterm elections. You may also order the book from Westbow Press, a division of Thomas Nelson Publishers, or its 35,000 outlets, which include bookstores, who can help order the book for you. This is the first of 3 E-books on ObamaCare. The second book will be called ObamaCare Revealed, and the third will be ObamaCare: Dead or Alive.
Richard L. Reece, MD, 1-860-395-1501, doctor.reece@gmail

A Letter from Healthcare.Gov

Dear Sir:

Congratulations! You have qualified and are eligible to receive a federal health exchange subsidy under the provisions of the Patient Protection and Affordable Care Act. In your case, this federal subsidy amounts to $4200 per annum. The subsidy assumes the information you provided to us about your income and your citizenship status and other particulars is correct . The subsidy is provided to you courtesy of your generous federal government.

However, you should be aware this federal subsidy may be withdrawn and you may have to pay it back if:

a) Our technology or outside technology experts, in the process of correcting and modifying the healthcare.gov website, determine the information you provided to us is incorrect, insufficient, deficient, or misleading. This correction and modification process is ongoing and will continue into the future.

b) The Supreme Court determines that the wording of the Patient Protection and Affordable Act meant what is said, namely, that only citizens participating in the state exchanges were eligible to receive subsidies.


c) The lawsuit succeeds that was initiated by the House of Representatives claiming that the President exceeded his statutory authority as granted by Article 1 and Article 2 of the Constitution of the United States.

d) The Republican Party of the United States gains control of the House of Representatives, the Senate, and the Presidency and repeals the Patient Protection and Affordable Care Act.

All of these events are unlikely to occur. In the meantime, enjoy your subsidy, and good luck in finding a physician who will accept your health exchange plan.

Sincerely and maybe forever yours,

Your Healthcare.gov Representative

Twitterdum and Twitterdee

Tweedledum and tweededee,
Agreed to have a battle,
For Tweedledum said Tweedledee
Had spoiled his nice new rattle.

Lewis Carroll (1832-1898), Through a Looking Glass

I became interested in Twitter for two reasons:

One was the instant spectacular successes of Twitter and Facebook as the leading social media sites linking billions of people across the globe.

Two was the emergence and prominence of Kevin Pho, MD, as America’s leading social media blogger .

In March 2013, I favorably reviewed Doctor Pho’s and Susan Gay’s book Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices, with these words:

“Dr. Pho and Ms. Gay offer highly organized key points, useful statistics and exuberant testimonials from doctors who have successfully leapt over the digital divide. There is plenty of practical advice, too, on topics ranging from what to post and when to engage, confer or rebuff, to how to decide what might be unethical . (Answer:“Can you say it aloud in a full hospital elevator?”).”

In any event, it is a fine book. I recommend it. I trust it is selling well. It was such a pervasive book that I decided to take the plunge and start twittering to see if I could rattle the health reform cages.

We live in a information-rich, attention-short age, and I hoped I could gain the attention of a few more readers in 140 characters or less in an age long on information and on short for pith. I have been told I am full of pith, so why not?

I have been twittering ever since. I have composed 465 tweets. The number of Tweets I have done now crop up alongside tweets of Kevin Pho, the Mayo Clinic, New York Times Health, and WSJ Health News. along with tweets of many distinguished personages, including Laura Landro of the Wall Street Journal.

Here are a smattering if my latest tweets.

• Keywords for doctors searching Net for ObamaCare options: affordability, worksite clinics, direct pay, concierge, independent practice.

• Unfavorable views of health law spiked in July with only 37% supporting it. More unhappiness will come in November midterms.

• Supreme Court ruling on subsidies would feature Straight & Narrow against Broad & Flexible. See Medinnovation blog.

• 4 corporate trends to save health costs : HSAs, self-funding, worksite clinics, direct pay for doctors and surgeries.

• Sharp premium spikes are due to miscalculations and uncertainties of demographic signups for health exchanges.

• GOP lawsuit basis: Article 1 vests power in Congress; Article 2 requires Obama to faithfully execute laws.

• On ObamaCare, Mark Twain might have said, “It’s not as bad as it sounds.” See medinnovation blog for other things Twain might have said.

• Because 3rd party administration accounts for a much as 40% of health costs, consumers and corporation are turning to direct pay.

My twittering tale has a happy ending. The number of page views has more than quadrupled since I started twittering, and now number consistently over 6000 each day.

How tweet it is.

The Straight and Narrow Versus the Broad and Flexible

Straight and law-abiding route through life.

Definition, Straight and Narrow

Wide is the gate and broad is the way to destruction.

Matthew 7:13

The stage is set. The issue is: should only state health exchanges offer ObamaCare subsidies or can the federal government also offer these subsidies? The question may be en route to the Supreme Court.

It promises to be a fascinating exercise.

It will be between originalist judges, who believe the original wording of the Constitution persists to this day, and activist judges, who maintain you must interpret the Constitution in light of current events.

It will be between those who say the authors of the health law meant what they said when they narrowly wrote subsidies could only be granted in “exchanges established by states,” and those who insist the broad intent was to have the government subsidize everyone who qualified for the exchanges.

It will be between those who say the other side is morally rigid and those who say only they are morally compassionate.

It will between those who say subsidies are only legal in state exchanges and those who say subsidies are legal everywhere, in state and legal exchanges.

All of this assumes that the Supreme Court will take the case. If the Court does and rules for the states, ObamaCare will likely die If they do not take the case, ObamaCare will continue to be deeply unpopular among Americans.

Today the polls indicate ObamaCare is more unpopular than ever since it passed 4 ½ years ago.

Public Approval of Health Care Law

Polling Data

Poll Date Sample For/Favor Against/Oppose Spread

RCP Average 6/1 - 7/26 -- 39.8 55.8 Against/Oppose +16.0

Rasmussen Reports*
7/25 - 7/26 1000 LV 39 57 Against/Oppose +18

CNN/Opinion Research
7/18 - 7/20 1012 A 40 59 Against/Oppose +19

Quinnipiac
6/24 - 6/30 1446 RV 43 55 Against/Oppose +12

Bloomberg
6/6 - 6/9 1005 A 39 53 Against/Oppose +14

FOX News
6/1 - 6/3 1006 RV 38 55 Against/Oppose +17

What matters most? Objective language or subjective intent? Exact words or supposedly noble deeds?

ObamaCare – A Festering Boil

What happens to a dream deferred?

Does it dry up

like a raisin in the sun?

Or fester like a boil –

and then run.

Does it stink like rotten meat?

Or crust and sugar over –

like a syrupy sweat?

Or maybe it just sags

like a heavy load.

Or does it explode?

Langston Hughes(1902 -1967), Harlem (1951)

What will be ObamaCare’s fate?

That question may largely be answered in the November 4 midterms.

In the interim, ObamaCare is festering like a boil. The boil may burst spontaneously with 8 million gaining coverage or it may be drained by its political opponents.

In the meantime, internal pressures are building within the boil with most agreeing the abscess is a mess.

• In Colorado, 339, 561 health plans have been cancelled: in Nevada 90,000 cancellations have occurred.

• In 3137 of America’s 3144 counties, premiums in the individual markets have gone up an average of 49% for 82% of women and 91% of men having rising premiums.

• Administrative incompetence in managing healthcare.gov continues to build with HHS admitting it cannot resolve 89% of eligibility issues surrounding who got subsidies and who will get them in the future.

• The question persists whether nearly 5 million Americans receiving subsidies got them illegally if one sticks strictly to the wording of the ACA: oy may be up for the Supreme Court to decide.

• The House of Representatives has sued President Obama, mostly on the issue if he exceeded his authority of delaying the individual mandate and whether by doing so violated article 1 and 2 of the Constitution. The Supreme Court may have to decide that one too.

And so the Obamacare boil festers.

Will it be drained by political gestures?

Will it be lanced by Supreme Court sequesters,

with Justices'paying homage to judicial ancestors?