Make the shell smaller, please!

So, Obamacare has passed, been legally upheld by the Supreme Court and appears to have met its enrollment goals.  So how far have we really come?  Not that far.  Let’s look at the statements and actions of some of those who actually run a portion of the system:

We need look no farther than The New York Times, May 26, 2014 for two separate indicators:

First, in an article titled “Hospitals Look to Health Law, Cutting Charity”, the author describes how some large hospital systems are reducing the level of charity care they provide, encouraging patients to sign up for Obamacare instead.  Or perhaps Medicaid.  Or if the patient doesn’t qualify for coverage, bill them directly.  One big shell game, as long as the hospital doesn’t have to eat the costs.  (The author didn’t say all of this- the author just stated the facts behind the cost shifting).

Then, in the editorial section, same date, we see responses to an earlier article that blamed the pay of insurance executives for the high costs of care, and attempted to shift the spotlight away from physicians.  It was the responses (letters to the editor) that interested me.

No less than three physicians wanted us to know it wasn’t the doctor’s fault.  Not to be outdone, a hospital association executive pointed out that it wasn’t the hospital’s fault.  Finally a nurse wrote in saying guess what?  If we only paid them more… (actually I do think nurses are the “good guys”).

So it’s one big shell game, and it’s not the doctors, hospitals or nurses at fault.

Here’s the news, all of you experts- we know it’s one big shell game.  Just make the shell (costs) smaller!  So the part that falls on us is tolerable.

With all of your expertise and training, you must be able to conceive of a solution to the problems of the health system that is more sophisticated than simple cost shifting!  Two children can do that (“make him pay…no, no, make him pay!).

So now that Obamacare has passed, been upheld and met the enrollment goals, do we all now get to sit back?

No.  It’s time to focus on costs.  Aggressively.  Now.

Is it a good thing that some states refuse to implement the health care reform law (Obamacare)?

One of the more significant results of President Obama’s reelection is the impact on the health care reform law- his reelection eliminates the threats to repeal the law on “day one”.  However, some states are actively resisting the law’s implementation.

Specifically, one aspect of the law requires states to set up health care exchanges, where individuals could buy insurance at a competitive price (the exchange does not actually provide the insurance, but determines which insurers can participate).  Many states are refusing to set up the exchange.  One notable example is Texas.  Recently, Texas’ governor Rick Perry refused to implement an exchange in his state.

The Federal government will step in and operate the exchange in states that are unwilling or unprepared to implement an exchange on their own.  The deadline for implementation by the states is January 1, 2014.

So here is the question- how do you feel about states that refuse to implement the health care reform law, even after the Supreme Court decision and the reelection of President Obama?

How do you feel about states that refuse to implement the health care reform law even after the election and Supreme Court decision?

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It’s really going to be on us.

Now that the dust has settled somewhat on the recent Supreme Court decision, we are seeing some states dig in and harden their positions against expanding health care coverage.

I truly believe that at the end of all of this, we will have a significant portion of our population who either:

  • continues to lack health coverage,
  • has coverage, but no physicians or hospitals will accept it, or
  • has coverage, but so much is excluded that the financial burden on families continues to be devastating.

And so the path forward, for many, will require:

  • a very high level of personal involvement
  • engagement with an effective support network and/ or advocacy group
  • active use of online research and management tools
  • activism- vote- engage your elected representatives.

Stay tuned, as this blog will comment on each of these issues.

 

So now the hard work comes- reducing costs.

First, let’s acknowledge the incredible victory in passing and then having confirmed by the Supreme Court the health care reform law.  It’s a great thing that millions will gain access to health insurance.

But this is only the beginning…

First, let’s face it, costs will rise in the short term.  With insurers covering millions who have previously gone without, many with pre-existing conditions, costs will rise.  The real challenge is in reducing costs, not so much of the insurance, but of the basic care services that the insurance must pay for- doctor visits, hospital stays and drugs.

The core problem underlying our runaway costs is that our system is designed, at nearly every stage, to deliver the highest cost service possible, and as many services as possible.  Reasons for this include:

  •             Fee for Service pay structure
  •             Defensive medicine and the fear of litigation
  •             Overcapacity of some service lines (supplier induced demand)
  •             A huge medical complex that can and does influence regulations

Until we focus on costs, and change key structural aspects of the health care industry to support a lower cost model, health care itself, whether accessed through insurance or not, will remain out of reach for many.

 

Should we keep the health reform law? #healthreform #obamacare #supremecourt

Shortly, the Supreme Court will begin deliberating the fate of the health care reform law (Obamacare).   One of the key provisions of the law concerns the individual mandate– the requirement that everyone purchase insurance or face penalties.

I have commented on this particular issue in a previous post.

In addition the the very constitutionality of the law, the Supreme Court will also decide whether the rest of the law will stand if the individual mandate is overturned.  This principle is called “severability”.

So we might wind up with an all or none decision- if the individual mandate goes, so does the requirement that insurers cover those with pre-existing conditions.  So does the prohibition against setting the price of an insurance policy based in part on gender.

So here is my question:  on an all-or-none basis, should we keep the health reform law or repeal it?  What do you think?

On an all-or-nothing basis, how do you feel about the health reform law?

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