What will the next 4-8 years look like for health care?

With a presidential election coming, it might pay to get ready for the next “era” in health care. Regardless of whether our next president is a Democrat or Republican, I believe a strong focus on cost control will be an effective strategy. Here’s why:

If Republicans win the white house, one stated goal is to repeal Obamacare. Rather than dig in and fight for another cycle, Democrats should consider embracing a strong cost control approach as a way to blunt the attack. If Republicans see a pathway to budgetary control even with Obamacare structurally in place, the more moderate elements in the party might accept a future of market based reforms instead of legislative reforms. If Democrats ignore the need to control costs, they can look forward to attack after attack on the legal foundations of the law itself. And yes, continued escalation of costs does indeed threaten the entire economy.

Now if Democrats win the white house, they will have an opportunity to embed key features of Obamacare deeper into the fabric of our society. In doing so, they will either do something that is great in the long term, or ruinous. If they ignore the need to control costs, and instead allow an entitlement to spread wider and wider, while not reining in the providers of these services, other important national needs will be squeezed out- or our taxes will rise to punishing levels- or our debt will increase accordingly. A Democratic administration will need to ensure that the law works economically- not just socially.

So regardless of who wins the next election, the next 4-8 years in health care should focus very closely, and aggressively, on costs.

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.

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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