A Bigger, Bolder Obamacare Was Needed
A recent article at MedPage Today reported on an expert discussion about Obamacare’s critical need to repair its online portal at healthcare.gov so those Americans wishing to purchase qualified health plans on the exchange can do so by December 1st. This would leave them only two weeks to secure coverage by December 15th (note: this deadline’s been extended to December 23) in plans that would take effect on January 1st, 2014 – when Obamacare formally takes effect.
The forum for this was the esteemed Center for Studying Health System Change’s annual “Wall Street Comes To Washington” conference in which Wall Street analysts weigh in on the latest trends in American healthcare. Obamacare was the obvious choice for the hot seat this year and there was no shortage of dire predictions about what will happen if the bungled Obamacare website roll-out at healthcare.gov isn’t fixed by the end of November.
The big fear is that only the sick and infirm will be motivated enough to persevere through whatever hurdles remain, leaving the insurance pool with too few healthy subscribers to subsidize the increase in less healthy subscribers. This, of course, will cause next year’s premiums to rise more than if there were a better balance of less healthy and more healthy people in the pool. It’s Insurance 101 – or what Obamacare’s opponents call “socialism”.
Maybe MORE Uninsured?
Even worse would be the scenario in which the site’s problems aren’t fixed in time for the required December 15th enrollments while millions have had their prior “sub-standard” plans that didn’t meet Obamacare’s requirements cancelled. In that scenario, they’d join the ranks of the uninsured.
Not only is that the opposite of what Obamacare intends, it would also spell doomsday, as some perceive it, for those Democrats in Congress in swing states who are up for reelection in 2014. They, in turn, might abandon Obamacare’s cause and join ranks with those on the rabid right hell-bent on repealing it.
Team Obama has, regrettably, played right into their hands. Just when it looked like they had cunningly outfoxed Republicans over their ill-advised government shutdown and debt ceiling fiascos, we learn that the White House crew isn’t as facile at actually managing things – including its signature program that will be its legacy, for good or ill – as they are with the political stuff.
From the MedPage Today article:
“With meager enrollment, the ACA’s issues around narrow provider networks may only worsen. Hospitals, at least, are working with exchange plans in hope that patient volumes will increase over time and then they can go to plans and get better prices. If patient volumes aren’t high enough, providers such as hospitals may opt to not participate at all…
“‘What if they give a party and nobody comes?’ Sheryl Skolnick, PhD, managing director of CRT Capital Group in Stamford, Conn., asked. ‘Now you’ve got yet another problem, which is not just that you can’t get the members on. Now you only have a few plans.'”
Should this be what ultimately unfolds, there’d be too few plans and too few providers for Obamacare to prove viable. It might still survive as some sort of sub-standard healthcare option on the order of Medicaid where access is limited because many doctors won’t accept its lower payments for their services. But that isn’t what anyone originally envisioned – nor would it be considered a success.
It’s the next and closing thought in this report that most caught my attention…
“The root cause of these potential problems — the buggy HealthCare.gov — must be working well in the next couple of weeks, they (the Wall Street analysts) said.”
But the buggy website isn’t really the root cause of Obamcare’s doldrums, is it? It’s more the proximate cause – along with the mishandling of the junk policy cancellations and insurance plans that are skimping on provider networks and low-balling doctors and hospitals with Medicaid-level rates that many will reject.
It’s what Jeff Green of “Curb Your Enthusiasm” would call “A whole bowl of wrong”.
What IS the Root Problem?
So if the website fiasco isn’t Obamacare’s root problem, what is?
You have to go back to its original design – back to the days of a freshman Obama administration that miscalculated the political resistance our first black president would receive to virtually ANY of his initiatives.
Did they not believe Senate President Mitch McConnell when he said, on the day Obama was sworn in, that he’d do everything in his power to obstruct him and make him a one-term president?
Did they not get that the campaign to discredit the president and undo his very election was their opponents’ singular mission and that no amount of extending the olive branch of compromise would bear fruit?
They obviously didn’t, opting instead for the naive strategy of attempting to appease them by cobbling together a hodgepodge of “reforms” that may have been too clever by half – soon to be labeled by their enemies as “Obamacare”. The idea was to emulate the Massachusetts’ prototype for health insurance reform – as opposed to health system reform – that relied on expanding the private markets of insurers and providers with mandated insurance coverage.
This was a Republican idea first offered by the conservative Heritage Foundation to rid society of all the free-loaders – they call them “free-riders” – who weren’t buying health insurance but relying instead on “the kindness of strangers” paid for with higher premiums for everyone else.
That worked OK in Massachusetts – though it hasn’t resulted in any health system reforms that are long overdue, so success is a relative term.
But Massachusetts didn’t have the fractured politics that’s escalated so ferociously since Mr. Obama became president. Those on the rabid right blame him for that – it does coincide with his becoming president, after all.
They’re purposely, of course, mixing causation with correlation. The fevered animus we see now on the right may correlate with Obama’s term, but it’s not caused by it.
It’s caused by their confederate concerns about his skin color. It’s packaged not in racial terms, of course – it’s everyone else that’s playing the race card. For them, it’s about him being a socialist.
He’s a damn poor one if he is, given that Obamacare expands the private healthcare sector – anathema to real socialists.
So if the socialist claim is B.S., what’s it a smokescreen for if not racism?
Obamacare’s Branding Problem
It was Obama’s failure to recognize such deep-seated hatred for what it was – perhaps too encouraged by his election victory or his prior success winning in a white man’s world – that led him to adopt an overly-complicated and under-powered melange of measures that were destined to falter for a multitude of reasons:
It’s hard to sell complex – Simple lends itself to bumper sticker slogans and successful branding far better than the complex (remember Hillarycare?);
It’s hard to implement complex – See healthcare.gov;
It doesn’t poll well – All the polls show the public doesn’t really “get” Obamacare – they love some of its provisions and hate others; overall, more dislike it than support it because of its poor packaging and branding;
It actually was never properly branded – The “Affordable Care Act”, or ACA, has Washington written all over it, while the “Obamacare” tag that’s gained more traction was a negative Republican moniker to which Obama conceded;
It had too few champions – Virtually all of its many players remain conflicted about Obamacare, and relying on those with multiple agendas and conflicts of interest to implement your program is a recipe for failure;
It was too moderate – Despite claims by opponents of a government takeover of healthcare – a charge that would have been made for any plan he offered – Obamacare reeks of moderation, without seriously addressing critical health system dysfunctions that are essential to true reform like…
Medical malpractice – Defensive medicine continues to plague the practice of medicine in America…
Fee-for-service payments – The “piece-work” mentality encouraged by fee-for-service payments continues to drive medical over-treatment that increases spending and medical errors…
Over-consolidation – Obamacare actually encourages provider consolidation that gives them more bargaining power to dictate higher healthcare prices.