Stanley Feld M.D.,FACP, MACE
Is President Obama trying to destroy the healthcare system in America?
Yes he is!
Actually he is right on schedule to have Obamacare implode on itself.
I remember when he told Barney Frank and John Kerry not to worry about not including the Public Option in the Affordable Care Act. We will get to a single party payer system.
They did not understand how President Obama could make such a compromise. They thought the Public Option was the only way in the Affordable Care Act Obamacare) to get to their goal.
The goal was a single party payer system.
They did not have the votes then and they do not have the votes now.
As hard as it is to believe, it seems that President Obama wants his legacy legislation Obamacare to fail.
Otherwise he would not have had Obamacare constructed with so many perverse incentives for stakeholders.
The only route to success is to align both primary and secondary stakeholders incentives. Obamacare is misaligning all of the stakeholders' incentives.
The incentives are more misaligned now than they were in the dysfunctional healthcare systems days before Obamacare.
The stated goal of Obamacare was to provide affordable healthcare insurance to all, with access to quality care to all without rationing of care.
The effect of Obamacare has been just the opposite. The healthcare insurance coverage will not be universal. It is unaffordable to many in the middle class. It is also unaffordable to many of the subsidized poor that do not qualify for Medicaid. There is limited access to care. There is an increase in the rationing of care.
President Obama claimed Obamacare’s health insurance exchanges would create a competitive free market insurance system.
The health insurance exchanges would force the healthcare insurance companies to be competitive. Healthcare insurance competition would lead to a decrease in healthcare costs.
Health insurance exchanges have not worked as advertised. President Obama’s health insurance exchanges have not resulted in a competitive free market system.
Healthcare premiums have skyrocketed.
Healthcare insurance deductibles and copays are higher.
Hospitals and doctor networks are skimping for two reasons. Doctors and hospitals are choosing not to participate in Obamacare. Healthcare insurance companies are not electing to include many well known doctor and hospital networks.
Many excellent drugs are not on the insurers' formularies because of the cost. When newer brand name medications are on the formulary the co-pays are unaffordable to patients who need them. Patients therefore do not fill the prescription.
The healthcare insurance premiums are often higher than what consumers previously paid for their private insurance pre Obamacare even after some consumers receive government subsides.
The Obama administration will conclude soon that the free market healthcare system does not work.
The administration will claim that only healthcare system that will work is a government single party payer system.
However, President Obama has not created a free market healthcare system with his health insurance exchanges. It is a highly regulated market.
In his over regulated marketplace he has created incentives that have further misaligned stakeholders vested interests than they were pre Obamacare.
In the Obamacare system the healthcare insurance companies are led to believe they remain the king of the healthcare industry. They believe they can continue to control healthcare costs.
The government remains totally dependent on the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for government healthcare programs.
In performing these services the government has permitted the healthcare insurance industry to pad direct patient care costs with items that are insurance companies expenses and should not be counted as direct patient care.
The increased distortion is magnified when the government dictates the benefits the insurers must offer patients in the health insurance exchanges and the private insurance markets.
This causes the premium prices to skyrocket .
Consumers might not need these added government benefits. Consumers have no choice. They have to pay for unneeded benefits. These benefits are added to the cost of insurance as well as the net profit of the healthcare insurance companies.
The healthcare insurance industry is also permitted to choose their own networks of physicians and hospitals.
The insurance companies try to maximize their net profit at their lowest cost. Therefore they have kept the best hospital and physicians out of their networks. This affects the quality of care.
It must be realized that quality of care has not been adequately defined or accurately measured.
In some cities and states consumers only have one insurance carrier. Other carriers have opted out. There is not even a pretense of competition. This insurance carrier usually picks the hospitals and physicians that will accept the lowest reimbursement. The healthcare insurance industry is offering low fees to providers. They will take only those providers into their networks that accept those low fees.
An additional incentive distortion is the Obamacare requirement for the healthcare insurance companies to charge the same premium for anyone who signs up for Obamacare. There is no risk weighting permitted.
The hope is all consumers will sign up and enable the industry to keep premiums down.This rule generates two negative incentives. The healthcare insurance industry must overcharge the healthy and undercharge the sick. Therefore the healthcare insurance companies try to attract the healthy and avoid the sick.
This has backfired on Obamacare. The healthy young have realized the trap. They are not signing up in the heath insurance exchanges.
Previously when they were employed the employer didn’t mind covering the young. The young help lowered the overall premium because they were young healthy.
There are only two options left to the government. Obamacare can bail out the insurance industry and bully the healthy and low risk young into buying healthcare insurance from the government health insurance exchanges.
Many cities, towns and stats have underfunded healthcare coverage commitments. These local commitments include retirees. These cities, towns and states can now dump these consumers into Medicare and the health insurances exchanges.
In addition, there are many people who have chronic illnesses who have been afraid to leave their jobs because they could not get healthcare insurance in the individual market in the past.
These patients can now obtain insurance in the health exchanges at the same cost as everyone else. This will further contaminate the risk pool and increase the health insurance exchange premiums.
The Obama administration figures all taxpayers will cover the added costs. Taxpayers will bail out insurance companies for the poor risk pools that are decreasing their profits.
It looks like the real purpose of Obamacare is to destroy the relationship between the employer and his employee by driving employees into the health insurance exchanges just as it has destroyed the relationship between the consumers and their physicians.
President Obama understood this as the bill was written.
Small employers are dumping employees from their healthcare insurance plans into the individual market and the health insurance exchanges.
In 2015 group employer insurance will affect an estimated 80 million people. They will loss their insurance and be forced into the health insurance exchanges.
The insurance industry will quit providing insurance and President Obama’s plan to have a single party payer will occur by default.
Taxpayer will pay the difference through higher taxes. In the meanwhile nothing has been done in making healthcare premiums more affordable, access to care more available, quality of care better or preventing the rationing of care by a government body.
Consumers will not stand for government control over their healthcare decisions.
There is a better and cheaper way. It is to put the consumer in charge, not the government.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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