RIP, Obamacare

Posted by & filed under CGR Staff.

Kent Gardner We stand watch at Obamacare’s bedside, filled with uncertainty about the timing of its demise and what will follow. There are good deaths and bad deaths—good ones are peaceful and offer time for reflection and fond farewells. Bad deaths are filled with misery and leave behind discord, estrangement and confusion.

Born of compromise

Although the Patient Protection and Affordable Care Act (ACA) passed without Republican support, it did not emerge full grown from the head of Obama. Unlike the Clinton Health Care Reform, the Obama Administration consulted with and received the support (mostly) of the American Hospital Association, the American Medical Society, America’s Health Insurance Plans (AHIP), Pharmaceutical Research and Manufacturers of America (PhRMA), Consumers Union, and many other interested parties. The Obama Administration did not want to resurrect the AHIP-funded Harry & Louise ads that doomed the 1993 Clinton plan. Born of compromise, ACA was a frail child.

Each of the interested parties got something in exchange for their political support. AHIP won the personal and employer coverage mandate and dodged the “Medicare for All” public option. AHA, courtesy of the “out of pocket maximum,” hoped for fewer bankruptcy-driven write-offs. PhRMA escaped negotiated drug prices. AMA’s support bought a long list of free preventative services, like annual physicals and screenings. Consumers advocates won community rating coupled with an end to “pre-existing condition” exclusions.

Rejecting the “single payer” models of the United Kingdom and Canada, the ACA retained private insurance and provider markets, imitating the health care systems of many of our trading partners, e.g. Germany, France, Japan and Switzerland. While private, the payers and providers in these countries are subject to comprehensive price regulation. Read more »

“Affordable” Care Act Won’t Be—If We Can’t Control Cost

Posted by & filed under CGR Staff, Rochester Business Journal.

Kent GardnerThe Supreme Court—through the actions of tie breaker Chief Judge John Roberts—has resolved the constitutionality of the Patient Protection and Affordable Care Act (ACA). In the best tradition of the court, his Solomonic ruling declares that the law is within the powers of Congress. Good law? Bad law? “Not my problem. It’s constitutional.” He also applied the “duck” test to the Administration’s “penalty”—if it looks like a tax and quacks like a tax, it’s a tax.

The constitutional sideshow behind us, let’s get back to the Main Event: Health care remains an unaffordable, inequitable mess. ACA addresses some of the coverage problems built into the American health insurance model, but it will inevitably create some inequities of its own.

Cost is still an enormous problem. In fact, the law will increase the share of GDP spent on health care. ACA’s supporters are eager to report the Congressional Budget Office (CBO) finding that the law will not increase the deficit. First, remember that this is a forecast built on complex models, loaded with assumptions. The CBO finding is an estimate, not a measurement. Read more »