One hoot for Obamacare

From the pages of In Business magazine.

I’m still annoyed at the way the Affordable Care Act was passed. Remember this quote: “You have to pass the bill to find out what’s in it.” That’s no way to run a railroad, let alone pass landmark legislation.
Nor am I pleased that the case for it was made on a broken promise. “If you like your health plan, you can keep your health plan, period. If you like your doctor, you can keep your doctor, period.” Those kinds of commitments must be kept.

And I still have concerns about, especially data security with increasingly sophisticated hackers, and the ACA’s overall demographics. It needs more young people (i.e., healthy folks) who don’t cost the system to pay for the geezers (like yours truly) who do.

But I’m also mindful that it replaced a health care system that was unsustainable and would have bankrupted the country in time. For all of the flaws associated with the ACA and its botched implementation, repealing it without a clear idea of what comes next would cause more chaos than a tornado ripping through a trailer park.

Adjustments will be made to benefit health care consumers, who also happen to vote. But with the debate so polarized, we’re forgetting to take the long view of whether this new and evolving system will bend down the cost curve.



Hospital administrators have explained it to me this way: Providers are no longer reimbursed (by Medicare) based on the volume of tests and services they provide, but on quality outcomes. Likewise, they are no longer paid for costs incurred due to preventable events (falls, bedsores, and the like). That forces providers to join the process-improvement party, which incentivizes cost control. And if providers are successful in controlling the cost of care, this eventually will be reflected in more moderate (i.e., sustainable) annual increases in health insurance premiums, which are linked to the cost of care.

What concerns me about the political discourse is that we don’t have our eye on the ball. What happens if we don’t have a large enough supply of doctors to treat a higher percentage of insured health consumers?

What happens if there are more cost centers to address? What happens if the Independent Payment Advisory Board established by the ACA goes overboard in rationing care?

Will we be able to make smart adjustments, or will we just keep carping at one another?

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