- They are prohibitively expensive to administer.
- They are prohibitively expensive for consumers to purchase.
- They offer much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.
One thing we think we know about the Republicans is that they take a dim view of waste, fraud and abuse. So how come the U.S. House of Representatives, in Republican hands, has voted 56 times to repeal or cripple the Affordable Care Act, better known as Obamacare?
They’ve put forth this extraordinary effort despite an explicit veto threat from President Obama. Their repeated effort reminds one of Onan in the Bible, which politely says he spilled his seed on the ground.
It’s a waste of the legislative calendar and the talents of the House members. It’s a fraud because it gives the impression that the House is doing the people’s business when it is holding a protracted political rally. It’s an abuse of those who need healthcare because it introduces uncertainty into the system for providers, from the insurers to the home-care visitors.
It’s symptomatic of the political hooliganism which has taken over our politics, where there is little to choose between the protagonists.
Republican groups think that Obama is the doer of all evil in the nation — especially to the economy — and the world. Daily their Democratic counterparts gush vitriol against all the potential Republican presidential candidates, only pausing for an aside about the wickedness of Fox News.
Their common accusation is middle-class job woes. They’re on to something about jobs, but not the way the debate on jobs is being framed.
The political view of jobs is more jobs of the kind that we once thought of as normal and inevitable. But the nature of work is changing rapidly, and it cries out for analysis.
The model of the corporation that employs a worker at reasonable wages that rise every year, toward a defined-benefit pension, is over. Today’s businesses are moving toward a model of employment at will; the job equivalent of the just-in-time supply chain.
While more of us are becoming, in fact, self-employed, the structure of law and practice hasn’t been modified to accommodate the worker who may never know reliable, full-time employment.
The middle-class job market is being commoditized, as the pay-per-hour labor market includes everything from construction to network administration. Sports Illustrated — synonymous with great photography — has just fired all six of its staff photographers. Don’t worry, the great plays will still be recorded and the Swimsuit Issue will still titillate, but the pictures will be taken by freelancers and amateurs.
Two forces are changing the nature of work. First, the reality that has devastated manufacturing: U.S. workers are in competition with the global labor pool, and business will always take low-cost option. If unemployment goes up in China, that will be felt in the U.S. workplace. Second is the march of technology; its disruptive impact is the new normal. Accelerated change is here to stay.
All is not gloom. The trick is to let the old go — particularly difficult for Democrats — and to let the new in. There will be new entrepreneurs; more small, nimble businesses; and whole new directions of endeavor, from gastro-tourism to cottage-industry manufacturing, utilizing 3D printing. Individuals will be free in a new way.
Government needs to think about this and devise a new infrastructure that recognizes that the nature of work is changing. The emerging new economy should have simplified taxes and Social Security payments for the self-employed; portable, affordable healthcare; and universal catastrophe insurance, so that those who are not under an employer umbrella can benefit from the equivalent of workers’ compensation. The self-employed, rightly, fear the day they can’t work.
Rugged individualism has a new face. The political class needs to look and see the new workplace.
Llewellyn King (lking@kingpublishing.com), an occasional contributor, is executive producer and host of “White House Chronicle” on PBS.
Republican lawmakers eager to repeal the Affordable Care Act are pushing tax credits and much greater freedom for states and health insurers to make healthcare-finance policy as the GOP starts to present its plan to replace the ACA.
The Republican program, which President Obama is expected to veto, would end ACA coverage requirements for individuals and employers, end expansion of Medicaid, kill state and HealthCare.gov federal insurance marketplaces and, indeed, end virtually everything else under the ACA, including taxes ”it imposes on medical devices and other things to finance enlarged coverage,” the Associated Press reported.
On Medicaid, the GOP plan would give states much more freedom in how to spend money in that federal-state pr0gram — even as more conservative states now seek the ACA’s added Medicaid money.
Given President Obama’s veto pen, we suspect that most of the Republican offensive is primarily rhetorical, leading up to the 2016 presidential election. And because the ACA has already developed powerful constituencies of beneficiaries, it’s far from clear how the GOP program will play politically in 2016, especially given that voter turnout is always higher in presidential-election years than in others.
”The roles and responsibilities of the two positions made working together difficult in the past,” John Byrnes, M.D., a board member of the Healthcare Financial Management Association and founder of the Byrnes Medical Group, told the news service.
“CMOs generally don’t have a business background, so they speak a different language than the CFO and vice-versa,” noted Dr. Byrnes, the former CMO of SCL Health, in Denver.
The disconnect includes building design. “You don’t really find finance offices close to clinical care, patient care areas,” he said.
But with the Affordable Care Act, Dr. Byrnes says, “CFOs are starting to realize that any improvement in care that the chief medical officer can drive through the organization also has significant financial benefits because more often than not it will remove some of the unnecessary costs in patient care out of the organization.”
Finding common ground benefits both the clinical and the financial sectors because it bridges the goals of lower costs and improved patient outcomes.
But a Reuters study suggested that these new entrants, while enthusiastic about getting preventive care, were no more likely than others to see the aforementioned pricey specialists. If anything, the study reminds us at Cambridge Management Group that the newly insured is boosting demand not only for primary-care physicians but also for nurse practitioners and physician’s assistants.
Reuters said that the profile of people covered by the Affordable Care Act exchanges came from ZocDoc, a free online appointment-booking tool used by millions of people in all 50 U.S. states.
”The data, covering thousands of users aged 18 to 64, suggests that ‘the vast majority who signed up in the first wave of Obamacare didn’t have acute medical needs, contrary to expectations,” Dr. Oliver Kharraz, ZocDoc’s co-founder and chief operating officer, told Reuters. ‘The biggest news here is the absence of dramatic utilization differences.”‘
Still, a caveat: ”The question is whether, over time, preventive care visits lead to more use of specialists,” Elizabeth Carpenter, director of the healthcare-reform practice at Avalere Health, told Reuters. “Obviously, the more individuals seek preventive care and screenings the more likely they are to be referred to a specialist.”
Mr. Shrinkman writes: “Few ordinary patients–the true bearers of change in healthcare policy–appear in this book, and virtually all of them came from the Time article {that Mr Brill wrote that was the basis of his book}. Mr. Shrinkman suggests that Mr. Brill is full of the hubris and social isolation of the “1 Percent” — as the gap between the very rich and everyone else widens.
Repeal of the ACA “is not a possibility,” George Scangos, chief executive at biotechnology company Biogen Idec Inc., told Reuters . “They {the Republicans} would somehow have to explain to millions of people that they will lose health insurance.”
Aetna Inc. said it is talking to Republicans and Democrats about a possible “grand bargain” to salvage the ACA if the U.S. Supreme Court rules against key elements of the law later this year.
“Blowing up the (Affordable Care Act) is like shutting down the government,” Aetna Chief Executive Officer Mark Bertolini told some investors. “So we are having conversations on both sides of the aisle about what … things you change in the ACA, what we could introduce, about how to make a grand bargain should the Supreme Court decide.”
