An editorial in today’s New York Times takes to task Republican claims about Obamacare; lost jobs, lost health care insurance, etc. and with some justification. The editorial points out that as a result of Obamacare millions of Americans have obtained health insurance (including expansion of Medicaid) – quite true.
However, the NYTs and other naive supporters of the ACA miss the point. Obamacare needs major changes because:
- It has not controlled health care costs and indeed contributes toward higher costs
- It has not created a pathway to virtual total insurance coverage
- It has created a spiral of adverse selection and resulting higher costs for fewer Americans
- It has created a growing and uncontrollable new liability in the form of premium subsidies and Medicaid costs
- It has created massive compliance and administrative requirements (and costs) in every corner of the health care system from employers to health care providers
- It has stimulated and encouraged massive cost-shifting in terms of out-of-pockets costs in the quest for lower premiums
- It has created unachievable expectations among average Americans and greatly added to the misperceptions about health care, what causes insurance premiums to escalate and the role of insurers
- It is based on erroneous assumptions such as more competition among insurers is cost effective, that employers will replace health benefits with higher wages and that co-op consumer-run non-profit plans will save money.
- It survives on risk sharing and cross subsidies for insurers that are not sustainable
- The coverage mandate and penalties are ineffective and uninforcable because of extensive exceptions and very limited ability to collect the penalties.
In essence, Obamacare has partially achieved one of its goals; expanded coverage. But that is like building a grand structure on time and on budget only to have it fall in the first major hurricane.
And no, Bernie doesn’t have the answer either. But make no mistake about it, the “answer” will involve a major rethinking and restructuring of how Americans receive health care … and we are just not ready yet.