Some blame “Obamacare” for pretty much everything; high insurance costs, increasing deductibles, access issues (real and imagined), narrow networks with fewer physicians, hospital closures, global warming (oh, wait, no such thing).
And worst of all, this is all due to the “Obamacare health plan”.
Which is kinda weird as there’s no such thing.
Outside of Medicaid and Medicare, there is no governmental health plan option available anywhere. None. Yet I’ve heard from doctors’ office staff (who really should know better), folks in the health care industry, and lots of the “people on the street” who attribute everything bad about health insurance, coverage, cost, bureaucracy to Obamacare.
- All health plans are offered by commercial insurers and health plans. Anthem, Blues plans, United Healthcare, Aetna, Humana, you name it – all are independent, private insurers.
- These health plans design their own insurance offerings, market them to the public and employers, balancing access and cost, coverage and deductibles, benefits against market demand. Yes, there are tight definitions about core benefits that must be covered: this is so consumers’ health needs are addressed, not excluded by some fine print buried deep in a Summary Plan Description.
- Health plans alone determine what doctors are in-network, deductibles and copays, premiums and physician reimbursement. Not the feds or the Exchanges, but each insurer/health plan.
- Health care costs are going up (in some places by a lot, in others not so much) because of factors like:
- too much crappy medicine,
- a reimbursement system that pays docs too much for doing stuff to patients and not enough for talking with those same patients,
- over-utilization of some health care services,
- an aging population,
- obesity and other lifestyle factors,
- outrageous prices for some drugs (driven by for-profit pharma)
- a large uninsured population that forces health care providers to charge insured patients more to cover their costs of treating those without coverage (we’re talking about you, Texas, and you, Florida, and Kansas and Mississippi and Alabama and Wisconsin and…)
- stupid benefit design that relies way too much on deductibles and nowhere near enough on coinsurance (where members pay a percentage of the cost for each service, thereby exposing them to the real cost of services)
- a completely disjointed and dysfunctional health care non-system with prices much higher than any other industrialized country and outcomes mostly worse.
As Donald Rumsfeld said, “you’ve got to go to war with the Army you’ve got.” Much as I despise Rumsfeld, he was unfairly pilloried for that very perceptive comment. The reality is simple – “Obamacare” was, and is, an attempt to broaden coverage and allow the private market to figure out how to improve care and reduce costs.
Yes, there are a lot of regulations about how insurers have to do that; given the insurance industry’s financial motivation to avoid insuring sick people and actually pay claims it is no surprise that the regulators are trying to protect consumers from big insurers and their legions of lawyers.
Is this ugly and are there stupid regulations and are costs going up way too much in some areas and is it all way too complex and confusing?
What did we expect when reforming an industry that is responsible for one out of every six dollars of our economy? And was failing miserably at delivering good care at a sustainable cost?
Hell, we can’t even prevent trains from crashing, or fund a bill to fix our crumbling infrastructure, or reform our amazingly nutty income tax system, or stop doctors from making millions dispensing drugs to work comp patients.
We are well on the way to fixing one of the biggest problems in our country, And we’re “disappointed” in health care reform?
What does this mean for you?
It is, indeed, a clustermess.
Some people will get hurt. Some companies will fail, Some will get fabulously rich. Some will go to jail. But in the end, more will have insurance, insurers will compete on a relatively level playing field, and incentives will be more aligned with what we consumers want – better health at low cost.