Saturday, January 4, 2014

Monetizing Ezra Explanatory Journalism & Health Deform

Ezra Klein of WaPo's "Wonkblog" wants to monetize his brand, just as health reform becomes a reality.

Although the stated goal of the law was to cover the uninsured, at least 4.7 million insured people had current individual policies canceled that didn’t measure up to new requirements.
Wonkblog reports the four measures that would indicate health reform success:

1.  Are more people covered?
2.  Do people have better access to health care?
3.  Are people getting healthier?
4.  Is healthcare becoming more affordable?
The post puts these answers off, waiting for census data and overall health care spending numbers to come in.  I offer a few observations for those who desire more:

Are more people covered?  The government claims:

Health and Human Services Secretary Kathleen Sebelius told reporters that 2.1 million have signed up for coverage through Dec. 28. That includes the 1.1 million that the White House had announced this past Sunday, who had enrolled through Dec. 24 on There are also 3.9 million people who have been found eligible for Medicaid.

Eligible for Medicaid is not enrolled in Medicaid, making the "6 million people covered" a spurious number.  Until real data comes out on Medicaid enrollment, fewer people under PPACA are covered as of January 1, 2014.

-4.7 million lost coverage
 2.1 million signed up
-2.6 million

Also, Obama issued a waiver for those with canceled policies:

Hundreds of thousands of people whose health plans are being canceled because their coverage doesn’t meet Obamacare rules will be exempt next year from the U.S. mandate that all Americans carry medical insurance.  

Note:  The White House backed away from their prior prediction to enroll 7 million people through exchanges in 2014.

Given many employers are jettisoning retirees from their plans and onto private exchanges, it's not clear more people will be covered.  Many elderly retirees will miss their opportunity to spend hours per person signing up for new coverage.  A number of employers shafted retiree health in the same way pensions changed over the last two decades from defined benefit to defined contribution.  Recall that PPACA provided $5 billion to employers to ensure retirees keep coverage.

Do people have better access to healthcare?   The issue is how many people with new coverage, private insurance and Medicaid, are able to get into a primary care physician practice.  Many physicians do not accept new Medicaid patients into their practice.  Many Medicaid recipients may only have a hospital ER at their disposal, until primary care capacity can be expanded. 

One of the hurdles in getting access is meeting the plan deductible.  Who knew President Obama's health reform would make George W. Bush's high deductible health plans look like gold plated coverage?  PPACA will ensure legions of underinsured people, still at risk for medical bankruptcy. 

After spending hours per person signing up for private exchange coverage by phone, retirees get to navigate complex networks and variable pharmaceutical formularies.  Will they get to keep their physicians and have their existing medicines paid?  It's a PPACA dice roll.

Are people getting healthier?  PPACA's pay for performance will not make people healthier, just as it hasn't improved education test scores or any measure that requires collaboration and knowledge.  It will usher in a new era of fraud as providers lie, cheat and steal to garner the prize.  Think executive stock options, where widespread cheating soiled the "most pure" incentive/reward system.

Is healthcare becoming more affordable?  That depends.  It's becoming more affordable for employers as they continue their longstanding practice of shifting responsibility and costs to employees.  For the individual rising deductibles and co-pays are a larger hurdle for using healthcare services.  This explains the Wonkblog condundrum:

Perhaps surprisingly, these two metrics (overall healthcare spending and citizen opinions on healthcare affordability) don't always add up: Even with health costs growth slowing dramatically. public survey research shows Americans feel even more pinched when it comes to their health bills.

They add up for those who understand the shift of responsibility to the individual from employers and Uncle Sam's pushing exceedingly high deductibles.  It's not a conundrum, nor an unfortunate byproduct.  It's the plan.  Employers will continue to shift responsibility to workers, even jettisoning the plan and paying employees a defined amount to buy health coverage. 

PPACA follows what I've noticed leaders offering in both the public and private sector, complexity, dishonesty about the true aims of their program and ignorance about the heavy losses they cause the people they say they're serving.  I see leaders self-serving, but serving the people?  No way.

Ezra Klein wants eight figures from the landed gentry to fund his next venture in "explanatory journalism."  Sorry, Ezra missed a key cause of PPACA's private sector profitgasm, it's designer Nancy-Ann DeParle.  Did Ezra find Obama's carefully grown Surgeon General nominee?

"Explanatory" refers to why things happened, i.e. it looks backward.  "Predictive" states what will happen in the future based on theory.  I made a number of predictions in 2009:

1.  Reform sets the table for employers to shed that pesky health insurance benefit.
2.  Incentive pay will make things worse
People with knowledge and understanding can make predictions, recognizing that differing outcomes are an opportunity for learning.  My health reform predictions are on the table.

Here's another.  If Ezra raises eight figures from the people who fund the Blue Team, I predict he'll push their memes.

 Mr. Klein has had discussions with several potential investors and venture capitalists in an effort to start the website himself

I don't expect that to be good for the average citizen.  That's what we've gotten the last fifteen years from both the Reds and Blues.   However, it greatly benefited their sponsors, which Ezra aims to tap.

Update 1-29-14:  Ezra will join Vox to start an innovative news site.  I recommend they name it "Wankerblog."

Update 2-17-14:  Private equity is betting on PPACA funding their next profitgasm.

Update 2-24-14:  Becker's Hospital Review listed 19 health care investment areas for PEU's.  These are hardly niche areas.

Update 3-26-14:  NYT ran an article by Ezekial Emanuel under The Agenda:  Why Employers Will Stop Offering Health Insurance."   That was my prediction of PPACA's intent in 2009 when the bill passed.

Update 6-19-14:  It seems House Ways and Means Committee staffers wanted their personal profitgasm.  They weren't content remaking the table for others to make huge profits.

Update 5-22-15:  Rising deductibles have many people underinsured, a new barrier for access to healthcare.

Update 3-15-18:   Skyhigh healthcare costs differentiate the U.S. from the rest of the globe.  PPACA's cost curve bent in the wrong direction, acceleration.

Update 8-18-18:  High medical costs and medical debt sent a record level of seniors into bankruptcy.   This occurs as private equity firms buyout healthcare companies with the clear intent to make huge money.  Drastic price increases in drug costs came courtesy of the greed and leverage boys.

Update 9-11-19:  Executives focus on revenues and billing, which turned UVA Health System into a nightmare for thousands of patients.  Earlier in her career CEO Pamela Sutton-Wallace said "I am creating systems where I am having an impact on the communities that I serve."  She was the top leader during four of the six years UVA Health System sued former patients more than 36,000 times for over $106 million. She is now headed to New York's Presbyterian Hospital.

Update 9-25-19:  Employers shifted costs to employees via higher deductibles and increased co-pays.   PPACA has not helped make healthcare more affordable.  It has made a lot of money for the PEU boys.