PPACA turned out as predicted thus far. Naked Capitalism confirmed points I made long ago with their piece "Medical Homelessness" for the newly insured.
More than 3 million Californians are newly insured. At the same time, a third of our primary care doctors are set to retire.
In 2009 I shared my concern regarding doctor supply and the Obama administration's woeful strategies to add primary care physicians. Texas, with the highest rate of uninsureds in the U.S., did its part to ensure physician access remained a problem. Continuing with Naked Capitalism:
Well, of course they’re going to retire. ObamaCare’s ACOs are just HMOs all over again. And who wants to go in debt for an M.D. to end up as an employee in a hospital, with some administrative drone making all the medical decisions? I don’t think so.
Also in 2009 I wrote "Capitation and managed care return as global payments and accountable care organizations."
It (capitation and managed care) produced widespread physician resentment and a public outcry about perceived perverse incentives. Politicians promise better measures, but the result will be the same. Doctors and hospitals will focus on maximizing payment, not quality.
Recall how incentive pay imploded Wall Street. They packaged investment junk for the public. Goldman Sachs bet against the products held by their customers. It made them billions. Goldman is as unpopular as managed care at the moment.
Don't forget the decade of widespread stock option backdating by corporate executives. Stock options were the "most pure form" of incentive compensation. Yet, nearly 30% lied, cheated or stole.
Incentives distort, a clear theme in high quality care communities. Doctors are paid a fair salary and supported in a laser like focus on quality.
Global Payment and Accountable Care Organizations are repackaging, simple bait and switch. You can buy it. I'm not.
Add that this repackaging was designed by Nancy-Ann DeParle, a PEU with CCMP Capital Partners before PPACA and a PEU with Consonance Capital after PPACA. Despite shedding all "conflicting assets" DeParle received at least one private equity payout from a health care company while employed at the White House.
Now for my major point that PPACA was intended to accelerate the shift in responsibility for health care coverage from employers to workers and a tapped out Uncle Sam. The Fiscal Times reported:
More and more companies are considering dumping employer-sponsored coverage and shifting their workers to private policies sold on the law’s insurance exchanges.
The move is tempting for businesses, as it could result in huge savings —likely totaling hundreds of billions of dollars over the next decade. Meanwhile, the cost could come at a price to the federal government in the former of more insurance subsidies, or to employees who may have to directly shoulder more of the burden of their health care coverage.
Lastly in 2009 I predicted PPACA would set the stage for employers to shed that pesky health insurance benefit. In 2010 I concluded "a seismic shift is underway, transferring responsibility to individuals and a tapped out Uncle Sam."
Two groups, corporate chiefs and their purchased politicians, need hundreds of billions in savings to fund executive incentive pay increases, a portion of which can be donated to "trusted politicians." This is how democracy ignores the will of the people to benefit the few, which I believe was the purpose of PPACA, as designed and implemented.
It wouldn't be truly American if PPACA did not advance the for-profit health care component. PEU's like disequilibrium, thus they see healthcare as a place to make big money.
Update 11-16-14: CNBC reported on employees taking on the greater burden I predicted. "The employees could see up to a $6,150 reduction in their health-care
benefits and little or no increase in their pay," the report said. We shall what comes true.
Update 5-5-15: MarketWatch reported many corporations have jettisoned their retiree healthcare benefit due to PPACA's incentives.
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.
Update 4-16-20: A coronavirus pandemic revealed
America's broken healthcare system and PPACA's many shortcomings. How
many 22 million newly unemployed can afford the premiums? How many of
these will get COVID-19 and die at home without proper care?
Update 1-20-22: In 2020, the average health insurance premium contribution was 6.9% of median income, while the average deductible was 4.7%, combining for a mighty 11.6% of median income. Curve not bent in the least.
Update 4-3-22: The average health insurance premium more than tripled for a family plan since PPACA passed in 2010. Cost curve bent but in the wrong direction. Concave went convex.
Update 10-2-22: The Commonwealth Fund found that 29% of people with employer-sponsored health coverage and 44% of those who purchased coverage through the individual market and ACA marketplaces were underinsured.
