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 HealthCare.gov. 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.
Update 2-19-21: Nancy Ann Deparle had a banner payday after Consonance Capital sold
Enclara Healthcare to Humana in 2020. Enclara is "one of the nation's
largest hospice and benefit management providers." Yet, Humana intends
to spin off Kindred Hospice as it prefers a partnership model for end of
life care.
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 3-27-23: The U.S. has long not gotten its money's worth for healthcare. Life expectancy continues to decline.
