The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

The oracles at the Congressional Budget Office this week descended from Delphi to predict 20% premium increases if the Trump Administration ends illegal Obama Care subsidies for insurers, and Democrats are happy to agree. Yet a careful reading of the report reveals some surprising results that are far less ominous and for consumers mostly benign.

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The ACA has expanded funding for Medicaid services, but it has also to an even greater degree expanded the pool of people eligible. It used to be that Medicaid did a fair job of providing for the truly disabled and needy. Now it does a lousy job of serving more people. My wife and I have an adult child living at home and will for the rest of our lives. Please join me in supporting the repeal of the ACA and put Medicaid funding back in the pot for the truly needy and disabled in our society. Our daughter will thank you.

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Wait, I thought Obamacare was supposed to solve the problem of access to affordable health coverage—especially for older Americans!  Are Democrats now saying their signature legislation has made the problem worse?

Senator Debbie Stabenow (D-Mich.) has introduced the “Medicare at 55 Act” to allow Americans aged 55-64 to buy into the Medicare health insurance program. Seven other Democrats are original co-sponsors of the legislation.

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The ACA is dead, long live the ACA. At a time when it seems that all we hear about in healthcare revolves around the political folly of legislating healthcare, there has been little attention paid to the underlying crisis that threatens access, quality and cost; a workforce that is exhausted, depressed, and clinically, burnt out.

This problem has been lurking behind all the grandstanding of repeal and replace and has been evolving and increasing at an alarming rate. Burnout, in this case, is defined as a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), a feeling of cynicism (depersonalization), and a low sense of personal accomplishment.

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The individual market shrank by 15% between March 2016 and March 2017, including a 25% decline among unsubsidized policyholders.  The individual market is not “sound.”  Because of rising premiums, millions of people who are not receiving subsidies can no longer afford to buy individual policies, and millions more may forfeit their policies in the next round of rate hikes.

Relinquishing at least some regulatory authority to the states might produce more functional markets where insurers can offer consumers the coverage they want at a price they can afford.

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With the Republican Senate failing to repeal the Affordable Care Act last week, the administration and Congress should consider paying greater attention to the healthcare problems of 2009.

When I graduated medical school in 2009, as the nation debated healthcare reform and the future of our healthcare system, the main challenges impeding doctors and patients were obvious to me. They included a rigid and perverse physician reimbursement system, a labyrinth of increasingly complicated, costly, and sometimes contradictory mandates and priorities, and a runaway malpractice system.

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In Part 1, we learned that real per capita health spending saw a 25-fold increase the 8 decades starting in 1929 even as real per capita GDP grew only 5-fold during the same period.

Whereas the previous post looked at cost trends in broad 20-year snapshots, today’s post looks at that extraordinary growth in health spending in much finer annual-level detail. Looking at real per growth has the advantage of removing general inflation so that we get a clearer picture of what’s going on, as well as telling us what is happening to the average U.S. resident.

With that in mind, I examined the difference in annual growth rates for real per capita health spending vs. all real non-health GDP per capita over the full period for which such data are available: 1929 to 2015. Doing the comparison in this fashion has the advantage of not letting the health sector’s ever-increasing size distort our picture of how much the rest of the economy is growing.

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With Republican repeal-and-replace efforts temporarily sidelined, now is a good time to step back and take a big picture view of exactly how we got into the mess we are now in regarding health care.  What should be clear to people of all political persuasions is that Obamacare did not solve America’s health care woes.

If we take a long-term view (i.e., remembering that 90% of the nation’s population was uninsured back in 1940), the law has modestly reduced the number of uninsured. Most other promises made for the law were broken, most notably that a) if you like your plan, you can keep your plan (PolitiFact’s 2013 Lie of the Year); b) the law would lower premiums for the average family by $2,500 per year; c) the law would not add one dime to the deficit; and d) there would be no new taxes on the middle class. The jury is still out on another huge promise, but at this point I see no overwhelming evidence that the law has bent the cost curve as promised.

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The federal share of national health spending grew by about one-eighth between 2008 and 2016 and by the year 2025 is projected to have increased by nearly one-fifth. By 2025, federal, state and local taxpayers will be financing fully two-thirds of American health care . Some might say “not bad for government work.”

Careful readers might also note that the state and local government share of national health spending shrank slightly during the same period–a reflection of President Obama’s vision to give Uncle Sam a bigger role in health care, displacing decisions formerly made by stat and local governments and the private sector in the process.

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Despite the surge in enrollment and spending—or perhaps because of it—Medi-Cal, California’s Medicaid program, has failed to fulfill its stated goal of improving health-care access for the indigent and disabled. A recent report from the Santa Clara County Civil Grand Jury highlighted the conundrum many of the state’s Medicaid enrollees face: “You’ve Got Medi-Cal, but Can You Get Medical Care?” By extending Medi-Cal to younger, healthier people—many of whom could be better served by the kind of bare-bones private insurance that ObamaCare outlawed—California has made it harder for those who most need low-cost care to get it.

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