“Two articles over the weekend highlight the continuing effect of Obamacare on the health care industry – particularly how it is accelerating industry consolidation. In both the insurance and hospital industry, players are consolidating to lower costs, gain market share, and defend their bottom lines. The big question, however, is whether these trends will ultimately benefit consumers and the health care system as a whole, through improved quality and lower costs.”

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“Under Obamacare, the industry is transfigured from an inefficient, barely competitive mess that tries, against the laws of health care gravity, to control medical costs, to a non-competitive, profit-regulated utility rewarded with 15 to 20 extra cents for every dollar it allows its medical costs to rise.”

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“At first glance, it would seem that this graph vindicates the ACA – come 2021, the difference in growth rates between NHE pre-and-post ACA have fallen to less than a percentage point. What they gloss over, however, is the massive spike in growth rates starting in 2014, when the ACA’s coverage provisions go into effect. This adds to the absolute cost of the ACA over time, even though the growth rate slows down eventually, based on projections.”

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“Such human misery, multiplied by tens of millions of people, rolls up into a bureaucratic colossus of breathtaking complexity. Running a Medicaid program involves coping with a jungle of paperwork, cacophony of regulations and, worst of all, sanctimony in nearly every conversation with every stakeholder. It requires constant vigilance against scam clinics, crooked providers, rogue labs, pill mills, vaporware vendors, and a scuzfest of health care bottom-feeders. A successful day in the Medicaid ‘business’ is measured not by goals achieved but catastrophes averted.”

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“The future frightening payoffs of college loans are taking a backseat to the immediate and soaring costs of health insurance students are getting slapped with as they return to school this fall, all thanks to Obamacare. Because of a rule in the Affordable Care Act that lifts caps on policy payoffs, the cheap insurance policies typically healthy students previously got are skyrocketing, some over 1,000 percent.”

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“With a shortage of doctors in the U.S. already and millions of new patients set to gain coverage under President Barack Obama’s health-care overhaul, American medical schools are struggling to close the gap.”

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“These problems with the Medicare program predate the passage of Obamacare. For decades, politicians have been wrestling with Medicare’s runaway costs. Conventional fixes, like raising the retirement age, reducing benefits, or raising premiums were considered politically toxic. So instead, Congress sought the path of least resistance: paying doctors and hospitals less to provide the same level of service.”

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“Ultimately, what we should want is a Medicare system that pays primary-care physicians without the maddening inconveniences. We should want a way of paying primary-care physicians that no longer puts them at the mercy of the RUC, that eliminates most if not all Medicare-related billing costs for primary care, and renders the SGR moot.”

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“The Affordable Care Act sets up new insurance exchanges through which people can buy coverage, and it provides tax credits to help low-income people with that purchase. The law says each state should set up its own exchange but also directs the federal government to set one up in any state that does not. The IRS is planning to provide tax credits in state-based and federally run exchanges. Issa and other conservatives say the subsidies should only be available in state exchanges — not the federal fallback.”

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“Amid the political bickering, however, many have lost sight of the most important question: Does the aAffordable Care Act’ improve the quality of care and thereby make health care more affordable? The answer, unfortunately, is no. “

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