“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.”

“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.”

“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.”

“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. “

“These reforms will be gradually implemented leading up to 2014, when the biggest part of the law — the expansion of coverage to an estimated 30 million of the currently uninsured — is set to kick in. If we get it right, more people will have the security of health insurance, the nation can become healthier and spending will be restrained. If things don’t go according to plan, it could disrupt the $4.78 trillion health care economy by squeezing hospitals, health insurance companies and state governments. Waits for doctor visits could get even longer.”

“There’s good reason to believe that in short order, the health plans sold in Obamacare’s heavily regulated, state-based insurance exchanges will degrade into something akin to today’s Medicaid managed care plans. If a lot of consumers who presently get their health coverage at work are dumped into these state exchanges (as many independent analysts predict), then tens of millions of Americans could find that they’re worse off under the new law and that their health benefits have been substantially devalued.”

“Because ObamaCare relies heavily on Medicaid — the federal/state program that provides health insurance for the poor — to expand coverage. But Medicaid is already swallowing up state budgets, forcing states to cut back on everything else, especially support for two- and four-year public colleges.”

“Unless Obamacare is repealed, it will add $1.7 trillion in new spending. That much is certain. Any offsetting reductions are dubious, at best. Budgetary analysis and historical experience point to the same conclusion: If fully implemented, Obamacare will drive up health costs for all Americans and widen the river of government spending and debt.”