Wednesday, May 21, 2014

The Good, The Bad and The Ugly: The Affordable Healthcare Act

I have openly stated for the record that if one desires to explore how the Federal Government operates in the function of health care administrator, just look at the Veterans Administration Hospital Services – where the average wait time to see a physician is five months. In all sincerity, this is how, based on observation and past history, I perceive Obamacare will be implemented and administered. However, I will say, regardless of political affiliation, one must wait and see if the Affordable Care Act actually accomplishes and does what it was indicated to do when initially proposed by and signed into law by the President.

It was first hard to understand why any legislature would vote for a bill that none had ever read, to have any comprehension of all the mandates, subsides and regulations entangled in large sums of paper that represented the law itself. However, it is possible to evaluate its eventual effectiveness – namely by determining if it actually meets its objectives of reducing health care cost, provide health care coverage for all and lastly, if you can actually do what the President stated: keep your physicians or policy if you like them.
The last is a given so I won’t spend too much effort on that. However, the first, reducing cost is the main concern. It should be clear that in order to reduce health care cost, one must know how much health care service are in dollar terms.  This is something that varies by hospital to hospital and specialty to specialty as research notes. For example, the Washington Post reported that the cost for a patient on a ventilator at one hospital was $115,000 and $53,000 at another and $30,000 at yet another. Procedures for lower limb replacement in the same article ranged from $117,000 to $25,600. One example showed that inpatient cost for joint replacement in Oklahoma was $5,300 but $223,000 in Monterey, California. In NYC, cost for treating asthma varied 321% between two hospitals approximately 60 blocks apart.  And I won’t even go into cost for aspirin, toilet paper and overnight stays in a hospital ward.
A social Marxist would say let us have one cost across the board, but such would not consider a surgeon with 20 years experiences and no clinical complications experienced by patients and a first year without any clinical experience (which would go against all the rules of rewarding expertise and competency).

The President often repeated that the ACA would reduce the cost of premiums by $2,500 for a family of four. However, using the same math the Administration employed, one scientist calculated it would increase premiums for a family of four by more than $7400 by 2222.  When I did the formula, I came out with a similar figure closer to $7,900 per family of four (my model assumed that both head of household were not employed). The Manhattan Institute, although they did not disclose their method completely, predicted and increase of 41% which in any case is way more than $2,500.  This was as of the end of last year and was an overall estimiate not giving any weighted effects for states like Georgia or Indiana where increases are estimated to be 198 and 72 percent accordingly.
New information shows that based on official filings by insurance companies in Virginia, that policy rate increases range between 3 to 17 percent for 2015, and are attributed to new cost associated with implementing the ACA as a function of being mandated to cover less healthy and previously folk that never had health insurance.

Although the President stated that this law would assist in providing coverage for folk who did not have health insurance. It is difficult for me how his administration came up with the number of people who did not have health care coverage since it fluctuates, similar too manner in knowing how many cares are owned by people versus the actually number that are drivable and on the road. Since this proposal was implemented during the start of our current and present recession, the Obama Administration goal of signing up 7 million really wasn’t too difficult since close to 40 million currently have no form of health coverage, inclusive of the botched roll out of the web site.  To be completely honest, as the federal government, it is difficult for me to believe then even have a clue of how many uninsured folk in America, regardless of being either democrat or republican.
Although many promulgate that the subsides will help deal with these projected increases, in reality they will not hide the pain that certain folk will have for paying extra for others who cannot afford to pay for their policy or being required to pay for service they do not need. My mother for example, is 72 and still wonders why she has to pay for maternity coverage (when she can’t have children or why she has to, by law have prostate cancer coverage when she doesn’t have a prostate).
In summary, anyone who will say that the ACA is a failure or a success is not being honest or objective. All will have to wait for small and large business, which the president gave waivers, to sign up and see what other laws go in place or changes made to the ACA to complete the final product to evaluate it appropriately. What can be said that it will have a major impact on the U.S. Economy, since the government has taken control of approximately 30% of the U.S. GDP with its control of health care insurance and health care delivery? What we can say is that the ACA will definitely change how many small and large business hire and provide insurance coverage.  What we can say is that the ACA will limit individual choice in healthcare and may even impact the growth of the health care delivery industry as a hole. Lastly, what we can say is that in time, all will feel the impact of ACA whether for the good, the bad or the ugly.



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