The Obamacare Shock (Krugman and Friedman)

[No1]

May 26, 2013
The Obamacare Shock
By PAUL KRUGMAN

The Affordable Care Act, a k a Obamacare, goes fully into effect at the beginning of next year, and predictions of disaster are being heard far and wide. There will be an administrative “train wreck,” we’re told; consumers will face a terrible shock. Republicans, one hears, are already counting on the law’s troubles to give them a big electoral advantage.

No doubt there will be problems, as there are with any large new government initiative, and in this case, we have the added complication that many Republican governors and legislators are doing all they can to sabotage reform. Yet important new evidence — especially from California, the law’s most important test case — suggests that the real Obamacare shock will be one of unexpected success.

Before I can explain what the news means, I need to make a crucial point: Obamacare is a deeply conservative reform, not in a political sense (although it was originally a Republican proposal) but in terms of leaving most people’s health care unaffected. Americans who receive health insurance from their employers, Medicare or Medicaid — which is to say, the vast majority of those who have any kind of health insurance at all — will see almost no changes when the law goes into effect.

There are, however, millions of Americans who don’t receive insurance either from their employers or from government programs. They can get insurance only by buying it on their own, and many of them are effectively shut out of that market. In some states, like California, insurers reject applicants with past medical problems. In others, like New York, insurers can’t reject applicants, and must offer similar coverage regardless of personal medical history (“community rating”); unfortunately, this leads to a situation in which premiums are very high because only those with current health problems sign up, while healthy people take the risk of going uninsured.

Obamacare closes this gap with a three-part approach. First, community rating everywhere — no more exclusion based on pre-existing conditions. Second, the “mandate” — you must buy insurance even if you’re currently healthy. Third, subsidies to make insurance affordable for those with lower incomes.

Massachusetts has had essentially this system since 2006; as a result, nearly all residents have health insurance, and the program remains very popular. So we know that Obamacare — or, as some of us call it, ObamaRomneyCare — can work.

Skeptics argued, however, that Massachusetts was special: it had relatively few uninsured residents even before the reform, and it already had community rating. What would happen elsewhere? In particular, what would happen in California, where more than a fifth of the nonelderly population is uninsured, and the individual insurance market is largely unregulated? Would there be “sticker shock” as the price of individual policies soared?

Well, the California bids are in — that is, insurers have submitted the prices at which they are willing to offer coverage on the state’s newly created Obamacare exchange. And the prices, it turns out, are surprisingly low. A handful of healthy people may find themselves paying more for coverage, but it looks as if Obamacare’s first year in California is going to be an overwhelmingly positive experience.

What can still go wrong? Well, Obamacare is a complicated program, basically because simpler options, like Medicare for all, weren’t considered politically feasible. So there will probably be a lot of administrative confusion as the law goes into effect, again especially in states where Republicans have been doing their best to sabotage the process.

Also, some people are too poor to afford coverage even with the subsidies. These Americans were supposed to be covered by a federally financed expansion of Medicaid, but in states where Republicans have blocked Medicaid expansion, such unfortunates will be left out in the cold.

Still, here’s what it seems is about to happen: millions of Americans will suddenly gain health coverage, and millions more will feel much more secure knowing that such coverage is available if they lose their jobs or suffer other misfortunes. Only a relative handful of people will be hurt at all. And as contrasts emerge between the experience of states like California that are making the most of the new policy and that of states like Texas whose politicians are doing their best to undermine it, the sheer meanspiritedness of the Obamacare opponents will become ever more obvious.

So yes, it does look as if there’s an Obamacare shock coming: the shock of learning that a public program designed to help a lot of people can, strange to say, end up helping a lot of people — especially when government officials actually try to make it work.

http://www.nytimes.com/2013/05/27/o...hock.html?src=me&ref=general&pagewanted=print

 

[No1]

May 25, 2013
Obamacare’s Other Surprise

By THOMAS L. FRIEDMAN

LISTENING to the debate about President Obama’s health care plan, some critics argue that Obamacare is going to need Obamacare — because it’s going to be a “train wreck.” Obama officials insist they’re wrong. We’ll just have to wait and see whether the Affordable Care Act, as the health care law is officially known, surprises us on the downside. But there is one area where the law already appears to be surprising on the upside. And that is the number of health care information start-ups it’s spurring. This is a big deal.

The combination of Obamacare regulations, incentives in the recovery act for doctors and hospitals to shift to electronic records and the releasing of mountains of data held by the Department of Health and Human Services is creating a new marketplace and platform for innovation — a health care Silicon Valley — that has the potential to create better outcomes at lower costs by changing how health data are stored, shared and mined. It’s a new industry.

Obamacare is based on the notion that a main reason we pay so much more than any other industrial nation for health care, without better results, is because the incentive structure in our system is wrong. Doctors and hospitals are paid primarily for procedures and tests, not health outcomes. The goal of the health care law is to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.

To do this, though, doctors and hospitals need instant access to data about patients — diagnoses, medications, test results, procedures and potential gaps in care that need to be addressed. As long as this information was stuffed into manila folders in doctors’ offices and hospitals, and not turned into electronic records, it was difficult to execute these kinds of analyses. That is changing. According to the Obama administration, thanks to incentives in the recovery act there has been nearly a tripling since 2008 of electronic records installed by office-based physicians, and a quadrupling by hospitals.

The Health and Human Services Department connected me with some start-ups and doctors who’ve benefited from all this, including Dr. Jen Brull, a family medicine specialist in Plainville, Kan., who said that she was certain she had been alerting her relevant patients to have colorectal cancer screening — until she looked at the data in her new electronic health care system and discovered that only 43 percent of those who should be getting the screening had done so. She improved it to 90 percent by installing alerts in her electronic health records, and this led to the early detection of cancer in three patients — and early surgery that saved these patients’ lives and also substantial health care expense.

Todd Park, the White House’s chief technology officer, said many new apps being developed have been further fueled by the decision by Health and Human Services to make available massive amounts data that it had gathered over the years but had largely not been accessible in computer readable forms that could be used to improve health care.

It started in March 2010 when Health and Human Services met with “45 rather skeptical entrepreneurs,” said Park, “and rather meekly put an initial pile of H.H.S. data in front of them — aggregate data on hospital quality, nursing home patient satisfaction and regional health care system performance. We asked the entrepreneurs what, if anything, they might be able to do with this data, if we made it supereasy to find, download and use.” They were told that in 90 days the department would hold a “Health Datapalooza,” — a public event to showcase innovators who harnessed the power of this data to improve health and care.

Ninety days later, entrepreneurs showed up and demonstrated more than 20 new or upgraded apps they had built that leveraged open data to do everything from helping patients find the best health care providers to enabling health care leaders to better understand patterns of health care system performance across communities, said Park. In 2012, another “Health Datapalooza” was held, and this time, he added, “1,600 entrepreneurs and innovators packed into rooms at the Washington Convention Center, hearing presentations from about 100 companies who were selected from a field of over 230 companies who had applied to present.” Most had been started in the last 24 months.

Among the start-ups I met with are Eviti, which uses technology to help cancer patients get the right combination of drugs or radiation from Day 1, which can lower costs and improve outcomes; Teladoc, which takes unused slices of doctors’ time and makes use of it by connecting them with remote patients, reducing visits to emergency wards; Humedica, which helps health care providers analyze their electronic patient records, tracking what was done to a patient, and did they actually get better; and Lumeris, which does health care analytics that uses real-time data about every aspect of a patient’s care, to improve medical decision-making, collaboration and cost-saving.

Obamacare will be a success only if it can deliver improved health care for more people at affordable prices. That remains to be seen. But at least it is already spurring the innovation necessary to make that happen.

http://www.nytimes.com/2013/05/26/o...rise.html?src=me&ref=general&pagewanted=print

 

[tru_m.a.c]

haha you know folks in HL aren't up on their health care knowledge like that

I will say actually working in the industry, the fluff pieces are cool, but doing the work is beyond fukkn stressful. You'd be surprised how many ppl across healthcare have no idea what the regulation timelines looks like.

 

[Chris.B]

socialist utopia crushing down

 

[Calmye]

I wish Obama wasn't such a p*ssy and fought for universal healthcare.

Sent from my SCH-I535 using Tapatalk 2

 

[No1]

haha you know folks in HL aren't up on their health care knowledge like that

I will say actually working in the industry, the fluff pieces are cool, but doing the work is beyond fukkn stressful. You'd be surprised how many ppl across healthcare have no idea what the regulation timelines looks like.

Yeah, it'll probably become part of my legal practice just based on the field I'm in, so I try stay abreast. But I'm obviously a novice. It's crazy that all of the healthcare stuff won't be fully implemented until 2018.

 

[¯\_(ツ)_/¯]

socialist utopia crushing down

I know...I'd be too if I was against this.

 

[Dusty Bake Activate]

It's funny how the Affordable Care Act is incorporating useful, streamlining innovations that the private sector has moved toward like moving to all electronic records, use of real time analytics, and consolidation of data into user-friendly one-stop depots, yet right-wingers are still trying their best to paint it as a bureaucratic nightmare.

That's the irony of the whole thing. It's a conservative program that utilizes competition to bring down choices, allows more choice, makes things more lean, cutting inefficient administrative waste, and incorporates the latest technological innovation. All things conservatives have been telling us for years that the private sector has over the government. But somehow this is being assailed as a wasteful, big government clusterfukk.

 

[tru_m.a.c]

It's funny how the Affordable Care Act is incorporating useful, streamlining innovations that the private sector has moved toward like moving to all electronic records, use of real time analytics, and consolidation of data into user-friendly one-stop depots, yet right-wingers are still trying their best to paint it as a bureaucratic nightmare.

That's the irony of the whole thing. It's a conservative program that utilizes competition to bring down choices, allows more choice, makes things more lean, cutting inefficient administrative waste, and incorporates the latest technological innovation. All things conservatives have been telling us for years that the private sector has over the government. But somehow this is being assailed as a wasteful, big government clusterfukk.

to be fair, the health care industry is in the stone age compared to everyone else

 

[88m3]

Rand Paul Mocks Obamacare For ‘Turtle Bite’ Diagnostic Codes Ordered By The Bush Administration

By Sy Mukherjee on May 28, 2013 at 12:55 pm

Sen. Rand Paul (R-KY)

On Monday, several news outlets highlighted comments that Sen. Rand Paul (R-KY) made to the Iowa Republican Party earlier this month in which he mocked an Obamacare provision for being burdensome and silly. Paul ridiculed the health law for forcing doctors to use 122,000 new medical diagnostic codes for describing Americans’ injuries to the government, including for “injuries sustained from a turtle” and “walking into a lamppost.”

The new codes do, admittedly, exist. There’s just one problem with Paul’s claims — they were adopted by the George W. Bush administration, long before Obamacare was even being debated.

Paul is referring to the transition from the ICD-9 — the current system of medical code classifications that originated from the World Health Organization (WHO) — to the far more detailed ICD-10. That’s a change that was mandated by the Bush White House in its waning days and is reflective of changing international standards for coding care. Many countries have been using the updated codes for over a decade.

In a press release from August 15, 2008, Bush’s Department of Health and Human Services (HHS) wrote that it had issued rules to implement “a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective Oct. 1, 2011.”

Several medical groups, including the American Medical Association (AMA), balked at that timeline, arguing that it was too short a window for implementing such a large, complicated change to the way that hospitals code Americans’ procedures, injuries, and diseases. The Bush HHS listened to those concerns, delaying ICD-10 implementation to October 2013. The Obama administration sustained that postponement, and then delayed implementation even further to to October 2014 at the request of the health care industry.

It’s possible that Paul’s confusion stems from the shifting timeline, since much of Obamacare also goes into effect in 2014. But the health law has nothing to do with the specific codes that Paul mocked in his speech — and as the Bush HHS release shows, the decision to shift to the ICD-10 started before President Obama even took office.

Paul — who is himself a doctor — isn’t alone in his confusion. One poll found that 32 percent of surveyed health workers inaccurately thought the ICD-10 was linked to health care reform, 29 percent were unsure, and the other 39 percent answered correctly that the two were unrelated.

Paul’s office had not returned a ThinkProgress request for comment as of press time.

http://thinkprogress.org/health/2013/05/28/2066421/rand-paul-mocks-obamacare-codes-bush-admin/

Must've went to the same medical school his father did

 

[tru_m.a.c]

Yeah, it'll probably become part of my legal practice just based on the field I'm in, so I try stay abreast. But I'm obviously a novice. It's crazy that all of the healthcare stuff won't be fully implemented until 2018.

crazy that it won't be

its crazy that it even HAS to be.....dude we can't even get the switch to ICD10 right

its very true though, the election definitely had everyone stalling. If Obama isn't in office, you could throw the legislation in the bushes. You see the result of that through the HIX (health exchanges).

Every day we're getting a new CMS ruling

Its crazy in out here. But fun crazy.

 

[Mr. Negative]

It's funny how the Affordable Care Act is incorporating useful, streamlining innovations that the private sector has moved toward like moving to all electronic records, use of real time analytics, and consolidation of data into user-friendly one-stop depots, yet right-wingers are still trying their best to paint it as a bureaucratic nightmare.

That's the irony of the whole thing. It's a conservative program that utilizes competition to bring down choices, allows more choice, makes things more lean, cutting inefficient administrative waste, and incorporates the latest technological innovation. All things conservatives have been telling us for years that the private sector has over the government. But somehow this is being assailed as a wasteful, big government clusterfukk.

buncha good ole boy nikkas fighting the great and ominous monster called "progress" and yet have no idea why they're fighting at all.

 

[Morph]

That's the irony of the whole thing. It's a conservative program that utilizes competition to bring down choices, allows more choice, makes things more lean, cutting inefficient administrative waste, and incorporates the latest technological innovation. All things conservatives have been telling us for years that the private sector has over the government. But somehow this is being assailed as a wasteful, big government clusterfukk.

Forcing people to buy health insurance is hardly "conservative".

What's going to happen is that by artificially setting premiums low (e.g. California) (which is hardly "Free Market" or "competition"), California will ration healthcare services. You might not get what you need, but you'll still have to pay for it. It's pretty wasteful now that you've authorized the same once size fits all solution to the 30 million or so people that will be getting health coverage in the next few years.




Words of wisdom from Obama's "Car Czar":

We need death panels.

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

So the government will get to decide who needs health services more than others (scary as fukk, if you ask me).

Here's Rattner's op-ed, the guy is truly a creep, but he speaks the truth about Obamacare and how terrible it will be:
Beyond Obamacare

 

[tru_m.a.c]

What's going to happen is that by artificially setting premiums low (e.g. California) (which is hardly "Free Market" or "competition"), California will ration healthcare services. You might not get what you need, but you'll still have to pay for it.

So the government will get to decide who needs health services more than others (scary as fukk, if you ask me).
[/URL]

You sir have no idea what you're talking about.

Premiums are not set by the government. They're set by the payors and increases are regulated by state governments (if your state has the law on the books).

Secondly, you have 0 idea what rationing in healthcare entails. You're just regurgitating talking points you've heard on tv.

 

[Dusty Bake Activate]

Forcing people to buy health insurance is hardly "conservative".

Maybe not to a :sadpaul: stan. The individual mandate is the brain child of The Heritage Foundation, buddy.

But my point was the ACA incorporates many of the attributes that are proven to operate in a lean manner and cut waste in the private sector, which I listed.

What's going to happen is that by artificially setting premiums low (e.g. California) (which is hardly "Free Market" or "competition"), California will ration healthcare services.

The government doesn't set premiums. The insurance companies compete on exchanges, which should theoretically lead to lower premiums. What are you talking about?

You might not get what you need, but you'll still have to pay for it. It's pretty wasteful now that you've authorized the same once size fits all solution to the 30 million or so people that will be getting health coverage in the next few years.

It's not one size fits all. People still have a choice of insurance, and you seem to be conveniently ignoring that all those uninsured people will be paying into the system now, not to mention the budgetary alterations ($700 billion cut from the wasteful Medicare advantage and tax increases).

Words of wisdom from Obama's "Car Czar":

Why don't you post the entire article instead of one decontextualized quote?

http://www.nytimes.com/2012/09/17/opinion/health-care-reform-beyond-obamacare.html?_r=0

In his speculative view, he's saying that rationing of any services in Medicare is explicitly NOT included within the ACA, and said that they should in order to keep their spending goals.

So the government will get to decide who needs health services more than others (scary as fukk, if you ask me).

Here's Rattner's op-ed, the guy is truly a creep, but he speaks the truth about Obamacare and how terrible it will be:

I'm confused. This supposed, speculative "rationing" you're being so alarmist about is from Medicare. You started this post saying forcing people to buy health insurance isn't conservative, and I assume you are against forcing people to buy insurance. Well that's essentially what Medicare is. You're just paying through taxes instead of out of income, which I would think would be worse to a conservative.

Now you're saying it's "scary as fukk" that there might be rationing from Medicare. I would think you would be against Medicare altogether. If there were rationing of Medicare, why wouldn't that be a good thing? That's "starving the beast" if I've ever seen it. Except, unlike in the 80's it would be real in this scenario.