Thursday, April 3, 2014

Analysis of Obamacare

First of all, let me say that this country is in dire need of healthcare reform. The cost of healthcare, the lack of transparency in pricing and the spiraling costs of health insurance premiums have become a huge issue over the past decade. When the ACA was passed, the primary focus was obtaining health insurance for those previously denied due to pre-existing medical conditions and for those who could not afford health insurance. These are two important ingredients to a workable healthcare reform but are far from resolving the most important issues of overall cost control.
It is my experience as a businessman and 10 year health insurance broker that the ACA falls way short of being the answer to our country's healthcare problems. Due to federal coverage mandates, insurance plans for those who could not obtain federal premium subsidies, for the most part, increased and benefits decreased. Any program, whether in private business or governmental in nature has to serve the total universe applicable to its execution. The ACA only is beneficial to a segment which accounts for far less than 50% of this total universe.
The coverage and profitability mandates placed on insurance companies have led to a major decrease in network physicians and hospitals in the individual segment of the market. Over the long term, this has to erode the quality of healthcare available to the consumer. It is this writer's opinion that there are many out there that will not realize this effect until they visit an out of network hospital or physician and are faced with a huge bill for out of network services.
The execution of the ACA was implemented far before all ingredients were finalized and not only led to much frustration in consumers attempting to sign up for coverage but also led to a portion of those signing up early having to change plans due to their physicians and hospitals dropping out of networks. Given the fact that many lost their coverage January 1 and were forced to move to new plans plus the fact that a large number of people were dumped into the Medicaid system, the numbers reported by the government are misleading. The true number of previously uninsured who have signed up for Obamacare is far less than the 7.1 million touted by the Feds.
So, what is the answer here? In my opinion, due to the lack of cost control, that this current program is not sustainable for the long term. Due to the imbalance of healthy versus unhealthy signups, premiums are projected to rise dramatically. To those who call for a universal single payer system, are you ready for the heavy taxation that would have to accompany such a venture? There is no free lunch in today's governmental economy. This country simply cannot afford to take on universal care at this point in time due to the deficit and budgetary imbalance prevalent today. It is my opinion that a panel consisting of corporate business leaders, physicians, politicians, insurance executives and others from leading medical research institutions should be formed to work diligently to fix this program over the next seven months prior to the beginning of 2015"open enrollment.
It is ludicrous for politicians to be patting themselves on the back and touting the success of a program that, in its current state, is unsustainable. Check the egos at the door and form a coalition that can compromise and fix the problems. This approach will help us all and take the focus off a small segment and place it squarely on the total universe of the healthcare arena.

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