Successes & Failures of 2016 U.S. Elections — Part 14

THE SCOPE, BENEFITS AND FAILURES OF OBAMACARE:
HEALTHCARE NEEDS IN THE UNITED STATES (OBAMACARE
II):


by Sunil J. Wimalawansa

Health is wealth; we must take care of it to our best.


“It will be little avail to the people that the laws are made by men of their own choice if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood.”- President James Madison.

What is Obamacare and why insurance premiums skyrocketed:

( January 18, 2017, Washington DC, Sri Lanka Guardian) The three primary goals of Affordable Care Act (ACA) (Obamacare) were to increase access, affordability, and portability (i.e., including the ability to obtain coverage irrespective of having health conditions and carry forward).  Although the ACA, sometimes called “Obamacare,” increased access to care through widening the insurance net and incentivizing people to obtain coverage (i.e., through imposing annual penalties that are added to year end taxes for not having insurance), it passed the expense to those who were already insured, mostly to middle and upper class people, unfairly penalizing them.

The situation is worsened by those with agendas, health-insurance propaganda, and the flood of advertising by companies attempting to sway public opinion and the decision-making process, while lobbying the government for a system that benefits them (not necessarily the needs of the public).  These types of actions frequently mislead the public and the government regarding the quality of healthcare delivery, restrictions, values, and cost.   It is unfortunate that, when it comes to healthcare, we fail to consider, discuss, or understand fact-based information that is relevant and specific to us as individuals and families.

Benefits of Obamacare: 

There are several key beneficial components in the ACA.  Examples of benefits of Obamacare include, mandates for the provision of portability, having coverage irrespective of pre-existing conditions, the ability to include children (up to the age of 26) who are not working in healthcare plan of parents, and free coverage through Medicaid for those whose income is below the national poverty line.  These are excellent benefits derived through the ACA.

Problems with the Obamacare:

Click on the image to read the previous parts of this series

Each year, for those who were paying for an Obamacare plan, the premiums rose steeply at the times of their annual renewals.  The costs also shifted to those who already had healthcare insurance coverage.  However, the rate of increase varies from state to state and were skewed, based on competition and the groups of insurance companies involved.  For 2017, premium increases are varied from 15% to 125%; on average about 25% per person.  A similar trend was also observed during the George W. Bush administration.

One of the major problems with the Obamacare plan is the awkward and disastrous insurance exchanges, which are impractical and expensive to use.  As with any other consumer-driven business, the added costs, including the underwriting costs for the insurance companies were overblown and passed onto the consumer to increase company profits.  In any new healthcare law to be administered, this must be prevented through value-added processes and operational efficacies.  Moreover, Obamacare included a penalty and taxes; both must be repealed by the new administration.

Other failures of Obamacare and ways to rectify it:

In addition to the escalating costs there are several other key failures of Obamacare.  These includes, but not limited to, regulatory mandates-related loss of millions of jobs, and failure to address pilferage, greed, and waste.  Others are, procedural and specialty-care driven financial incentives of entities and third-party payers, lack of established limits allowing too high profit margins for procedural payments, senseless and unreasonable controls by third-party payers to fatten their coffers.

Further incursions are the regulatory burdens, third-party payers enforced restrictions to practice effective and compassionate medicine by physicians.  Some of these includes, refusal of necessary medications and referral approvals leading to enhanced sickness, increased costs, and perhaps deaths.  The overall situation was worsened due to the lack of control of prices of drugs and medical devices, overburdened regulations that prevented healthcare workers from carrying out their jobs, and tremendous wastage in the healthcare sectors.

It is estimated that proactively resolving or eliminating some of these items could bring down the cost of Obamacare by more than 40%.  This taken together with application of similar fundamentals to other United States healthcare systems, the use of new technologies and digital means to improve the management and maintenance of health of patients, and a knowledge-based, patient-centered practice of medicine could dramatically bring down the healthcare costs in the United States to levels comparable to those of other industrialized countries.

Signing into Obamacare was a nightmare for some:

For the majority, getting registered for the Obamacare was a nightmare.  Some tried via the government website (healthcare.gov) more than 100 times before they could successfully register.  Others gave up their registration attempts with frustration.  During the period of signing-in, the healthcare.gov website was down more than it was functioning.  Moreover, some of those who managed to get registered found the plans were too costly (i.e., rising premiums and deductibles, with less benefits) and have too many restrictions, and faced an inability to follow up with their physicians as promised.

Some were upset to see that those who failed to sign up for Obamacare were getting better insurance coverage for a lower price outside of the ACA.  Those (several millions) who were pushed into Medicaid based on their income had the most restricted and the worst coverage through the mandated, third-party insurance companies.  Nevertheless, there is also some who significantly benefitted from this legislation.

Refining and improving the Affordable Care Act:

The new plan needs to have flexibility for employers to provide coverage and employees to choose what they want, without penalizing them.  The cutoff point of companies with 50 or more employees being required to provide health insurance has inherent problems.  This important aspect needs to be thought through carefully and a plan should be devised and implemented to modify this requirement without penalizing employers.

The company size should not be a barrier to healthcare insurance coverage.  The new scheme to facilitate the populous to obtain and maintain health insurances through the new replacement plan, should include the following:

  • Payroll deduction incentives;
  • Increased access to tangible and portable Health Savings Accounts;
  • Increasing the maximum contributions allowable for health savings accounts as incentives for greater participation and compliance.
  • Age-adjusted “tax credits” for healthcare;
  • Allowing individuals to shop on the open market including across the state lines;
  • Empowering individual sates to control Medicaid funds;
  • Allowing insurance companies to bid across state lines, thus increasing the competition;
  • Allowing more flexibility to local government and businesses to enhance and add value to the program;
  • Providing incentives for people to maintain good health;
  • Allowing individuals to carry forward unused healthcare savings;
  • Delivering patient-centric healthcare;
  • Delivering lower cost healthcare through knowledge-based and technology-driven clinical/ disease management; and
  • Expanding remote monitoring and hospital- and clinic-based tele-health for improved maintenance of self-health management.

The alternative approach is to do a major overhaul and make the new plan somewhat closer to a “universal access” care model of insurance, for which predictable and capped services are provided to all.

To be Continued


Professor Sunil J. Wimalawansa, MD, PhD, MBA, DSC, is a physician–scientist, social entrepreneur, educator, and philanthropist, with strategic long-term vision.  The author can be reached via wimalawansa.org

 

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