Thursday, October 30, 2014

The Failed Experiment

With all the crises, scandals, and more mundane sorts of incompetence that comprise the daily fare delivered to our doorstep with the morning paper, it seems that yesterday's hot topic is forgotten as a new one supplants it today.

The scandal of Mr. Obama's use of taxpayer money to reward his corporate cronies and big donors in the government bailout was eclipsed by news of Attorney General Eric Holder's Justice department facilitating the sale of guns to Mexican drug lords, and this remarkable breach of the law was obscured by the administration's refusal to protect American diplomats in Benghazi, which took a back seat to the incredibly botched rollout of Obamacare, which was followed by KGB-style spying on journalists by the Obama administration, which was lost amidst reports of Secret Service shenanigans with hookers in South America, which was overshadowed by the abuses of the IRS against the administration's political foes, which was superceded by the spying of the NSA on American citizens, which was pushed off the front pages by the incompetence of the Veteran's Administration which resulted in perhaps hundreds of unnecessary deaths, which were forgotten amidst the flood of illegal immigrants pouring across our essentially undefended borders, which was quickly overshadowed by the sudden appearance of ISIS in the vacuum left by the unnecessary American withdrawal from Iraq, which was ignored when the CDC seemed to not know what to tell us about Ebola.

Now we're being reminded that 2015 is going to be a critical year for Obamacare, and the portents are not looking favorable. Barbara Boland at CNS News reports that almost a quarter of a million of the nation's doctors are not going to participate in the exchanges for reasons Boland explains in her article:
Over 214,000 doctors won't participate in the new plans under the Affordable Care Act (ACA,) analysis of a new survey by Medical Group Management Association shows. That number of 214,524, estimated by American Action Forum, is through May 2014, but appears to be growing due to plans that force doctors to take on burdensome costs. It's also about a quarter of the total number of 893,851 active professional physicians reported by the Kaiser Family Foundation. In January, an estimated 70% of California's physicians were not participating in Covered California plans. Here are some of the reasons why:

1. Reimbursements under the Affordable Care Act (Obamacare) are at bottom-dollar - they are even lower than Medicare reimbursements, which are already significantly below market rates. "It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60," a study by the think-tank American Action Forum finds. "For example, Covered California plans are setting their plan fee schedules in line with that of Medi-Cal-California's Medicaid Program-which means exchange plans are cutting provider reimbursement by up to 40 percent."

2. Doctors are expected to take on more patients to make up for the lost revenue, but that's not happening, because primary care doctors already have more patients than they can handle. "Furthermore, physicians are worried that exchange plan patients will be sicker than the average patient because they may have been without insurance for extended periods of time, and therefore will require more of the doctor's time at lower pay," says the study.

The study also points to two reasons that doctors might not get paid at all:

3. An MGMA study indicates that 75% of ACA patients that had seen doctors had chosen plans with high deductibles. Given that most of the patients are low-income, doctors are concerned that the patients cannot meet the deductibles and they, the doctors, will get stuck with the bill.

4. Health and Human Services requires that insurers cover customers for an additional 90 days after they have stopped paying their premiums: the insurer covers the first 30 - but, it's up to the doctor to recoup payment for the last 60 days. This is the number one reason providers are opting to not participate in the exchange plans. Currently, about a million people have failed to pay their premiums and had their plans canceled.
As Boland notes, Obamacare is asking doctors to take on sicker patients for less money, and with the risk of not getting paid at all.

What are the lessons to be learned from all this? Here, in my opinion, are two:

1. When Americans vote they are voting irresponsibly if they don't vote for the person they believe to be the best qualified candidate to lead the country. To vote for someone because he/she speaks well, is young, attractive, the right gender, or the right race or ethnicity is to betray one's responsibility as a voter. To vote for someone on the basis of such factors when that person has nothing in his or her resume that suggests that he or she has the requisite background to lead the country is doubly irresponsible. It's like taking the most popular kid in the senior class and putting him at the helm of an aircraft carrier because he's so cool he'll surely know how to manage the thing.

2. Since WWII the left has been arguing that big, centralized government and European-style socialism is the solution to all of our problems. Their brief has been that when technocrats, bureaucrats, and wonks run our lives we'll be much better off than if we were free to make our own decisions without ivy-league graduates telling us what to do. The left rejoiced when the Democrats gained control of both houses of Congress and the White House in 2008 because now, they believed, they'd finally be able to conduct their grand experiment and prove how effective big government can be. Six years later it takes the blindest of leaps of faith to still believe that, given expanded power, government will be efficient, competent, transparent, and lawful.