Pythia on the Potomac

My apologies for no previous warning, but I am mostly out of Wi-Fi range right now. I am presently sitting in a Hastings bookstore. Anyway, I have been doing some reading. You will want to check out Robert Samuelson's piece on the submarine that is called the Affordable Care Act, or more popularly ObamaCare. His specific topic is the process whereby "acceptable" health insurance is defined.

Defining essential health benefits poses a basic conflict. On one hand, everyone wants broad coverage; on the other, the broader the coverage, the more expensive policies will be -- pushing government spending up (because government pays for the subsidies) and wages down (because employers will shift compensation from wages to fringe benefits).

Sebelius ducked this question by requiring each state to define essential health benefits based on existing policies in that state. Almost no one anticipated this. The ACA does not suggest it. Sebelius asked for advice from the nonpartisan Institute of Medicine (IOM). Its report talks of a national standard for essential health benefits, although it also notes that the ACA allows the secretary to provide state-by-state waivers beginning in 2017.

Contrary to Nancy Pelosi's famous remark that we had to pass ACA to find out what's in it, one now wonders whether there was anything in it beyond an a vague grant of enormous powers. Almost every action the Administration has taken so far has been to defer or delay any decisions or clarifications. Go figure.

What was Secretary Sebelius' motive for this surprising step?

Medicare -- the government's largest health program -- is national. The uniformity allows economies of scale. If Medicare, hypothetically, varied by state, its already huge costs would almost certainly be higher. The advantages of using existing plans may also be exaggerated, because the ACA mandates that some benefits not routinely included in most plans -- eye care and dentistry for children, and mental health and substance abuse -- be covered.

The larger problem is that Sebelius doesn't deal with exploding health care spending. She ignored the report from the Institute of Medicine, which recommended that she define the essential health benefits package in a way that puts a ceiling on its costs. Sebelius delegated that unpopular choice to the states.

Whatever one thinks of the ACA, it is one more sign that there is as yet no possibility of any responsible action on health care costs.

Comments

[Jimi]

It was always part of the plan to allow the costs to rise out of control. The Agenda driven Left need a Single Payer System. The only way to get there is to bankrupt the private system, and ObamaCare is specifically designed to get us to that point, but just in a round-about way, because they know they can't get there without forcing it on the population.

The useful idiots of the left have been hoodwinked into believing that this is going to be a big payday for the private insurance companies, where as by design, they will most certainly go out of business, either by choice or by attrition.

You can't insure everybody and expect costs to go down (expected 20% of GDP by 2019 if ObamaCare is allowed to be fully implemented), and with the legislation setting up the strategy of limiting how the insurance companies can do business, and limiting how much they can charge it will only be a short amount of time before the masses are dumped into the "Public Option", where the really needy get their "Free Health Care" paid for and controlled solely by a Centralized Bureaucracy based in Washington D.C. From that point forward the narrative will always be the control of behavior and the rationing of care. The end result will be less care for less people at lower quality for more money....just like everywhere else that this old and weak idea has been tried.

[Donald Pay]

Jimi is right, of course. Many of us believe that the health insurance industry cannot deliver health care to all Americans at an affordable price if they are going to maintain their high administrative costs, salaries and bonuses. But we'll see. Mayve the health insurance industry change.

Why should we be paying top dollar to paper pushers? If the industry is made to compete in insurance exchanges they will have to make a decision: is the company in business to provide top dollar to administrators or is it in business to provide health coverage to participating consumers. Those insurers who can cover people while reducing costs will survive. Those who can't will go under. It's called creative destruction--ie., free enterprise.

[Jimi]

"It's called creative destruction--ie., free enterprise."

The Free Market system can work in Health Insurance if the government would stay out of it. By nature.....Capitalism is the true defintion of Economic Darwinism, and the setup already has the Mechanism needed to ensure the customer gets the absolute best quality at the absolute best price....it's called "Competition!"

The Right can except the mandate, but only if the private sector competition is allowed to flurish. The mandate is crap if the government is allowed to pick winners and losers and control how business is done in health care. Health Care can be treated just like any other business.

[GT]

Cost is not the problem. Cost is a symptom. Any attempt to control cost is like giving pain medication to a patient without first identifying the cause of the pain. Hence the failure of three decades of cost controls.

[lynn]

"Contrary to Nancy Pelosi's famous remark that we had to pass ACA to find out what's in it, one now wonders whether there was anything in it beyond an a vague grant of enormous powers. "

I actually did read part of the first draft of this Obamanation, and I was amazed at this very fact. There were numerous examples of unlimited and unspecified powers given to Sebelius and future committees and bureaucracies after the thing was implemented.

At least Ben Nelson is now reaping the benefits of his vote to pass this thing. He decided not to run again because he knew he would never win after his Cornhusker Kickback.