ObamaCare signing

It goes without saying that the cataclysmic legislation that very few of our intellectually challenged Congresspeople read — I hope this reminds everyone of Al Franken and Nancy Pelosi — is very likely going to die under the weight of its ill conceived business plan. Aetna is now pulling out, and the reasons are not subtle: $300 M in losses this past year….

The WSJ states it mildly:

Beyond Aetna, most insurers including nonprofit Blue Cross Blue Shield plans are hemorrhaging cash amid rising costs, disappointing enrollment and the failing ObamaCare co-ops. UnitedHealth Group said in April it would liquidate all its Affordable Care Act coverage. About the only companies above water are Medicaid contractors accustomed to delivering a lower standard of medical care.

This was supposed to be the signature achievement for Mr Obama, yet it is proving to be singularly failed in almost every aspect.  And when we hear that we have this or that many millions who “are now insured who previously did not have insurance”, please ask yourself this:  does “insurance” = “healthcare”?  It most certainly does not.  ABC Insurance purchased on some confusing state exchange is filled with surprises:  rising premiums (subsidized or not), rising deductibles (usually not subsidized), and a greater and greater number of physicians who just are not taking new patients with Medicaid level fee schedules.  THAT does not translate into anything other than a new headache and a rude trick.

When the law was passed, very few — if any — members of Congress had a clue as to what was in it or what it meant.  But they passed it anyway they did.  It reorganized the payment system into super HMOs known as “ACOs” or Accountable Care Organizations.  This was the ;language that effectively allowed the massive merger and acquisition behavior that we have seen since 2010.  It has gotten to the point where there are only 4 or 5 actual “employers” of hospitals, physicians, and nurses in the country.  And they do not work for YOU.  These units were lauded 6 years ago in those venerable sources like the New England Journal of Medicine for their ingenuity and potential:

ACOs are best understood as affiliations of health care providers that are held jointly accountable for achieving improvements in the quality of care and reductions in spending. ACOs may take a variety of organizational forms, including integrated delivery systems, primary care or multispecialty medical groups, hospital-based systems, and even contractual or virtual networks of physicians, such as independent practice associations.1 In designing an organizational framework, providers and regulators will have to contend with trade-offs involving such factors as control and governance of the organization, the extent of integration among providers, allocation of risk and rewards, and exclusivity of membership. 

It appears likely that the regulations will allow for considerable variation in the form of ACO that providers adopt but will nudge them toward greater integration and more interdependent relationships. And well they should.  Thomas L. Greaney, J.D., N Engl J Med 2011; 364:e1January 6, 2011DOI: 10.1056/NEJMp1013404

I love the “and well they should part”.  And note the JD.  That “greater integration” was code for a green light for massive business mergers that have left the public and the physician-patient relationship — already on life support in 2009 — now effectively flat-lined.  Now, panicking, the Obama administration is attempting to out a stop to the merger mania thru the courts.  But unless the law is repealed, this will continue as it is the only way to spread the unreasonable financial risks inherent in the law itself.  Which is why the larger groups like Aetna and United Health Care have decided to dump the plan rather than merge their way out of the red ink it is creating.

In the meantime as I once told Senator Durenburger many years ago:  health insurance does not = actual health CARE.  Health Care is what goes on when you are injured, sick, frightened, or depressed and seek help.  No amount of political grandstanding or legislation will change that.  That’s why you need to read laws before you pass them,

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