Thursday, October 27, 2016

ACA and Reality

We have been following Health Care Policy for eight years now. It is easier to do cancer genomics than it is to unravel the uncertainties and complexities of Government Health Care Policy.

Along comes the MIT "Professor", one of the authors, who thinks we are all stupid, if memory serves me correctly, in NEJM and states:

As the country focuses on the 2016 election, we offer several key messages from our findings. State implementation continues to strongly affect the success — or shortcomings — of the ACA. This reality is most obvious in decisions about whether to expand Medicaid under the law, since the lack of expansion in 19 states has left roughly 3 million adults without coverage. But state policies also affect middle-income families’ ability to sign up for exchange coverage, which has been impaired in some states by legislative barriers to enrollment and lack of outreach. In essence, some state policymakers who rail against the ACA as a failed policy have created a self-fulfilling prophecy by taking steps to prevent people from signing up and benefiting from new coverage. Such actions may have contributed to the large gap between exchange enrollment rates in states participating in the federal exchange and those in states with their own exchanges. Though undermining coverage expansion may be politically expedient in some places, it is indefensible from a public health perspective. With one presidential candidate pledging to build on the ACA and the other pledging to repeal it, and with state-level battles over the law ongoing, much is at stake in this year’s election. Overall, our results reveal several ACA provisions working effectively to expand health insurance coverage to millions of Americans. Whether the law continues to expand coverage in the future most likely hinges on the outcome of the November election.

The ACA has become a bureaucratic mess. From ICD 10, the EHR, Quality Metrics, ACOs, and the like we now have a system which has massive overhead, dramatic burdens, reduced care etc. One of the major problems is that the Millennials do not get the mandate policies thus making private, or any other plan, excessively costly. We argued eight years ago that it must be universal, it must cover all, like auto insurance. Otherwise there will be arbitrage. Humans, even the Millennials, are economic machines optimizing their own returns. So why pay for something if you don't need it.

Then again in this article in NEJM we have the author who feels we folks are just fools, I think that is what he implied, and we can be manipulated, again I believe he implied that as well. Thus in my opinion why would one ever listen again? Poor MIT, what is happening? Leadership perhaps?