My Turn: Obamacare — another view
November 18, 2013
The recent "My Turn" piece on Obamacare by U.S. Rep, Tom McClintock does make one correct statement: "The Obamacare website is a monument to governmental incompetence" — to the delight of conservatives across the country.
Unfortunately, much of the rest is misinformation.
There is no evidence that 80 percent of the signups are shunted to Medicaid. Those doctors opting out of Medicaid are doing so because congress, in their zeal to reduce spending, is reducing compensation.
The vast majority of signups are being assigned to private insurance policies, often with governmental help with payment. Some policies will be more expensive, some less, but until Obamacare takes full effect, we will not know how many of each.
Given the consumer's increased purchasing power under exchanges, it is highly likely that the average prices would be less than an individual could get going up against an insurance company on their own.
Similarly, what employers are choosing to do is because what they think of Obamacare, not what Obamacare is actually doing, because it is not doing it yet.
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The statement is made that there are now fewer people with insurance because of Obamacare. It is true that insurance companies can no longer offer policies that don't really insure. There are still plenty of policies do meet standards of adequacy.
There are also many people who are now covered by their parent's insurance and are people who are no longer excluded because of a preexisting condition.
The column makes the common misstatement that "American health care system was the finest in the world."
Sadly, this is not true. When evaluated by objective outcome criteria, the US ranks 37th, between Costa Rica and Slovenia (http://www.photius.com/rankings/healthranks.html).
This is largely because of our large number of uninsured people as the only "developed" country that does not provide health care for everybody — a problem that Obamacare seeks to correct.
Obamacare has its problems, but the Republican proposal has even more. It proposes to make health insurance tax deductible, but does not say how to raise the missing revenue (whatever happened to the balanced budget?) Unfortunately, many cannot afford health care even with a tax deduction.
It proposes people shop across state lines for insurance. (Whatever happened to state's rights ?) Imagine a nice cheap Massachusetts insurance policy trying to work out payment with Tahoe Forest for your health care.
It proposes accommodating preexisting condition by "expanding the risk pool" i.e.: put you in a group that is charged a lot more.
It proposes allowing a healthy young person is able to buy a policy for next to nothing. Unfortunately such a policy will cover next to nothing and healthy young people can have health disasters too. Medical bills are the commonest source of bankruptcy.
Also these sorts of cherry picking violate the basic assumption of insurance — everybody shares the risk together. That way the not young and healthy plurality like me will not have to pay an arm and a leg for our insurance.
Liability law badly needs an overhaul by non-lawyers, but medical liability accounts for only 1 percent of total medical costs.
The greatest defect in the proposal is what is not there: a way to get us all insured.
Rather than standing on our ideologies and hurling invective and blame, let's work together to fix the remaining defects in our health care system so we can give rich and poor the health care they deserve.
John Eaton, M.D., is a Truckee resident.