Obamacare: Examination and Response
An appraisal of the Affordable Care Act and-- with some guesswork-- its tricky politics. Then, a way to capture major new revenue, even paying down existing Medicare debt, without raising premiums or harming quality care. Then, an offering of reforms even more basic, but more incremental. Finally, the briefest of statements about the basic premise.
Gail Wilensky, the former director of Medicare and Medicaid, was quoted as disdainfully describing the Affordable Care Act as more a system of "coverage extension" than healthcare reform. Many of us who have struggled with the distortions which healthcare insurance has imposed on healthcare itself, share that sense of frustration. When you get down to it, Obamacare attempts to do very little except mandate universal coverage with insurance. But be careful what you wish for. A program which trumpets its intention to solve the problems of cost and quality, might just decide to do almost anything to the healthcare system. In the following chapter, we review some of the things the Act might have done, that seem like valuable contributions to cost and quality. Just in case the administration is looking for ideas.