Obamacare delenda est

This op-ed in today’s USAToday does a nice job of briefly explaining how, when considering healthcare reform, incentives matter:

The medical system is about to be overwhelmed because there are no disincentives for overuse ObamaCare was lauded by many for covering all Americans with pre-existing conditions. That’s not the issue. We’re going to get into trouble because of the kinds of coverage that the new law mandates. There are no brakes on the system. Co-pays and deductibles will be kept low, and preventive services will have no co-pays at all. That sounds like a good deal for patients, yes? But without at least a pause to consider necessity and/or cost, expect waiting times to increase, ERs to be clogged and longer lead times needed to make an appointment.

…In the new system, my patients will be able to see me as often as they’d like. But will they get the same level of care? I don’t think so. I anticipate that more expensive chemotherapies and cardiac stents or transplants, for instance, will have a tougher time being approved, as is already the case in Canada.

…During the battle over this reform, you often heard, even from President Obama, that you’d be able to keep the plan you have. What he didn’t say — but what we now know — is that because of this new law, the private markets will have to remake their plans, that the costs will rise and that the plan you were told you could “keep” is in all likelihood no longer available. But when your plan changes, backers of reform will simply blame it on those evil private insurance companies.

Siegel makes an illuminating analogy:

imagine if your car insurance covered every scratch or dent. Wouldn’t you expect your premiums to rise to meet the expanded coverage? And wouldn’t you expect your auto repair shops to become clogged with cars that didn’t really need to be repaired, competing for time and space with other cars with broken transmissions or burnt-out motors?

He also reminds readers of what a low-margin business healthcare actually is:  (Recall that the combined annual profits of the 10 largest insurers is less than 1/7 of what Medicare loses to fraud every year.)

The truth is, private health insurance is a low-profit industry, with profit margins of 4% compared with over 20% for major drug manufacturers. With the additional costs of no lifetime caps and no exclusion for pre-existing conditions, these companies will be compelled to raise their premiums in order to stay in business. The individual mandate is supposed to be the tradeoff by providing millions of new customers, but there is no guarantee that this additional volume will preserve profits with all the new regulations. This is what occurred in New York state in 1992, when a new law denied exclusion on the basis of pre-existing conditions.


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