The editors of Bloomberg enter the lists on reforming the PPACA:
Now that the rush of enrollment has passed, the challenge is to identify and respond to at least three kinds of concerns. The first involves relatively narrow problems with the law itself. For example, many state-run exchanges are poorly run; states such as Maryland and Massachusetts need help to fix them in time for the next open enrollment period, which starts in November. The law’s programs to cushion insurers from excess risk may also need reinforcement — if not enough young people sign up for insurance — to lessen any shocks to premiums next year.
That leads to the second kind of problem — with the health-care system generally. This includes persuading still more young people to sign up next time; getting more doctors and hospitals to coordinate care, making good on the promise to make medicine more affordable; and smoothing the transition from employer-based coverage for people who lose it.
I’ve mentioned before the stated objectives of the PPACA:
The Patient Protection and Affordable Care Act will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs.
It’s just about four years since the PPACA was enacted into law and neither of those objectives has been effected. Some say that other worthwhile objectives have been acconmplished and those were, in fact, the real objectives. To believe that you must believe that the president and Democratic Congressmen have been lying. I prefer to believe that they genuinely believed that insurance reform would effect the changes that were the stated objectives.
But that can only be true if care and insurance are identical. Not just congruent. Identical. And they most definitely aren’t. Care is limited by the resources available for care and those resources are limited by design. Roughly a third of doctors won’t accept new Medicaid patients. About 10% of doctors (and 57% of psychiatrists) don’t accept insurance at all and that trend is increasing rather than decreasing. Among primary care providers more than 30% plan to stop practicing within five years (more than 50% among physicians over 50). There is already a critical shortage and that’s before you factor in an increased number of people seeking care.
We’d better all hope that excessive care-seeking by the insured is a figment of our imaginations.
I think the prospects for reforming the PPACA in any substantial way are very slim for the foreseeable future. They’ll fight it out on this line if it takes all summer.