Obamacare's Coming Crisis of Acuity

November 20, 2014

A pillar of the Affordable Care Act, "personal responsibility," changes the issue from keeping a doctor to affording one for most working families.

As videos of MIT professor Jonathan Gruber - frequently cited as an expert on and one of architects of the Affordable Care Act by CMS, Congress, and the Obama Administration - surface exposing his claims that the American people had to be duped for their own good to get the law passed, he damages much more than his reputation. He undermines the legislative process that fixes unintended consequences of laws and makes them work by polarizing Democrats to close ranks and boxing in the newly controlling Republican House and Senate, both under pressure from their base supporters.

Regardless of what got us here, we are here and too deep into the process to drag ourselves out and too weighed down by major components that don't work to keep from sinking into disaster.

I strongly disagree with Gruber. The unpopularity of Obamacare among the American people is not rooted in their ignorance of what is or is not good for them, it is rooted in the politics, intransigence, and hubris of Congress and the administration.

The best example is the disingenuous policy of promoting "affordable" premiums at the expense of unaffordable deductibles. This fools no one living with that trade-off, and is doing real damage to the longer term health status of everyone. People forego care they can't afford, building a crisis of acuity. The growing emergency of epidemic diabetes, COPD, heart disease, kidney disease, and other chronic conditions is a clear and present testament.

Further, the administration's policy of claiming healthcare spending is "under control" is not only a blatant misrepresentation, it is a damaging one. Spending has little to do with a few more million people with insurance. It is far too early for exchange plans to have any positive effect on health status, which creates sustainable reductions in spending. It has everything to do with a hundred million people with unaffordable deductibles, many of whom are foregoing care, medications, diagnostics, and treatments. These are temporary effects with hugely expensive long-term consequences.

Ignoring hundreds of billions in annual waste in the healthcare system and trying to address it by paying less for it only exacerbates the root problem. Federal policy lavishly funding large, expensive hospital systems that tweak a few details and deliver no meaningful results while ignoring physician models that fundamentally transform the delivery system to deliver higher quality at up to a third less cost, is an institutional affront to common sense and responsibility.

Addressing these three areas with already available common sense solutions will allow both political camps to win and pay for it all with a few hundred billion dollars per year to spare. They will make the Affordable Care Act actually affordable and allow the opposition to take credit for contributing to fixing what is broken.

The American people are smart enough to know what is broken. They have to live with the consequences. The question is: Can Congress and the administration find a way to put the welfare of the American people ahead of their ideology to enable solutions instead of disabling them? Public pressure moves that dial, and that starts with each one of us.