Liberal New Republic editor Jonathan Cohn admits that under Obamacare the California networks have become exceedingly restrictive regarding doctors and hospitals. He even points out that one of Los Angeles’ finest hospitals, Cedars-Sinai, isn’t in the new Obamacare networks.
But don’t be upset, Cohn coos, Cedars-Sinai isn’t all it’s cracked up to be. And people just wanted to go there for the snob appeal, anyway, in order to hobnob with the rich and famous.
So don’t worry, be happy. You didn’t really know what you wanted, or you wanted it for bad reasons.
Get ready for this sort of argument to come your way from other liberals who are still actively promoting the wonders of Obamacare:
…[W]hile we might think we know what’s good for us medically, the relationship between hospital prestige and hospital quality is a lot weaker than it may seem. Health insurance is changing for some Americans because of Obamacare, but the changes are not the catastrophe many of them think….
Ratings from HealthGrades, a Denver-based company that uses government data and other information to judge hospitals around the country, [indicate] Cedars is “better than average” at preventing death following a serious complication from surgery, for example, but “worse than average” at letting patients get bed sores and bloodstream infections from catheters….
According to official government data, the readmission rate for heart failure and pneumonia patients is well below both the national average and the rates at other area teaching hospitals. But that doesn’t mean Cedars is the place to go when you have a routine broken arm.
But you may have already guessed that Cohn is merely warming us up for the biggie, the solution to all these woes and the conclusion of his piece:
The only way to avoid these problems altogether is to have government do the job instead. In other words, you need a single-payer system in which all hospitals accept everyone’s insurance. But that conversation never got past the phrase “government-run medicine,” and Americans, perhaps unwittingly, chose to place their faith in market forces. The insurers have adapted and so have the hospitals. Now it’s the consumers’ turn, and that means relinquishing the idea that cachet always equals quality. For many people, the hospital of the stars may seem like just another piece of the Beverly Hills lifestyle tantalizingly out of reach. But like so many other things in Hollywood, the true value of care at Cedars-Sinai might involve a little make-believe, too.
That last paragraph gives the reader the full flavor of Cohn’s agenda and assumptions, as well as his style. Americans “perhaps unwittingly” chose “market forces.” Those stupid Americans again, who don’t know what they’re doing. Of course, Cohn ignores the fact that Americans never actually chose Obamacare at all. It was never popular, and was passed through devious and Byzantine means. And “market forces”? Obamacare is so far from being an insurance system based on market forces that Cohn’s statement is quite simply ludicrous. He knows better, but he’s hoping we ignorant “unwitting” folk don’t.
As for that “cachet” factor — why, everybody knows that we all choose hospitals because they’re the ones the stars go to. Sort of like buying a Prada purse for $2K just to get a chichi bag, rather than a cheapo ripoff that’s really perfectly good. Shame on us for being such snobs!
Cohn ignores the entire topic of liberty and choice, as though it is of no importance whatsoever. And to Cohn, perhaps it isn’t — at least, for other people. Cohn himself is likely to have employment-based insurance obtained through his editorship at TNR or through the University of Michigan, which employs his spouse. Someone with employment-based insurance would not ordinarily be dealing with the exchanges but would instead be insured under the old, pre-Obamacare system. For now.
You may wonder how a hospital such as Cedars-Sinai can afford to turn down membership in the Obamacare exchange network in California. It may be because the hospital has other alternative sources of patients at present, and so at the moment it doesn’t need the exchanges to function. One source of Cedars’ patients is probably the very rich, many of whom could pay out-of-pocket. But the second source — which would be the bigger group, even in star-studded Los Angeles — is most likely composed of people with employment-based insurance, a type of coverage which has not yet fallen under the same restrictions as insurance in the individual market.
The vast majority of people in America still have employment-based insurance. But ask not for whom the bell tolls, it may soon toll for them starting in 2015. We don’t yet know exactly what will really happen at that point. But if employment-based insurance becomes more restrictive too, which is likely, then hospitals such as Cedars-Sinai could be facing the choice of accepting those lower reimbursement rates or going out of business, unless the hospital could find enough other patients to survive.
That might be somewhat similar to what would happen if single payer is ever enacted. The more the government controls the entire operation, the more freedom it has to set the reimbursement rates. When it becomes the only game in town, it has the most power of all. The entire field of medicine would become less lucrative and almost certainly less innovative, and would begin to attract fewer people as payments declined.
It brings to mind Churchill’s old adage about “equality” under socialism: “Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.” Everyone will finally be equal, except the very very rich, who will always find a way to be more equal than others.