ObamaCare's Terrible, Horrible, No Good, Very Bad Week
Three years ago, Blue Cross Blue Shield was described as "an undeclared Obama ally in implementing the health law," according to a Kaiser Health News/Washington Post report, offering coverage "in places other carriers may avoid." Given how ...cozy... the Obama White House can sometimes get with its private sector allies, it isn't much of a stretch to imagine than Blue Cross Blue Shield's multistate, multimillion dollar payout means the risk corridor is functioning exactly as intended -- delivering the goods to those with the pull.
But it isn't just the money -- care is suffering, too. And that's according to one of ObamaCare's architects, Dr Bob Kocher. Here he is from Sunday's Wall Street Journal:
What I got wrong about ObamaCare was how the change in the delivery of health care would, and should, happen. I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA. I joined my White House health-care colleagues— Ezekiel Emanuel and Nancy-Ann DeParle—in writing a medical journal article arguing that “these reforms will unleash forces that favor integration across the continuum of care.” We added that “only hospitals or health plans can afford to make the necessary investments” needed to provide the care we will need in a post-ACA world.
Well, the consolidation we predicted has happened: Last year saw 112 hospital mergers (up 18% from 2014). Now I think we were wrong to favor it.
I still believe that organizing medicine into networks that can share information, coordinate care for patients and manage risk is critical for delivering higher-quality care, generating cost savings and improving the experience for patients. What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care.
What we have here is a situation not really that much different from the "failure" of the risk corridors.
Small players -- those without pull in Washington -- are getting forced into mergers or forced out of business by ObamaCare's staggering complexities. Unlike the big players, they simply can't afford to comply with the law's 20,000 pages of paperwork and regulatory requirements. Again, this is as predicted, even by ObamaCare's architects. What they didn't predict (although plenty of the law's opponents did) is that, as Dr. Kocher admitted, care would suffer as a result.
But to our would-be central managers in Washington, consolidation is in itself a good of unlimited utility. A story from 2002 about Michael Moore visiting my old stamping grounds in Arcata, California, is a perfect illustration of just that:
Asked about Arcata limiting the number of pattern restaurants to nine, Moore said he didn't think it was a good idea. But what if corporate dominance transforms Arcata into "Anywhere, USA?" "You are in Anywhere, USA," Moore said.
Moore seemed to embrace capitalistic Darwinism. "If the small businesses suck they'll be driven out of business," he said. "If they got a good restaurant, people will go there and eat. You know in my town the small businesses that everyone wanted to protect? They were the people that supported all the right-wing groups. They were the Republicans in the town, they were in the Kiwanas, the Chamber of Commerce - people that kept the town all white. The small hardware salesman, the small clothing store salespersons, Jesse the Barber who signed his name three different times on three different petitions to recall me from the school board. F**k all these small businesses - f**k 'em all! Bring in the chains. The small businesspeople are the rednecks that run the town and suppress the people. F**k 'em all. That's how I feel."
Big business and big government love getting into bed together. Big corporations get regulatory protection from smaller, nimbler, and more innovative competitors. And big government enjoys more money and more power.
And if an industry doesn't have enough big corporations for big government to get into bed with? Then Washington can use the power of law to force them into being -- just like we're witnessing with health insurance and with health care itself.
Or as Caligula is supposed to have said, "Would that the Roman people had but one neck!"