Obamacare Delays and Rearranging Deck Chairs on the Titanic: Old People Can’t Surf

This week the White House announced yet another Obamacare delay–actually, to be precise, they termed it an “accommodation”.  The reason given for the delay was that there were concerns voiced by the Obama administration that the “rush” to sign up during the final days may cause delays and result in a website crash.  Therefore, it was proclaimed that those who were “trying to sign up” would be given an extension to mid April to complete the process.  Overall there have been more than 20 unilateral changes/delays/exceptions made by the President without Congressional approval or oversight.  Exceptions have been provided for businesses and those who serve and work in our Congress BUT the individual mandate remains in place.   In the meantime, many that have been counted as “signing up” have no insurance and a large number have not yet paid their premiums.  However, the biggest problem with the manipulation of the Affordable Care Act (ACA) may actually be the commentary of one of its greatest supporters–Senator Harry Reid.

With the 2014 Midterm elections looming, many of those in Congress who are facing reelection have commented on the latest delays in an effort to positively spin the news.  As you might expect, those in leadership roles such as Senator Harry Reid have tried to minimize the impact of repeated Obamacare failures and fixes on his part (a desperate attempt to cling to a majority). In an effort to explain the need for the latest delay Senator Reid has shown his complete lack of connection with the nation.  He publicly proclaimed and was quoted in the Washington Times as saying that “some [old people] may not be educated about [or understand] the internet”.  In reality, more seniors than ever before are utilizing the internet in order to maintain medical information.  Pew Research Center data indicates that as of 2013, nearly 60% of all Americans in the 50-65 year old age group are actively engaged in internet based social media.  Even more telling is the fact that 50% of those over the age of 65 are involved in AT LEAST one internet based social media outlet.  It is clear that the internet and medicine will be intimately connected in the future.  Twitter, a popular site for micro-blogging in 140 characters or less has seen a 79% increase in utilization by users in the 50-65 year old age group.  When you carefully examine the Senator’s comments he is clearly referring to those in the 50-65 year old range–those over 65 will be enrolled in Medicare and have no need to go to the exchanges.  The younger populations-such as the millennials–are assumed to be web savvy from birth.

The delivery of healthcare is already evolving digitally–particularly in the areas of the electronic patient and in mobile health applications.  For Senator Reid to make such a statement concerning the inability of older Americans to “understand” the internet not only is insulting but  shows a complete lack of connection to and respect for the very people he claims to want to protect.  Seniors are more web savvy now and are able to access the web in a variety of ways–there is data from non biased scientific surveys (such as those conducted last year by Pew) to substantiate my statement.  In reality, his comments are a sad attempt to explain the inexplicable–why do the Democrats in Congress continue to hang on to a system that is clearly failing?

The ACA continues to suffer setbacks–most of them at the hands of the President who has dedicated his legacy to its success.  The latest delay (or accommodation, as the Obama Administration prefers to call it) is more about the lack of enrollees and less about the ability of older Americans to successfully interact with the internet.  Many seniors are surfing on a daily basis.  The internet is not the problem with the ACA and healthcare reform–rather it is the legislation that is broken and badly in need of a fix.

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6 responses to “Obamacare Delays and Rearranging Deck Chairs on the Titanic: Old People Can’t Surf

  1. Get over it. It’s here, needs to be amended, but is the law. Unfortunately the Republicans did not come up with a serious plan to deal with the uninsured and uninsurable. When I retired from my medical practice 7 years ago, I was shocked to find my wife uninsurable (hx of breast ca 15 years earlier and mild HBP and mild increase in cholesterol) both probably repeated only because she was a physicians wife. Healthcare planning is difficult, but has to start with the premise that it is available and affordable.

    • Thanks so much for your thoughtful reply to my blog. Actually I agree with much of what you say. YOu state–”It is law” and that I agree is true–what is at issue is the President is charged with carrying out and fulfilling the law–which he is NOT doing. He has manipulated deadlines, given exemptions and provided no real evidence for actual paid and signed up enrollees. The President–without any Congressional oversight–has changed and altered the law and its provisions to meet his own (and his party’s) political needs.

      I also agree that healthcare planning is difficult–it is even more difficult when you cannot predict which portions of the law will actually be enforced. The point of the blog was to highlight the fact that Sen Reid and others are simply making excuses for failed legislation rather than trying to make it work
      Best regards,
      Kevin R. Campbell, MD

  2. Conrad Derrick

    Dr. Campbell- I’m no particular fan of Pres. Obama, much less Senate Majority Leader Reid. However, as a lawyer who has over my career had to fight tooth and nail with insurance carriers when they have wrongfully denied health insurance and other claims, I will say that something needed (or needs) to be done to level the playing field between the consumers and the all powerful insurance lobby. Certainly parts of the Affordable Care Act need to be revisited, but parts like the provisions requiring coverage for pre-existing conditions, the ending of lifetime caps on benefits, and the provisions allowing for young adult children to remain covered under their parents’ policies longer, are beneficial and needed. The Republicans in Congress continue to criticize the ACA, but they have yet to present a comprehensive proposal for health care reform as an alternative. I say, instead of doing nothing but criticize, make your case for amendments to the ACA, enact them, and let’s see whether the revised package will make any difference in the delivery of health care in this country.
    One other issue which I would like to see you address in your blog. A while back there was a special issue of Time magazine, I think it was, dealing with the cost of health care. The main part of the issue dealt with a study that was done about hospital billings for services. As I recall, it said that the Center for Medicare Services (CMS) determines reimbursement rates based upon the actual cost of those services plus some reasonable figure for overhead. However, as you well know, the charges that hospitals list on their bills are many times the amount of the Medicare reimbursement rates. Similarly, the rates allowed by health insurance carriers for procedures and services are only a fraction of the actual charges listed on hospital bills. The same thing goes for the bills of physicians- i.e. CMS determines what the actual cost for those services is and adds some reasonable amount for overhead (which presumably includes some profit- since medical practices obviously are “for profit” businesses), when it determines the reimbursement rates for physician charges. Unfortunately, for the consumers who can not afford or do not for other reasons have health insurance, and do not qualify for Medicare (or Medicaid), the medical providers (hospitals, physicians, allied medical professionals) expect payment of the full amount of their bills, not the reduced rates allowed by health insurers and CMS. The point of the issue was that the amounts charged by medical providers are too high and bear little relation to the actual cost for such services. The issue also pointed out that the administrative staffs of hospitals are exorbitantly compensated, even hospitals that are so-called “non-profit” facilities. Frankly, after reading that special issue of Time, my thought was- “When are Congress and the President going to tackle part 2 of the health care crisis- maybe they should think about imposing caps on charges by medical providers. Of course, “free market” economists would say such proposals were “socialism” and they would drive physicians, in particular, out of medical practice. The other option would be to move toward a government run one payer health care system system like in Europe and Canada. The complaint would then be, I don’t want the government making medical decisions for me. Well, for those on Medicare and Medicaid, the government to some degree is already making those decisions. For those who are insured, the insurance companies are making those decisions. The only people who have the freedom to make “unfettered” health care decisions are the uninsured, but they can’t get health care because the providers won’t treat them without “cash up front”. So, I say, “If not the ACA, what?”

    • Dear Mr Derrick
      Forgive my delayed reply. Thank you for reading my blog and providing a thoughtful response. However, your statement that Medicare reimbursement rates are based on cost + reasonable overhead is not even close to being accurate. In fact, recent surveys of large physician groups have revealed that with the expansion of Medicaid ( which reimburses at 55% of what most consider to be fair market value for procedures) nearly 2/3rds of MDs are likely to no longer accept government based insurance/payments going forward

      Simply put– doctors can no longer afford declining reimbursement, increasing paperwork and escalating malpractice — without tort reform, there is no healthcare reform.

      Best

      Kevin

  3. Conrad Derrick

    Dr. Campbell- I would love to continue this debate over a beer sometime. Tort reform?! That is a bugaboo created by liability insurance companies. Run away jury verdicts are so few and far between that they do not have any real impact on the cost of doing business and should not have any impact on insurance premiums. There is a common misperception that juries award excessive verdicts and punitive damages willy-nilly. In my 34+ years as a practicing attorney, particularly in the past 20 years, I have found most juries to be extremely conservative in what they are willing to award- thanks in large part to the insurance industry’s vigorous advertising campaigns suggesting that insurance fraud is rampant. What the general public also doesn’t understand is that so-called “run-away” jury verdicts are often cut by the trial judge as a result of post-trial motions, or the verdicts are never paid in full because the parties settle the case for some significantly lesser amount while it is on appeal. My observations are based upon 16 years as an “insurance defense” attorney before I changed sides, so I think I have some experience knowing how the insurance industry operates. Nevertheless, I do enjoy a spirited debate on the issues!

    Conrad Derrick

    • Mr Derrick
      Thanks for your thoughtful comments. I will continue to respectfully disagree. The “John Edwardses” of the world have made a name for themselves through ambulance chasing and high dollar verdicts against hard working caring physicians. Until there is tort reform, healthcare costs will continue to rise and unnecessary tests will be ordered–all in the name of defensive medicine. I look forward to the day when the patent, not the potential plaintiff’s attorney becomes the focus of the patient encounter.
      Best regards
      Kevin

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