Monday, November 18, 2013

Fwd: qotd: Obamacare is the Trojan horse for what!?

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-------- Original Message --------
Subject: qotd: Obamacare is the Trojan horse for what!?
Date: Mon, 18 Nov 2013 12:47:28 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

Bloomberg View
November 18, 2013
A Conservative Cure for Obamacare
By Paul Howard & Yevgeniy Feyman

The Patient Protection and Affordable Care Act is floundering.

Conservatives who take satisfaction in that should be careful not to get
ahead of themselves. The rollout problems - however serious and
continuing - shouldn't be confused with the law's outright collapse.

The reality is that large constituencies are in place to work to
preserve Obamacare.

What strategy, then, would move us closer to the patient and
consumer-focused health-care system that conservatives desire while also
recognizing the facts on the ground?

The answer might be simple: Propose changes that will make plans more
affordable and drive enhanced competition among insurers and providers.
In other words, make Obamacare a Trojan horse for conservative
health-care reform. The administration of President Barack Obama has
quietly introduced regulatory decisions that have made the exchanges a
viable market for high-deductible, health-savings-account-eligible
health plans.

Shortly after the law passed, it looked like the administration would
use regulatory rule-making to kill health savings accounts. But
subsequent rules clarified that HSA-qualified plans were actually the
default structure for bronze plans on the exchanges. (Some silver plans
qualify, too.)

Far from being driven to extinction, high-deductible, HSA-eligible plans
have an opportunity to capture significant new market share on the

Conservatives aren't going to repeal or replace Obamacare anytime soon.
But they can propose smart fixes that build on the HSA-friendly exchange
architecture to make the law more consumer- and patient-friendly. Reform
from the inside can set the stage for even bigger changes in the
not-too-distant future.

Comment: In recent months, many conservatives have been attacking
Obamacare as being a Trojan horse that will open up health care to
single payer, even though actually it has taken us further in the wrong
direction to a private insurance-dominated market. This article from the
Manhattan Institute more accurately describes Obamacare as a Trojan
horse taking us to high-deductible, health-savings-account-eligible
health plans, often referred to as consumer-directed health plans. But
let me clarify that.

The low actuarial value plans that will dominate the Obamacare exchanges
are high-deductible plans that already are or with very little tweaking
will be eligible for associated health savings accounts (HSAs). HSAs
work well for wealthier people who can take advantage of the tax
incentives, and who remain healthy so that they can use the accumulated
tax-advantaged funds in retirement. But families with more modest
incomes will be selecting the low-actuarial value bronze and silver
plans only because of the lower premiums. They will receive little or no
tax benefit, and if major illness strikes, they may not be able to
afford the out-of-pocket expenses, even if qualified for subsidies.

From a health policy perspective, the HSA component can be ignored.
Except for tax incentives for the rich, the HSA is really only cash to
be used for out-of-pocket payments. Even if funded by the employer, it
is still paid by the employee in the form of forgone wage increases. So
it is the high-deductible and not really the HSA that has such perverse
consequences - patients forgoing care because of not having the money to
pay the deductible, - whether having an empty pocket or an empty HSA.

What is particularly disconcerting is that it always was intended that
the exchange plans be high-deductible plans, simply to control premium
costs. Also, employers are now rapidly converting to high-deductible
plans for the same reason. The consumer-directed advocates no longer
need to hide in a Trojan horse since the deductibles are already highly
visible. Right before our eyes, it has been the Trojan army of
deductibles that has been conquering our health security, placing those
with health care needs in servitude.

The Trojan horse came, and the neo-liberals pretend they didn't even see it.

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