Parallel Universes

From John Goodman’s Health Policy Blog:

A short while ago I asked a Boston cab driver how she liked the health care system there. “It’s a hassle,” she said. “I had to go down a list of two dozen doctors before I could find one who would see me.” Turns out, she was on MassHealth (Medicaid). So I asked, “Did the list of doctors come from the Yellow Pages?” “No,” she said, “MassHealth gave it to me.”

Why am I telling you this story? Partly because I live in two parallel universes. One is the universe of health policy conferences at the Brookings Institution and the American Enterprise Institute and articles published in such places as Health Affairs and the New England Journal of Medicine. In the other universe, I quiz taxi cab drivers and others about what their life is like. I would lose a lot of good friends if I told you which universe is more informative.

Yet the more important reason for the story is that fully half of all the people who will be newly insured under ObamaCare are going to be in Medicaid. And if Massachusetts reform is the guide, most of the rest will be in highly subsidized plans that pay doctors little more than what Medicaid pays.

That brings me to the second set of parallel universes I live in: the world of public policy and the world in which people talk about public policy. Those two worlds are as different as night and day. Consider that:

  • While defenders of the new law have chattered endlessly about people who are uninsured because of pre-existing conditions (turns out there are only 12,500 of them) almost no one seems to have noticed that 16 million people are not only going to be forced into Medicaid, they are effectively going to be denied the right to buy any private insurance — whether or not they have a pre-existing condition.
  • While the Obama administration takes every opportunity to boast about the removal of annual and life-time private health insurance benefit limits, almost no one seems to have noticed that we are about to put 16 million people into plans that routinely limit benefits — regardless of what was promised at the point of enrollment.
  • While a case challenging the constitutionality of a federal mandate to buy insurance wends its way toward the Supreme Court, fully one-half of the newly insured under ObamaCare won’t be paying any premium at all and most of the rest will be paying premiums that are only a fraction of the real costs of the insurance.

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