Healthcare Comes to America – The ACA Is Working

Last night was the cutoff for signing up for health insurance on the new Affordable Care Act (“Obamacare”) healthcare exchanges.  Despite a very rocky start and despite an incredible blitz of lies and propaganda against it by opponents, the program has met its first year target. Charles Gaba at ACASignups tracks the numbers so we don’t have to:

…in spite of everything–the terrible website launch of HC.gov and some of the state sites; the still-terrible status of some of the state sites even now; the actively-hostile opposition and obstructive actions in certain states, the negative spin on every development by some in the news media–in spite of all of this, over 7 million people nationwide enrolled in private, ACA-compliant healthcare plans between 12:01am on 10/1/13 and 11:59pm on 3/31/14…slightly surpassing the original CBO projection for that period.

Of course, the deadline isn’t that final depending on where you live and whether you already started an application or you fall into other special categories.  Again, Gaba tells us:

the enrollment “extension period”, which is 15 days in most states, but which actually runs until April 30th in Oregon (without any “started by 3/31” requirement that I can see) and even all the way out until May 30th in Nevada (with the “3/31 start” requirement). Only 3 states (CT, RI and WA) aren’t offering any extension period at all, and I’m not entirely sure about Rhode Island as their press release was a bit confusing. I also have no idea know what the status of Hawaii’s exchange is.

Of course the 2nd open enrollment period kicks off again this November, but there’s also the other types of enrollments which haven’t ended, even for the current year.

  • Medicaid has no cut-off date; if you qualify, you can enroll at any time.
  • The SHOP exchanges (small business) don’t have a cut-off date. Most of them still aren’t functional (only about 70,000 people are covered by SHOP policies so far nationally), but some are, and they’re year-round.
  • If you’re one of the 5.2 million Native Americans living within the U.S., there’s no cut-off for you either.
  • Finally, for the rest of us, you can still enroll in an exchange-based QHP if you have a major life event such as getting divorced, giving birth, losing your job and so on.

This is a very good start for the country and for the economy.  My own preference, documented elsewhere, was and still is for a single-payer system similar to Canada’s.  But this is significant start.

Doctors Vote With Their Feet and Move to Canada

Opponents of universal healthcare tell a lot of tall tales.  In particular, one common tale we were told in the debates about whether the US could provide near-universal healthcare insurance coverage (the so-called Obamacare) was that “socialized” medicine doesn’t work. In fact, an oft-repeated tale is that the Canadian socialized insurance system is supposedly so awful that Canadians can’t get enough doctors and that doctors flee the Canadian system to go to the land of opportunity, the US.

Well, it’s more than a tall tale.  It’s a lie.  The Windsor Post points out how for the last ten years, the net flow of doctors has been from the US to Canada.  Yes, that’s right.  To the degree that doctors are migrating at all, they’re moving away from the bloated, inefficient, costly system that the US runs and moving to Canada.

“The job here is better,” is how Florida native Dr. Christopher Blue summarizes why he moved here in 2010 with his wife, Dr. Kristen Kupeyan (a Windsor native), after attending medical school in the Caribbean, and training in the United Kingdom and Michigan. Here, he works as a hospitalist, an emergency doctor and assists in surgeries at local hospitals, and has two practices with his wife. Having such a varied career is something he couldn’t do in the U.S. [bolding mine)]

But the lure of the Canadian system is more than the ability to have a more varied (and likely more meaningful) career, it’s also a matter of sheer economics.  Despite the US system ultimately costing Americans a multiple of what the Canadian system Canadians, and despite Canadians living longer and getting more out of their healthcare, for doctors, it’s dollars and cents.

 One of the big draws for him (Dr. Sajad Zalzala) was Canada’s system of universal health care. In the States, the health care system is like a class system, he said.

“If you have Blue Cross/Blue Shield (health insurance), you’re in great shape, you can go to what hospital you want, specialists, but that leaves everyone else not as fortunate,” he said.

…he has low overhead and fewer hassles. In the States, you need two or three staff just to fight with the insurance companies all day long, he said.

“It’s good. With the OHIP system you pretty much know how much you’re going to get paid as the patient leaves the room, as opposed to the States,” he said, explaining the insurance company may adjust your bill or reject it entirely.

The name for Canadians give to their healthcare system, Medicare, is a clue to how the US could dramatically improve its own healthcare system.  The US has a Medicare system also, and the two Medicares are actually quite similar in structure and operation.  The US Medicare system is also actually reasonably efficient, althought it could be more efficient if it, like its Canadian namesake had more power and authority to negotiate prices.  But the key difference is that the Canadian Medicare system covers all Canadians of any age.  The US Medicare system only covers Americans 65 years or older.  Much of the difference and savings comes from having a single payer insurance outfit.  Since the government system is the only insurer and covers everybody, it has no incentive to find administrative excuses to not pay or to exclude people.  Private insurance companies in the US do.  Thus the US spends 10-15% of every healthcare dollar paying for paper-pushers and phone-call-talkers that try to find reasons not to pay for services that have often already been performed.  That’s why US doctors need so many staff personnel to track the paper and fight the insurance companies and file claims.  The Canadian doctors don’t need that extra staff – staff that doesn’t add anything to the quality of care but adds a lot of cost.

Intergenerational Transfers, Social Security, and Medicare

The presentation I’m making to some open classes on campus this week and to a community group in early May.  Bottom-line: When media pundits and politicians tell us that the older generation is “screwing” the younger generation, they’re lying.  There sound economic theoretical and empirical reasons for intergenerational transfer programs and social compacts like Social Security and Medicare.  And, there’s not factual reasons to say “Social Security and Medicare are going bankrupt”.  Quite the contrary, these programs will be there in the future when the younger generation retires and even when my as-yet-unborn grandchildren retire.  The only real threat to Social Security and Medicare comes from an overly-privileged 1% of the wealth and income distribution that frankly doesn’t understand how the programs work.