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Editorial: Will Obamacare work? We’re about to find out

For at least three decades the mantra, particularly among conservatives, has been that competition will bring down the cost of health care. By and large, for many reasons, it hasn’t, but under the Affordable Care Act known as Obamacare, the belief is about to get a direct test.

If too few insurers agree to participate in the health care exchanges, if the prices insurers and providers demand are too high, and the subsidy required to make insurance affordable for the tens of millions of Americans without it too big, the experiment will fail. If so, the outcome will almost certainly be what almost all developed nations have and most critics of Obamacare don’t want: a single-payer health care system.

Only one insurer, Anthem Blue Cross Blue Shield, will be enrolling patients when New Hampshire’s federal/state health insurance exchange opens next month. So no competition there, at least not among insurers. That’s expected to change next year, since several insurers licensed by the state say they expect to join the exchange once they have more information.

Instead, as Concord attorney Curt Whittaker explained in these pages last week, market place forces came into play when Anthem, like many of its counterparts nationwide, decided to offer customers on the exchange a limited network of providers. The network incudes just 16 of the state’s 26 hospitals, those willing to swallow hard and accept the reimbursement rates Anthem offered. Concord Hospital is notably absent from the list. Mike Green, the hospital’s CEO, says that accepting Anthem’s rates would threaten the long-term financial health of the hospital and its ability to provide high-quality care. That may well be true.

The details aren’t public, but the reimbursement rates Anthem offered providers were probably based on those paid to care for people age 65 and older under Medicare. That rate is less than the going rate charged by providers, though not so low as the rates paid to care for the poor on Medicaid. They are, however, low enough that Anthem expects to lower the premium charged for its exchange plan by about 25 percent. Can hospitals and other providers maintain the level of care now provided when they are paid Medicare-like rates to care for more and more of their patients? It looks like we’re going to find out.

No way has yet been found to create a system with low costs, high quality, and convenient and rapid access to care. Something has to give, and in recent years, it’s usually been the percentage of health care costs paid by employees instead of employers. In the model Anthem is about to launch, it appears that convenience will suffer. People will have to travel further, and perhaps wait longer, to get care. If the price is right, that trade off may be acceptable.

In time, as more people shop on the exchange, perhaps because more employers drop health plans in favor of subsidizing employee purchases of insurance on the exchange, providers not in the network will presumably feel pressure to accept the reimbursement rates insurers offer. Otherwise they’ll lose market share. Again, we’ll see.

What may also happen, and this may be the best outcome of all, is that the changes called for under the Affordable Care Act cause insurers and providers to collaborate in ways that reduce costs by doing more to keep patients healthy in the first place. Continuously increasing health care costs, long the leading cause of personal bankruptcy, aren’t sustainable. The health care reforms under way may not be the answer, but if they don’t succeed, either the rolls of the uninsured will continue to grow and decent coverage become a rarity, or everyone will wind up on some form of national health insurance.

Legacy Comments8

It is going to be a major problem. The trade off is suppose to be lower costs. But sometimes you get what you pay for. The issue for many is traveling further, but another issue that seems to be left out of the discussion is how long it will take to get an appointment, have tests etc. That can affect folks who just might have a medical problem that would have a better outcome if it was discovered earlier. Costs for Anthem depend on the volume of folks who sign up. What if young folks decide they do not need insurance till they become sick and put off buying it? The volume on the network shrinks and Anthem has to raise it's prices. That is plain and simple math. Not many folks believed that business would put folks on part time or pay penaities either, but it is happening. Govt has a bad track record of running anything, yet folks trust they will do healthcare right. Did the govt all of a sudden become efficient, competent, and trustworthy about their grand ideas?

many democrats should lose their seats over this train wreck called the "Affordable" ObamaKare....many already have..... others like the architects have quit congress

Maybe...don't know...we'll see....might be true...who knows...Huh,...this does not sound like the Obamacare that was sold to us 4 years ago....

It looks like the Monitor, the Guardians of Ignorance, is in full scale cover Obama’s butt mode. Let’s face it the extreme left is not going to hold Obama accountable for any of his long list of failures until the American people rise up and vote his lackeys in congress/senate out of office. Today in the Monitor: Creativity challenged and talent less Editorial Cartoonist Mike Marland, continued his mindless democrat hacking by attacking those who do not support Obama’s failed policies. The problem with Marland the mental midget is that he used Obama supporter, democrat Max Baucus words to describe ObamaKare: It’s a train wreck to attack those disagree with ObamaKare (an overwhelming majority of Americans). Next let’s look at Katy Burns, well known Obama sycophant and fellow head in the sand liberal who refuses to hold Obama accountable. Mrs. Burns cries about the rich getting richer but fails to hold Obama’s policies accountable. Mrs. Burns says nothing about how the average family income is less under Obama’s best years than Bush’s worst years and how the rich are getting richer under Obama. Our first step in holding Obama accountable is to vote out Shaheen, Kuster, and Shea-Porter out in November 2014.

Van, the emotional hysterics allow their ideology and false beliefs to eclipse reality and eclipse their intellect. Obama could commit capital murder and they would defend him and make some excuse. Progressives swooned over this man because he was going to be the first "black" president but even on election night, Tom Brokaw and Charlie Rose pined that: "we really don't know a lot about this man and what his policies are and will be". Yet, both of these journalists were Obama supporters. People voted for the idea not for policies, people voted to make history not with the outcome in mind. Ideologues and those who believe that they are "informed" and the rest of the masses are not, will never yield. They will never stop their march towards Socialism or even more repressive government as they believe that everyone should have equal outcomes. All that this does is waste our lifetimes, we can't live our lives and enjoy them when we have to constantly be looking over our shoulders and wonder what some ideologue is doing to muck up the works.

This is the real hope of progressives and the Monitor editors: "everyone will wind up on some form of national health insurance". What the editors ignore is that someone has to pay for the people who will be in the exchanges and it will be those who have company paid health insurance. I attended a meeting where insurance consultants, the insurance company and others presented what the costs to the company and employees would be once Obamacare takes effect and the numbers were staggering. The company which already has a plan paying 75% of premiums will double their cost, plus pay a "tax" to offer insurance to employees; something that they already do. Premiums for employees could almost double, deductibles will go up as will co-pays and prescriptions will cost more. It was explained that all of this is due to Obamacare as those with insurance now will pay more to cover the rest of the people who will be covered by exchanges. The option to drop insurance will cost companies about the same as to cover employees. Moreover, younger folks will now subsidize the exchanges as well by paying too much for coverage that most probably will not use or need. I read in the NY Times the other day that people who are now self insured may realize a slight savings but many will pay more. One has to ask how this is "affordable". A family of four covered currently covered by their company with a household income of $80,000 to $100,000 will probably pay between $4000 and $6000 more in health care. It makes no sense. That takes $80 to $120 out of household budgets and what are families supposed to cut back on? Heat? Food? Clothing? Maybe they will cut back on discretionary spending like movies, eating out, vacations or other extras. Progressives would probably say...."well they should". But those 'extras' create jobs for people and discretionary spending on 'extras' stimulate the economy. Obamacare has set up a win-win for single payer advocates and a lose-lose as it will reduce choice, increase lines and wait times, inevitably ration care, cost people more of their household dollars and put us in a position where progressives will say: "oh, you can't go back, people will lose their healthcare". No Monitor editors, this is not an 'experiment' and 'we will see' moment, this is the end of health care as we know it for millions of people who were just plain happy with what they had. To take the attitude above with the Concord Hospital that the hospital's long term financial health might be threatened if they participate in the exchanges with Anthem as "that may well be true" is truly an ignorant statement. Again the Monitor editors are allowing their ideology to clearly eclipse their common sense and intelligence.

Exactly ItsaRepublic. ObamaKare is so bad its goal is to go to full scale socialized medicine and that would be a national disaster.

you're right, You can see how socialized medicine has devastated Canada, the UK, France and pretty much every other developed country in the world. What it will do is ruin us all!! Save us from Socialism at all costs !!!Thanks to all those in the carpe diem club for keeping America safe from that nasty socialized medicine. You guys are just too precious..SMDH

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