Once upon a time, a wonderful President and a compliant Congress decided to create the most idyllic health care and health care coverage system that could be imagined. Everyone in the country would have health insurance and the cost of that health insurance would miraculously go down. Evil health plans would be forced to accept anyone who wanted coverage and to charge reasonable premiums and spend most of those premiums on health care. Wonderful health insurance exchanges would be created that gave everyone who wanted to buy health insurance a place where they could quickly and easily find, compare and select coverage. And while the citizens would have to buy insurance or pay a penalty, everyone would be so delighted by the great and inexpensive coverage that no one would really have to worry about paying that penalty. Physicians, hospitals and other providers would be incented to and would be paid only for providing “value-based” care, which would mean every patient only got exactly the right and best health care for them; and the providers would be so happy that they were providing such great care and practicing in such a hassle-free environment. Everyone, providers and health plans and patients, would all have phenomenal information systems that easily collected and shared health data and that helped them make good decisions. Evil, greedy businesses would be required to provide health insurance coverage for their employees, or pay a penalty, but not too good a coverage, or they would pay a penalty. And evil, greedy drug and medical device companies could keep selling their products at an exorbitant profit but had to contribute to help pay for all the outstanding coverage people would be getting. All this would be done at an administrative cost of only tens of billions of dollars a year. And on the seventh day, the President and Harry Reid and Nancy Pelosi rested and looked upon their creation and said, this is good.
But lo, there was great evil in the land, doubters of the virtues of this magnificent scheme and those who opposed the President just to oppose him, for how could anyone possibly imagine that such a wonderful system created by such a brilliant President might not work. And somehow these evildoers made this health system paragon of excellence not work like it was supposed to. They caused the insurance exchanges to not be ready on time or to not function right (unless functioning right means it should take ten hours to get enrolled), they caused the coverage that was available to cost much more than the same coverage did before, and to have higher cost-sharing, so that the people could not afford to get services. They caused the people to be confused by the subsidies and penalties. They made providers overwhelmed and discouraged by the tens of thousands of pages of new regulations, programs and initiatives that they had to comply with, by their maddening new information systems and by reimbursement uncertainties. Health spending began to increase at a faster rate. Drug companies and medical device makers charged even more for their new products. And although there couldn’t possibly have been anything wrong with the system as designed, these evildoers somehow were able to make it all go wrong. And the people became disgruntled, for this was not what they had been promised, and they wondered if this really was health care paradise. And there was great confusion in the land and no one knew what would come next.
April Fool’s, just a fantastic tale!!! Oh, wait, that really did happen, oh no, never mind.