When Obamacare was passed, many individuals in the conservative circles made predictions about the effect this legislation would have regarding the health care insurance industry, health care providers and acquisition of health care itself.  At the time, those pointing out the failures of Obamacare were ostracized, called “doomsayers,” and outright liars.  But, as time has gone by, these predictions have been seen and continue to be exposed and felt across the country.  Stories of drastically increased health care insurance premiums, policy cancellations and pure unaffordability of premiums along with services that were previously covered now not covered have made headline news.   These stories were so frequent and horrid that Harry Reid (D-NV) called everyone who had an Obamacare horror story a liar in an attempt to “cover” the Democratic bumble in its passage.

“ALWAYS REMEMBER”

As it turns out, one of the architects of Obamacare, Ezekiel Emanuel, has just disclosed that “insurance companies as we know them are about to die.”  In fact, Emanuel predicts the end of health care insurance companies by 2020.  I wonder if Harry Reid would like to take to the stage and call anyone who said this years ago a liar now.

In an op-ed featured on New Republic, Emanuel stated, “The good news is you won’t have insurance companies to kick around much longer.  The system is changing.  As a result, insurance companies as they are now will be going away.  Indeed, they are already evolving.  For the next few years, insurance companies will both continue to provide services to employers, and, increasingly, compete against each other in the health insurance exchanges.”

Emanuel, in his op-ed, stated that individuals blame the insurance companies for increased premiums, denial of insurance, or denial of high-priced drugs because they are the easy target.  He stated that individuals do not place the blame accordingly:  underlying hospitals or physicians who charge high prices and pharmaceutical companies who set the prices for drugs.  Seeing this “misplacement” of blame, politicians seize on this position and gain support when they attack the health care insurance companies.  But, Emanuel claimed the actions of the insurance companies are the result of the way our health care system is structured:  “how it incentivizes and forces certain behaviors.”

According to Emanuel, new groups called “accountable care organizations” or ACOs “must start competing directly in the health care exchanges for exclusive contracts with employers.”  Because of Obamacare, new participants will “force insurance companies to evolve or become extinct.”

According to Emanuel in New Republic:

The accountable care organizations (ACOs) and hospital systems will begin competing directly in the exchanges and for exclusive contracts with employers.  These new organizations are delivery systems with networks of physicians and hospitals that provide comprehensive care.  This health delivery structure is in its infancy.  Today there are hundreds of these organizations being created and gaining experience within government sponsored programs or getting contracts from private insurers.  They are developing and testing ways to coordinate, standardize, and provide care more efficiently and at consistent higher quality standards.  Over the next decade, many of these ACOs and hospital systems will succeed at integrating all the components of care and provide efficient, coordinated care.  They will have the physician and hospital networks.  They will have standardized, guideline driven care plans for most major conditions and procedures to increase efficiency.  They will have figured out how to harness their electronic medical records to better identify patients who will become sick and how to intervene early as well as how to care for the well-identified chronically ill so as to reduce costs.

The key skill these ACOs and hospital systems lack – the skill insurance companies specialize in – is the actuarial capacity to predict and manage financial risk.  But over the next decade this is something they will develop – or purchase.

Emanuel claimed with the actuarial science skill, ACOs and hospital system will become integrated health delivery systems, such as Kaiser or Group Health of Puget Sound, cutting out the middle man insurance company and keeping the insurance company profits for themselves.

Another path the insurance companies may take would be to transform themselves into integrated health delivery systems.  Since insurance companies start out with the actuarial skills, they would only need to add providers of services in order to become an integrated delivery system.  According to Emanuel, the easiest way for the insurance companies to do this would be to purchase or enter into exclusive agreements with “efficient hospital systems, ACOs or physician groups.”

Personally, I don’t find any of this good news especially in reading the rest of the article and some of Emanuel’s statements.  Emanuel stated, “The worried well might wonder what happens if they contract a serious illness, such as cancer or some rare disease, will they be restricted only to physicians in the delivery system?”  His answer to his own question should raise the alarm;  “We should note that many people pick Kaiser or Group Health and get all of their care from those integrated systems, and they don’t  seem to worry that they are not getting the highest quality care.”

Out of the mouth of the architect comes the stark hard fact that these integrated systems may not provide the highest quality care nor provide a choice in health care provision.  Many saw this coming when the atrocity that is Obamacare was passed.  The states and congressional representatives have failed the American public and subjected us to the realization of health care delivery reminiscent of the communist USSR.

Everyone wants high quality health care at a reasonable price.  There is not one person in America who wants low or average quality health care nor is there any one person in America who doesn’t worry about getting high quality care.  With the health care structure and the insurance companies before Obamacare, individuals were able to receive high quality care at a reasonable price.   Specialty care was covered either through the chosen carrier or an additional policy, such as for cancer.  Individuals had a choice of providers and could see a provider outside of the network with approval at a higher rate, if the individual chose that option.  Many insurance companies provided for out of state coverage when treatments for certain conditions and diseases were more advanced than what was provided in the individual’s service area.  Granted, the out of pocket expense was greater but what is important to remember is the choice to receive or not receive those services.   There was always the choice to pay for services without going through the insurance company when the service was denied or out of network.

All of this boils down to the removal of the freedom of choice in health care, ranging from service providers to treatment.  Americans will be at the mercy of those “ACOs” or integrated health care delivery systems.  When an individual has a choice in providers for health care services, those providers know that individuals will seek treatment elsewhere when their services are below that of another provider; those services would include customer service, specialty services, preventive services and screenings, bedside treatment, etc. along with access to high quality care providers.  Without this competition, the need to strive to improve quality and expand services becomes nil.

Then, one must think about research.  Where does the cutting edge medical research take place in these new ACOs or integrated health care systems?

Emanuel went on to say that these integrated delivery systems would compete with their “objectively validated high-quality networks.”  To provide services for rare and serious conditions, Emanuel stated the integrated delivery systems will do one of two things.  First, they could identify “recognized centers of excellence – the absolute best places in the country – and contract special arrangements for the referral and treatment of their patients.”  Second, more expensive benefit plans would have a provision for second opinions.  He cited a market for supplemental insurance to cover second opinions for serious conditions that would appeal to the “well-heeled and worried.”

It has been my experience with insurance companies that a second opinion is covered when facing a serious condition or treatment such as surgery.  Now, according to Emanuel, only certain “plans” will include a second opinion while others will need to have additional insurance to cover a second opinion.  Most everyone should know that a second opinion is considered one of the rights of medical care.  Every individual is entitled to a second opinion concerning diagnosis and treatment when it comes to serious illness, diseases or surgical intervention.  It looks as though with Obamacare, a second opinion is a privilege afforded to those who pay the price for it, which means higher premiums for a plan that includes it or pay an additional insurance price to cover those second opinions.

Either way you look at it, Obamacare is destroying health care in America and doing nothing but nickel and diming an already financially strained citizenry.  At one time, America could boast the best health care system in the world.  It wasn’t perfect but it was better than any other country.  So what happened with the tried and true, “if it isn’t broke, don’t fix it?”  That has all changed with Obamacare.  What America can look forward to is what has been described by Emanuel.  Whether the care will be high quality at this point could be a toss up depending on the plan you choose and can afford.  At this point, the affordability of any plan is questionable.

So much for the promise, “if you like your health care plan, you can keep your health care plan, period.”  It looks as though America can kiss the insurance companies and their health care plans good-bye.  So, who was actually doing the lying, Harry?

About Suzanne Hamner