A Brief History…

Obamacare has had its problems in implementation but the real problem is the fact that it has severely distorted the health care market by forcing people into narrow high cost markets that do not reflect the real situation in American health care. I have previously expressed my opinion on how to do health reform.

American health care has been distorted by the type of “insurance” that was brought into effect by employer-based insurance. That is prepaid care, not insurance as we know it in every other market.

The history of American health insurance is greatly distorted.

Now we have this latest iteration of the failure of the Obamacare method and the alternatives.

I have believed for some time that what we see is a system of Medicaid for all. The benefits are skewed by politics and the market mechanisms are crippled. Now we see the situation is even worse.

At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.

Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.

What is going on ?

Meanwhile, Republicans usually eager to criticize the Obama administration or states for implementation problems risk looking hypocritical by showcasing the Medicaid waits. Many oppose expanding the program to people with incomes as high as 138 percent of the federal poverty line, as the law allows states to do, and are loath to demand more efficient enrollment to achieve that goal.

“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Oh OK.

Updated numbers provided by Bataille indicate that the total number of people affected remains about the same as reflected in the document. About 1.2 million have discrepancies related to income; 505,000 have issues with immigration data and 461,000 have conflicts related to citizenship information.

Many years ago, I was still interested in health policy research. I had an office at UC, Irvine and Orange County, where I live, was undergoing a transition from fee-for-service Medicaid (MediCal in California) to a new HMO-based program called Cal OPTIMA. This seemed a good opportunity to study the outcomes in two contrasting systems for the same population. No studies had been done to see how the MediCal Population would repond to the different incentives of fee-for-service and HMO. I developed a proposal to study this transition at a time when databases for both systems were available. The data from the fee-for-service program was still current and the new HMO program would provide the opportunity to see how the MediCal patients fared under the new program. I had obtained the cooperation of the UCI statistics department and had had some experience with this sort of study at Dartmouth where I had recently compacted a Masters Degree program in health policy research.

The Orange County Health Department had hired the recent director of HCFA, the Medicare intermediary. Funding was available from a large endowment fund devoted to the study of low income California residents’ health care. The organization was called “The California Endowment” and was funded when Blue Cross became a for-profit entity and was obliged by the state to donate a large sum to charitable causes.

The proposal is here.

All that was needed was the approval of the Cal OPTIMA program to use their data. All the funding was assured.

They refused. I wonder why ?