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Disability Insurance Observer: Yardstick

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It’s fun and easy to slam the Patient Protection and Affordable Care Act (PPACA) exchange system based on implementation delays, but it’s also a little childish.

The PPACA exchange system may or may not be poorly designed, poorly implemented and poorly run, but the reality is that the print publications feeding into have been running articles about insurance trade groups promoting the idea of state governments, or the federal government, setting up health insurance exchange programs for decades.

If the exchange concept is a fiendish Communist plot, it’s a Communist plot that’s pulled the bright red Marxist wool over the eyes of many people who think of themselves as Republicans.

And the human beings setting up the exchange programs seem, in general, to be nice, hard-working, tired, well-meaning people who may not necessarily like everything about the PPACA exchange program rules any better than the House Republicans do, but they got shouted down at a meeting and are stuck having to be loyal soldiers and pretend they like the rules.

And, another issue is the idea that PPACA will really do anything other than (possibly) improve the situation of poor people and sick people, which is a little naive.

The main point of PPACA is to create a PPACA II Development Gladiatorial Arena, where folks with money and power (insurers, brokers, doctors, hospitals, employers, government agencies, consumer groups, trade groups, lobbying firms and healthy people with incomes over 400 percent of the federal poverty level) can bash one another’s heads in without getting their blood all over the poor people and the sick people. 

So: Delays, shmelays. Until the delays get outrageously long and frequent, who cares. Lots of stuff in life gets delayed.

Even what exactly PPACA does for, or to, acute health care costs and access to care is just really about 40 percent of the story.

If all we wanted was to minimize U.S. health care costs and create a level playing field for access, the solution would be simple: Outlaw health care. Gross domestic product loss problem solved!

But then, of course, we’d probably end up with some unfortunate productivity loss issues.

Realistically, the best way to measure the performance of PPACA (and PPACA II, PPACA 2.5, PPACA III, etc.) is to look at a combination of how PPACA affects cost and access in the acute care market, how it affects cost and access in the post-acute care and long-term care markets, and how it affects absence in the employer market, and disability incidence both for workers and for people who are outside the labor force.

If the PPACA exchange system and market rules actually get off the ground, I think it would be good if disability insurance actuaries and other disability claims experts would get together and figure out how they would expect presenteeism, absence levels and disability incidence to change without PPACA, and what kinds of changes they would see as evidence that PPACA and its sisters had helped the situation or made matters worse.

Then, if and when the productivity and disability numbers start to come in, we can have knockdown drag-out PPACA discussions about something that matters.

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