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On the Third Hand: Indicators

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One thing about the Patient Protection and Affordable Care Act (PPACA) is that it’s a huge law. It does all sorts of things.

When people say, “I want to repeal PPACA! All of it!”, I doubt many of them are talking about the tanning salon or Medicare reimbursement innovation provisions, for example.

See also: On the Third Hand: Ninja content

Whether accountable care organizations (ACOs) are the best thing since chocolate or the worst thing someone invented the concept of running out of chocolate, few civilians have the same level of hatred toward ACOs that they have toward the PPACA public exchange system, exchange plans, and the idea that some people have to pay for health coverage or else pay “an amount” to the federal government.

I think that even many people who loathe PPACA, and are well-informed enough to know what the words mean, like the idea of insurers being able to sell health coverage to responsible but unlucky sick people at a reasonable cost, and to get away from the practice of trying to kick people with cancer out of plans because they failed to include information about treatment for acne and head colds in coverage applications.

So, anyhow: How will we know how well the PPACA commercial health insurance program is working?

One answer is that we’ll never know, because humans can never really know anything. Even if you think you exist, how do you prove that beyond any possibility of someone else’s doubt?

Another answer is that, in the long run, PPACA inevitably will fail, because all human endeavors inevitably end in dust. 

But, if we want quick and dirty ways to measure if the PPACA commercial health insurance system is great, terrible or so-so, what should we look for?

My thought is that some good health indicators might be the following, broken down for groups consisting of uninsured people, people in government health plans and people in commercial health plans:

  • The percentage of people who are up to date with tetanus shots.
  • Death rates for diabetes and colon cancer.
  • The percentage of people who were able to get treatment for a broken leg, appendicitis, or a heart attack without suffering severe financial distress as a result of out-of-pocket medical costs.

On the business side, I think good indicators could be:

  • The percentage of people who are still completely uninsured.
  • The percentage of people who leak out of the official system and get black market or gray market coverage.
  • The percentage of people who are paying the full retail cost of health coverage, without suffering extreme hardship and without help from any direct government subsidy.
  • Providers’ losses on uncompensated care.
  • The number of days hospital bills — including bills sent to government payers — spend in accounts payable.
  • The number of fistfights between doctors, hospitals, drug companies, insurers, agents, employers and high-income workers, because, let’s face it, something has to change. A failure to plan to make someone unhappy is a plan to fail.


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