It has been said that even if you put all of the economists in the world end to end, they still would not reach a conclusion. Well, “news flash!” — one of them has reached a conclusion. MIT professor of economics Jonathan Gruber, who helped construct Massachusetts’ health reform and who is described as an “architect” of the Patient Protection and Affordable Care Act (PPACA), has concluded that you are stupid.
From the plethora of the professor’s videotaped and snarky comments, it should now be apparent to every “stupid American” that the framers of PPACA engaged in misdirection worthy of Penn & Teller. According to Arthur Buckley, the author of Principles and Deceptions, “When a performer directs his audience to the conclusion that he has done something which he has not done, he has wrongly directed them into this belief, hence, misdirection.”
The professor’s most immediately significant comment is already memorialized in the briefs for the King vs. Burwell case to be heard by the Supreme Court this session. Speaking at Noblis Inc. on Jan. 18, 2012 Gruber said, “If you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits.”
Some believe that this may bring down PPACA and others believe that if the court rules for the plaintiffs, there will just be some executive action that magically morphs the federally-run exchanges into state-run entities overnight. In any case, as we learned in NFIB v. Sebelius, divining the outcome of this court is an exercise in futility.
Meanwhile, the Republicans and their newly-captured majority in the U.S. Senate will likely focus on repealing the medical device tax, the individual mandate or even the Independent Payment Advisory Board (IPAB). After the Democrat’s debacle that was the 2014 midterms, the Republicans may even have some support from the other side of the aisle for these forays into PPACA.
That’s all well and good, but I would like to suggest that all of is just more misdirection. As all of the other ACA Circus acts are performing, the real show is happening in doctor’s offices all over the country. If it succeeds, we may have assured ourselves of no viable option but a single payer system. Independent doctor’s offices are disappearing, and this time it isn’t a trick — it is real.
Part of the sales job Americans got before the law was passed was that PPACA would dramatically increase access. Those of us in the industry knew that having an insurance card in your pocket is quite different from being able to get an appointment with a doctor. The problem is deeper and more insidious than that, however. According to Scott Gottlieb, a physician and fellow at the American Enterprise Institute (writing in The Wall Street Journal), “Reforms … set to advance in the next Congress … favor the consolidation of previously independent doctors into salaried roles inside larger institutions, usually tied to a central hospital, in effect ending independent medical practices.”
Imagine how easy it will be for the government to control and regulate doctors inside hospital and ACO structures that they already control and regulate. As Dr. Gottlieb points out, “Local competition between providers, who vie to contract with health plans, is largely eliminated by these consolidated health systems.” He believes that as this arrangement spreads it will be more and more difficult for anyone to propose a free-market alternative to PPACA.
The hue and cry over “skinny” networks was shell shock to consumers who were used to accessing robust provider-laden networks. Soon, we may not ask, “Is my doctor in the network?” but whether the network exists at all. If and when that happens, expect the government to add regulatory structures that will seem an awful lot like single payer.
Or maybe they are just betting we are too stupid to notice until it is too late?