David Brooks: “Buckle Up for Round 2”

“The healthcare reform law was signed 10 months ago, and what’s striking now is how vulnerable it looks,” writes columnist David Brooks in the New York Times. “Several threats have emerged – some of them scarcely discussed before passage – that together or alone could seriously endanger the new system.”  According to Brooks, the threats include:

The courts.  “So far, one judge has struck down the individual mandate, the plan’s centerpiece.  Future decisions are likely to break down on partisan lines.  Given the makeup of the Supreme Court, this should concern the law’s defenders,” according to Brooks.

False projections.  Brooks notes that “The new system is based on a series of expert projections on how people will behave.  In the first test case, these projections were absurdly off base.  According to the Medicare actuary, 375,000 people should have already signed up for the new high-risk pools for the uninsured, but only 8,000 have.”

Employee dumping.  Brooks sees this as the potentially most serious threat.  “Companies and unions across America are running the numbers and discovering they would be better off if, after 2014, they induced poorer and sicker employees to move to public insurance exchanges, where the subsidies are much higher,” Brooks said.

Healthcare oligarchy:  Since the March passage of the healthcare law, “there has been a frenzy of mergers and acquisitions, as hospitals, clinics and doctor groups have joined together into bigger and bigger entities,” according to Brooks.  “The downside to this economic concentration is that there could be less competition and cost control.”

Public hostility.  “Complaints are especially high among doctors.  According to a survey by the Physicians Foundation, 60 percent of private-practice doctors say the law will force them to close their practices or to restrict them to certain categories of patients,” Brooks wrote.

“After the trauma of the last two years, many people wish the issue would go away.  But it’s not going away, especially since costs will continue to rise,” Brooks concludes.  “Some Congresses achieve healthcare; members of this Congress or the next one will have healthcare thrust upon them.”

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