Obamacare has signed up 8 million people. Democrats are breathing a sign of relief, but their trials have only just begun.
Now a large swath of America will experience first hand the shortages of doctors, the limited access to hospitals, the high deductibles, the large copays, the significant coinsurance requirements, and the long delays in care that will accompany Obamacare's implementation. They will see, first hand, what government-run medicine is like. And the rest of the electorate will have front row seat from which to watch the debacle.
The fundamental problem facing Obamacare is the same as when the misbegotten program was launched -- you cannot expand the number of patients without expanding the number of doctors. If you try, as the Affordable Care Act does, you will have long waits to see doctors, big increases in cost, and unsatisfactory patient outcomes.
The increases in cost, which we are now seeing in health care, come, of course, from an increase in demand with no commensurate rise in the supply. These price hikes will trigger the most deeply disturbing -- and controversial -- of Obamacare's provisions, the Independent Payments Advisory Board. Appointed by the president and confirmed by the Senate, this 15-member board will be charged with requiring alterations in Medicare practice to hold down costs sufficiently to cut program spending by $500 billion over the next decade. The formulae they develop will, undoubtedly, be adopted by states seeking to contain Medicaid costs and by private insurance firms.
Until now, IPAB has not come into existence because the rate of medical inflation did not require it. But now, with prices rising, it will become central.
If the president doesn't appoint the board or the Senate doesn't confirm the nominees, the Secretary of HHS assumes these duties herself.
Each January, IPAB will issue a cost-reduction plan. It will proscribe the use of certain high-cost medicines, limit access to diagnostic tests, and condition approval of surgery and treatments based on the number of quality-adjusted life years left to each patient, all to bring Medicare costs into line with the Obamacare cuts.
Congress may override the IPAB recommendations by a 3/5 vote of each House. Otherwise they automatically take effect by August 15.
Each year, Obama will face a bruising fight over the IPAB recommendations. Patients will protest and doctors will warn of bad outcomes. Sarah Palin's "death panel" will begin its reign.
At the local level, cancer patients will find that the nearest and the best hospitals won't take them. Pharmacies won't fill their prescriptions. Doctors will turn away patients. As the Obamacare bureaucracy struggles with the rising costs it caused, it will ration access to meds, hospitals, surgery and elective procedures for all in its reach.
Meanwhile, all Americans under 65 who are not on Medicaid -- both those on Obamacare and covered by private plans -- will find huge premium increases throughout the remainder of 2014 and during 2015. Deductibles will skyrocket. Stories of the financial hardship of paying the new premiums will abound.
And the cancelations will continue. Small employers will shut down their policies rather than accept the new higher premiums and their workers will have to fend for themselves in the high-cost Obamacare market. Those insured by large companies will see big increases in premiums and deductibles.
And employees will continue to see a reduction in their weekly work hours as their bosses squirm and maneuver to limit Obamacare's universal coverage mandate.
Meanwhile, many of the 8 million enrollees will not pay up, eroding the program. And those who go without health insurance will hate every penny of the fines Obama will impose. Or, they just won't pay them.
For those who feel the political damage of Obamacare is behind them, you ain't seen nothing yet!