The Roots of Skepticism Over Obamacare in Missouri

The skepticism over Obamacare especially in Missouri is not without its legitimate reasons. The Medicaid programs have found to be ineffective and less successful especially in the public healthcare sector. The doctors at University of Virginia conducted an insightful study to examine the surgical outcomes of patients at national level. According to their findings, the rate of in-hospital deaths of people using Medicaid is higher than those using private medical insurances. The stay in hospital is also longer. The study reveals that the average length of stay for people using Medicaid was 19 percent more than the rest. (Medicaid Policy Research, 2013)

Another study at England Journal of Medicine titled “The Oregon Experiment” showed that the Medicaid had made no significant improvements overall in the first two years. With Medicaid in place, there is certainly an increase in its use but that has not produced positive healthcare outcomes. Although the researchers noted increased rate of diabetes detection and low rate of depression but that does not involve the people facing tough financial conditions. (The New England Journal, 2013)

The law provides subsidies for seniors who cannot afford their medications with Medicare. It requires restaurants and vending machines to display the calorie count of each food. To encourage students to go into general practice, the law has helped repay their loans to pay for their medical studies and will greatly increase the compensation measures of general medicine Medicaid. A new federal agency created by law, the advisory committee of independent repayments, which will recommend Medicare reimbursement rates to hospitals and physicians.

This comprehensive bill is a phenomenal accomplishment of the Obama presidency. It will extend health coverage to millions of Americans and reduce the shameful practices of some U.S. private insurers. It is important to analyze what it does not. It does not simplify the astronomical stack of layers of payment system that overlap which increases from a few hundred billion dollars the cost of health care in the country. It does not give the United States the universal coverage at a reasonable price , managed by all industrialized countries. With this law, the U.S. health care system will remain the most complicated health care system, the most expensive and the most socially unjust major developed countries.

The new rule most important is called the "guaranteed issue". Starting from 2014, each insurer shall be obliged to issue health insurance to anyone, whatever their previous situation. This change would allow 20 million Americans who cannot now have health coverage, to have one. Meanwhile in 2014, states are expected to extend their health insurance high risk programs to cover those who are not. (William, 2013)

To work, the notion of guaranteed issue must be associated with the notion of individual mandate for example the need for each individual who buys insurance. Insurers need a broad base of insured risk that diversity is large enough to financially bear the notion of guaranteed issue. While all the other industrialized countries have integrated these two concepts long, this is the first time that the United States includes in its legislation.

The law is quite fragile - after the fierce battle with Conservative Congress - the notion of the individual mandate for health because it does not impose strict penalties for not buying health insurance, which will likely result in the choice of many Americans at low risk for not buying health insurance. In addition, prominent conservatives in several states have filed lawsuits against the federal government to demonstrate the unconstitutional aspect of the notion of individual mandate. If the individual mandate falls, the principle of guaranteed issue and this fall will be the heart of the Obamacare law. (Theodore, 2000)

The upward pressure over the cost of medical services is mainly from monopolistic behavior of providers of health services. Indeed, the opacity of the process of price negotiations between providers and private insurers allows them first to discriminate patients by price. The hospital billing system is extremely complicated and differs according to the interlocutors.

Private insurers negotiate rates with individual hospital or clinic (generally once a year) on all services. Therefore, for the same type of services, a health facility may charge customers different prices. According to studies, the difference in price paid for medical services in hospitals across the country can reach 260%. The pricing depends on the institutions and the negotiating power of private insurers, stronger or weaker depending on the degree of concentration of suppliers in the region.