The Obamacare website debacle is only a sideshow

With the health care reform rollout plagued by technical glitches, low enrollment, and consumer frustration, President Obama has recently enlisted the help of Google and other technology companies to fix the exchange website. These highly-publicized problems are mere sideshows to the real issue: what is happening to medical care in this country under the Patient Protection and Affordable Care Act.

The president has now called in computer engineers and programmers to make the site work. Wasn’t the website made with the wisdom of technology experts? And if they could not get it right in three and a half years how are they supposed to get it right in one month as the administration has promised? Alas, whether they do or not, it’s irrelevant.

Unfortunately, for those seeking health care, the problems with Obamacare transcend website outages and error messages. A recent CBS News story found that over two million people have already lost their health insurance. This directly contradicts multiple promises from the president that “if you like your health plan, you can keep it.”

The White House has now taken the offensive blaming “bad apple” insurance companies. We’ve seen this movie before. The real estate debacle wasn’t caused by Fannie or Freddie or misguided legislation. It was caused by the big-bad banks even though they were responding to said legislation. Now it’s the insurance companies’ fault for merely trying to stay afloat in the rough waters created by the ripple effects of this law.

With the federal government telling exchange health plans who they can cover, what they can cover, and limiting how much they can charge, many of the same ideas that plague the Medicaid system will likely sink these plans as well. These perverse market forces could foster a race to the bottom, causing these quasi-private plans to morph into Medicaid lite with limited access and poor quality care.

As the government compels “qualified health plans” in the exchanges to provide more services and limits premium increases, the successful business models for these companies are limited.

The strategy for these exchanges — to soak young healthy patients with exorbitant premiums to subsidize older and sicker ones — is a gamble, betting young people will take the bait. As companies continue to raise premiums on this cohort many are likely to jump ship, opting instead to pay the individual mandate penalty, which will be cheaper than the premium.

Another tactic is exchange health plans contracting with a narrow network of doctors, hospitals, and providers. As these patients become more consolidated among fewer doctors, these health plans will likely use their market share to bludgeon down reimbursements.

This scenario will thwart patient choice and personal preference by hindering patients from seeing the primary care physician or specialist that they have been seeing, may want to see, or need to see. For patients with complicated medical comorbidities that “like their doctor,” this will be a major hassle to have to start over with a new physician. It will waste patient and doctor time as well as foster additional inefficiencies in a system with scarce resources. Most importantly this could lead to delays and jeopardize patient care.

A recent Watchdog.org report featured in US News & World Report confirms that top hospitals are opting out of Obamacare. According to the report, eleven of the top eighteen hospitals are only accepting one or two health plans offered through the exchange. Cedars Sinai Medical Center and the Cleveland Clinic both only accept one exchange plan.

A September 2013 survey from the Medical Group Management Association (MGMA) of over 1,000 practices found that it’s not just the elite hospitals that are reluctant about the exchanges. Of the practices surveyed, only 29.2 percent planned to accept exchange products while 14.4 percent had already decided that they would not. The rest were undecided.

This early evidence suggests that patients in the exchanges will be left with limited choices, worse coverage, and deteriorating medical care. As the deadline for signing up approaches, get ready to see a high tech version of the lifeboat scene from “Titanic.” The formerly insured will be flooding the digital pathways, desperately trying to get covered, even by an inferior insurance product forced upon them.

With time, the hiccups with healthcare.gov will no doubt be resolved, but the deeply-rooted problems with Obamacare are beyond the expertise of Silicon Valley.