Is John Cochrane Confident Enough of Obamacare's Failure?

    He had a recent post entitled What to do when Obamacare unravels. 

    http://johnhcochrane.blogspot.com/2013/12/what-to-do-when-obamacare-unravels.html

    This is something that all the Obamacare hating fanatics have in common-they are certain of success, never mind the facts. I mean there have been some positive developments since the admittedly very rough October rollout. On the other hand one difference between Cochrane and many other opponents is that he at least claims to have a plan for 'when it certainly will fail.'

    "This fall's website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and "accountable care organizations" will take their turns in the news. There will be scandals. There will be fraud. This will go on for years."

    "Yet opponents should not sit back and revel in dysfunction. The Affordable Care Act was enacted in response to genuine problems. Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs."

     Ok, because most opponents think exactly this is the answer, certainly for the Republicans in Congress the answer is to go back to the idyllic pre ACA days when there were 53 million uninsured. 

    The website is no longer the disaster it was and with all those who have successfully signed up in December the government's sign up goals no longer seem like a pipe dream.

    "Perceptions about health reform are in an interesting place. Just about everyone on the right is still living in October, the annus horribilis of Obamacare (yes, I know it was just a month, and I don’t care), and is waiting to move in for the kill after the whole thing collapses. Meanwhile, a funny thing has been happening: enrollments surged this month, to such an extent that the original expectation of 7 million people signed up via the exchanges by the end of March no longer looks crazy."

     http://krugman.blogs.nytimes.com/2013/12/30/obamacare-not-a-total-disaster-continued/?_r=0

    As for the idea that the mandate will be a disaster the question has to be asked why this is. It wasn't a disater in Massachusetts so while will it be nationally? In interesting question is whether folks like Cochrane would hate it so much if a Republican President had given us ACA-after all it was originally the conservative alternative to single payer going back to Nixon. 

   At this point, Obamacare remains the conservative blueprint for Medicare. This may well be why conservatives oppose it at the national level but not that the state. Massachusetts is a liberal state which only elects Republicans to high office rather seldom. It's about the most conservative option at each level. For Medicare they'd accept it as it's the most conservative option that can even be uttered in the light of day-and even here only barely, without admitting this is what we're talking about. 

   Not to spoil the surprise, but Mr. Cochrane's solution that doesn't just go back to the pre-ACA system is: privatize, privatize, privatize. As to the proverbial homeless person with no insurance at all: get him a voucher. That he has no mailbox shouldn't hurt and so he'll get very good-private heathcare if he has a heart attack. I for one think that a great example of his plan in action was here on Long Island where recently a homeless man died in the last blizzard-he froze to death-at least we kept the cost curve down. 

    

   http://thinkprogress.org/economy/2013/12/18/3081571/bay-area-homeless-deaths/#

   What we need, Cochrane believes, is to submit healthcare to market discipline much as we did the airline industry. 

   "The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a "certificate of need" before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service."

    "We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. We'll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service."

    Yep, there's surely no difference between these two industries-what did Kenneth Arrow know?

    http://diaryofarepublicanhater.blogspot.com/2013/08/kenneth-arrows-on-market-efficiency-in.html