Program Design

This begins with an objective, cold-eyed analysis of the requirements of the program—which means no a priori assumptions can be made.  Even the most blatantly obvious underlying premises must be questioned and tested.

For instance.

The architects and designers of Obamacare (I’m being generous with those terms, but let’s go with them and see where we wind up) assumed, without checking, the following:

  • just about everyone wants health insurance
  • health insurance will make people healthier
  • those with health insurance are more likely to seek care from physicians and less likely to go to emergency rooms

Michael Barone, in the WSJ article at the link above, provided some data on the legitimacy of those unchecked assumptions.

  • a McKinsey & Co survey of those believed eligible for ObamaCare health-care exchange Plans found all of 11% of those who bought new these last couple of months were previously uninsured
  • two small insurance companies reported that only 25%-35% of those purchasing were previously uninsured

On those other two…assumptions…Barone described an in situ State of Oregon randomized experiment (in function, if not in intent) in the form of a lottery for allocating scarce Medicaid funds to applicants.

  • after two years of Oregon’s lottery, there was no significant difference between Medicaid-insured and uninsured in blood-sugar level, blood pressure, and cholesterol levels
  • those with Medicaid plans were 40% more likely to go to emergency rooms than those without insurance

Where were the Obamacare program architects and designers?

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