This is being written just days before the Supreme Court issues its ruling on King v. Burwell. It would have been more fun to wait until the ruling came down before penning this column, but such are deadlines. I suspect that no matter which way it goes, the hyperbole, second-guessing and Monday morning quarterbacking will be full throttle for a while. Of course, we will weigh in next time.
While waiting for SCOTUS, I have spent some time thinking about the continuum that brought us to this point. Were parts of the pre-PPACA system in need of repair or reinvention? Of course they were. Any right (or left) thinking person understands that the lack of transparency coupled with a system where physicians were paid piecework would inevitably lead to disastrous results. In- and out-of-network pricing, negotiated rates, phantom discounts and the like created a pricing scheme that was closer to Bernie Madoff's playbook than to anything remotely pro-consumer.
See also: When fixing doc doesn't fix anything
Yet, PPACA didn't do much, if anything, to fix those very real problems. Instead, there were the usual red herrings about pre-existing conditions. The vast majority of pre-ex issues for the 80-plus percent of insureds who had coverage through their employer had already been dealt with by HIPAA. Stories in the highly partisan press and State of the Union guest victims were based on thinly veiled and even more thinly sourced stories. We were beset by post hoc arguments that looked like red meat but tasted more like baloney.
We have learned that most politicians will tell you nearly anything if they think it will advance their agenda. To wit, the PolitiFact 2013 Lie of the Year: The promise that if you liked your (pre-PPACA) health plan, you could keep your health plan. We have learned that the word "accountable" in the name of The Act was more a term of art than a reality.
