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CPBJ Extra Blog

The great re-forming of health care

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So, Obamacare has winners and losers.

This is not new.

For one thing, people who understand health care and the law have been talking about this for years. It's only hitting home for most of the nation now as major provisions come into effect, but for insiders, it's hardly a surprise.

For another, health care had winners and losers before Obamacare. What the law does is, well, health care re-form. Or, more accurately, health care insurance re-form. Some of the old winners are now losers, and some of the old losers are now winners.

There is no possible scenario in which there are no losers. Yes, the administration has generally implicitly presented the law in that alluring light, including President Obama's repeated "If you like your health plan" statements — but it has patently been promoting its vision instead of explaining the intricate mechanics of the law.

You could say that they seem to think that if enough people believe what they're saying, it will come true — and I don't think you'd be far off. Certainly, public opinion and action matter enormously in Obamacare's ultimate outcome, and the law is a complex construction of evolving parts. There's a distinct element of possibility in the proceedings.

But all that doesn't change the eternal fact that utopia is never on the table. Promise people perfection — or even just more than you can deliver — and you're always going to disappoint them.

Overall, I think the administration made a tactical mistake by doing too little explaining and too much defending. It's a basic principle of persuasion: If a compelling counterargument could be raised, you're better off preempting it than ignoring it. Frame it your way, and all that; people don't like being gobsmacked.

Whether the administration also made the more serious mistake of overestimating its ability to successfully implement this massive change is a longer-term question. At this moment, the answer doesn't look too good.

There's a lot yet to be seen on these winners and losers; the continuing problems at are keeping some pertinent details under wraps. People who are liking the premium and subsidy figures they're seeing on the Obamacare marketplaces haven't all seen the deductible, copay, coinsurance and network details yet. People who have gotten policy cancellation notices haven't all been able to fully explore their options, and at least some of those notices were misleading — albeit not without some justification.

What is clear, however, is that if you took the president's words at face value, as they were manifestly intended to be understood, you made a mistake. There are a number of different spins on it — that it was a lie, that it was a generalization, that it was an unanticipated glitch, that it falls into that consummately gray world of "He misspoke."

Here's the thing, though: There's no way to spin this now that makes the president look both more credible and more competent. And that hurts his cause, at a time when it could use a lot of help. Obamacare is a fact — but its success isn't yet, by a long shot.

• • •

This transcript of Community Health Systems Inc. Q3 earnings conference call includes, among other things, Obamacare marketplace outreach efforts; whether the new board at Health Management Associates Inc. has been affecting the acquisition proceedings; how long it might take for CHS to implement its plans for HMA; and what a likely CHS settlement with the federal government on Medicare claims might say about HMA's position.

And speaking of HMA, it looks as if that due diligence process is a bit painful.

• • •

Remember all that drama about important changes hidden in massive regulatory dumps? It's not over yet. And I quote: "Weeks after denying labor's request to give union members access to health-law subsidies, the Obama administration is signaling it intends to exempt some union plans from one of the law's substantial taxes."

• • •

Someone agrees with me — but from a slightly different angle — that the administration has a serious messaging problem.

• • •

These stories wrinkled my brow. As best I can tell, the issue is whether health care providers can help patients buy coverage through the Obamacare marketplace — and how strong the anti-fraud efforts can be. First it looked like no, then it looked like yes. Maybe.

• • •

Finally, I know this only specifically addresses what it identifies as the nation's top 18 hospitals, but please raise your hand if you believe it's only an issue there: "Top hospitals to opt out of healthcare reform."

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