Here’s my comment on a recent Health Affairs blog post from Heritage’s Nina Owcharenko whining about the ACA as a g’vermint takeover.I wrote “I’m really pissing myself about this one. Only in the bizzarro world of American politics can the nutjobs on the right, and not just any nutjobs but on the right but Nina’s actual colleagues at Heritage design the basics of a health care policy and then declare it something that’s antithetical to their very being. Furthermore, it’s only in bizzarro world of American politics that a massive expansion of PRIVATE health insurance legislated in the ACA is called a government takeover, or in Nina’s words puts the “trend toward government-based coverage on the fast track”. If Nina had bothered to check she’d realize that the vast majority of Medicaid enrollees — 66% according to KFF– are in private plans and the rest are being moved there. Yet this is another expansion of government!” Of course if you look at the Health Affairs version where they moderate comments, you’ll note that some of the words I wrote and the words they publish are slightly different

What does a know-nothing Republican who doesn’t believe in science and is front-runner for his party’s nomination for President say about health care? Pretty much the same that the rest of them now do–unlike McCain, Huckabee et al in 2008. What’s the new Republican ideology? Apparently. there’s not much wrong with health care and what there is wrong, caps on malpractice payouts will fix. Perry cites the increase in the number of doctors in Texas since tort reform caps were put in as proof that it works. Wendell Potter at PR Watch shows that, when corrected with facts, everything Perry says is rubbish. But then again, were you surprised?

It’s hard to think of a more opaque market than that for individual health insurance. But perhaps there’s enough data that can be reworked so that ordinary people can get a better understanding of it. Todd Park, HHS’ CTO, for sure thinks so, and just last week arranged (as in he said in this blog post) to allow developers to download files with data from all the markets in all 50 states & DC.  My hope is that this will inspire people like eHealthInsurance.com to put the most important part of any plan comparison (out of pocket maximums) front and center on their plan comparison tools. Otherwise, I may just have to build my own….

This weekend tells us three things. One, American government is beyond broken. In this completely artificial debate, a minority opinion that after all represents a minority of the opinions of a party that only controls one third of the government dictates the terms of the deficit reduction compromise. A compromise that is pure fantasy anyway. Two, no one in DC gives a shit about the economy and particularly no one cares the lowest 30% of Americans who are un- or marginally employed or relying on support from society. We heard nary a peep even from any Democrats about them as we insanely cut spending in the middle of a recession. It’s 1937 all over again. Third, health care is for sure a government business, according to Wall Street, with the stocks of most major insurers and hospitals off 5-10% this morning on fears of cuts in Medicare.

Over at Managed Care Matters Joe Paduda makes the outrageous allegation that because the current Republican leadership all voted for the Medicare Modernization Act, (not to mention our adventure in the desert and the tax cuts last decade) they bear some responsibility for the current deficit. One wonders why the Democrats aren’t using this information and explaining it to the public instead of bending over and grabbing both ankles/adopting a position to the right of average Republicans! I’ve now figured it out. Joe must have obtained this information by phone hacking and because it was obtained illegally, Obama and co are honor bound not to use it!

The next few days will be all about exchanges, or more accurately the “American Health Benefit Exchanges for Individuals and Small Business Health Options Program.” Tim Jost has a long and excellent article at Health Affairs blog explaining them, and–Yikes!–it’s the first of three. There’s going to be different rules for individuals versus small businesses, and of course differences as to whether Medicaid plans (which will cover more poor individuals) will be part of the exchange. For states that decide not to implement the exchange themselves, it’ll be done by the Feds–assuming that the whole thing doesn’t get repealed (and it won’t). But I remain very concerned that the complexity of 50 different exchanges, not to mention the ability of HHS to really keep an eye on all of them, is a problem–one that would be much reduced with a single Federal Exchange looking something like FEBHP. As Jost says, The Senate version of the ACA which became law (in contrast to the House version which did not) creates the exchanges at the state rather than the federal level. For that we have Scotty Brown and the voters of Massachusetts to blame. And thus the weirdness of the American political system has given us a long series of headaches for years to come.