An Obamacare Survival Guide by Nicholas Tate is a good resource guide for explaining how the new legislation will impact citizens in 2014. The thrust of the new law is to level the playing field and lower costs through major purchasing exchanges which consolidate buying power to negotiate for better prices from providers of medical services and pharmaceuticals.
The theory behind the medical healthcare exchanges is greater choice for consumers, standardization for processing transactions, consistency, and significant economies of scale which evolve from learning curve over time. Medicare recipients will experience nearly $455 billion dollars in spending cuts and citizens will pay a penalty for not opting into the system. There will be no co-payments for approved preventive services as set forth by the law.
Tate explains that Obamacare will provide greater access to healthcare for the uninsured who number into the millions right now. Obamacare will be good for employees of small business since many are either under-insured or uninsured right now. Obamacare is projected to cost a trillion dollars in this decade. Approximately 84% of Obamacare expenditures are slated to reduce the legions of the uninsured.
Tate is concerned about the details of placing too much discretion into the hands of the Independent Payment Advisory Board which will make recommendations on cutting Medicare subject to a super majority vote to over-ride by the United States Senate. In addition, the President will have the discretion to appoint members to the Board. The author criticizes the idea of having a board but he does not make recommendations for improving how the entity should operate in practice.
This is an area which may require amended legislation to cure potential inequities in how the Board will function. For instance, the Board should have a majority of representation by physicians and not simply actuaries, accountants and financial people. In addition, the Board should have some representation by mayors of cities, as well as constituencies like AARP. The most concerns are voiced by physicians who seek to maintain control over the diagnosis and treatment of patients.