The Most Revolutionary Aspect of Obamacare

You may think you've got Obamacare down pat, knowing most of the vital things about it. You probably know, for example, that it calls for people to no longer be denied health insurance due to pre-existing conditions. It also requires people to have health insurance, which is available now in every state via "exchanges," or pay a penalty. There's a lot more you might know or can learn about it, but one part of the massive health-care reform is going largely unnoticed and it's rather revolutionary.

The Patient Protection and Affordable Care Act (referred to sometimes as PPACA or just Obamacare) is looking to turn the American health-care system on its head by providing incentives to get people healthier. This is a win-win proposition, as improved health can prevent many billions in health-care spending, while also extending lives. Until Obamacare, doctors and the greater health-care system generally operated under a fee-for-service system, which can seem reasonable, but doesn't always serve everyone well. In some cases, for example, patients are given more tests than they really need.

Obamacare dares to suggest that health-care providers be rewarded according to how effective they are and how healthy they keep their patients. The old system has been more reactive, with care providers treating people according to the conditions they present when examined. The new vision is more proactive, with care providers doing what they can to keep their entire populations as healthy as possible. Initiatives supported include making care more accessible via extended hours (which has been shown to reduce overall health-care costs by 10.4% ) and promoting a "medical home" model, where teams of health-care providers including doctors, nurses, case managers, and hospitals work together to coordinate the care of their populations.

Home, sweet medical home
Obamacare has some pilot programs in place, promoting Accountable Care Organizations (ACOs) and patient-centered medical homes (PCMHs). Accountable Care Organizations are created when health-care providers, hospitals, and related organizations come together and share responsibility for the health of a particular population. Their compensation will be based on their keeping costs down while also keeping their populations healthy.

Patient-centered medical homes are the "fastest-growing innovation in medical care," according to Consumer Reports, with more than 10% of primary-care physicians, some 27,000 of them, participating. One of the Obamacare-funded pilot programs "is paying 500 practices in eight states to turn themselves into medical homes for more than 300,000 Medicare beneficiaries. If any of those pilots, funded by the new Center for Medicare and Medicaid Innovation, turn out to effectively improve care and lower cost, Medicare and Medicaid can roll them out nationwide without additional congressional approval."

To get a better idea of what this new medical world can look like, imagine these practices as routine: Instead of having to remember what preventive care you need, your health status will be tracked electronically, with you and your health-care providers issued reminders when it's time for, say, a colonoscopy. Instead of having to call your doctor's office for test results, they'll be available online for you. If you're given a prescription or told to get a blood test, your medical home will be making sure that the medication has been picked up and is being taken, and will be following up to make sure the bloodwork is done, too. If you're hospitalized, your doctor's office will be notified automatically. Meanwhile, the hospital won't be reimbursed according to how many services they provide you. Instead, they'll see their rewards docked if patients are readmitted within 30 days or develop infections -- and will earn a bonus if patients report good results and high satisfaction. When a primary doctor sends you to a specialist, the two physicians will be involved in coordinating your care, not just passing you along from one doc to another.

The new medical world will feature teams of care providers, supported by insurers, who are invested in your good and improving health. They'll be aiming to give you effective care and will be rewarded for doing so. While most of us and the media are focused on Obamacare's temporary website glitches, these exciting innovations are not getting the attention they deserve. 

Learn more about Obamacare
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  • Report this Comment On November 29, 2013, at 8:27 AM, GhostdogWarrior wrote:

    This whole scam is a sweetheart deal for the Insurance carriers. There is NO WAY it will be able to support the risk pool so these "folks" will get dumped onto the medicaid program or in real terms the taxpayers. Then the insurance companies will leave their rates the same while taking on none of the risk. A deal first created by the banksters frauds and endorsed by Clinton, Bush and Obama. How can people not see things happening right before their eyes

  • Report this Comment On November 29, 2013, at 8:31 AM, MickeyDougal wrote:

    So what we're saying here is that doctors wanting to keep their patients healthy is a NEW idea? You know, if I were a doctor, I'd be insulted!

  • Report this Comment On November 29, 2013, at 8:34 AM, gary0515 wrote:

    There is no way any of these spin controlled news is going to make people pay enough in insurance that they could support 5 homeless. Lets not forget that they have to pay enough in deductibles a year equal to the cost of a new car. This is nothing more than another move on the war against anyone in the middle class left standing.

  • Report this Comment On November 29, 2013, at 8:42 AM, dwightiam wrote:

    you can tell the propaganda machine is in full swing! Obamac are/ACA must be doing horrible for them to be trying to create a positive "spin" for it. just today you can read all of the headlines for the articles about it. Here are just a few : "The Most Revolutionary Aspect of Obamacare", "Millennials Give Obamacare a Big Boost in Poll", "Beware, GOP: Obamacare Will Rise", "Health Care Law Seen As Troubled, But Fixable: Poll" . Plus, you take into consideration that Obama has put out TALKING-POINTS for his drones to discuss OBAMACARE over Thanksgiving Dinner with the family!

  • Report this Comment On November 29, 2013, at 8:50 AM, Veritas177 wrote:

    Hardly revolutionary, various types of similar payment systems have existed in the US for many decades. Some insurance companies, notably Kaiser Permanente have found success with the model, but is has certainly not turned out to be any miracle panacea for either cost or outcomes. Only a small percentage of practices are large and connected enough to leverage the technology, and the system is largely incompatible with the neighborhood doctor office that is the bread-and-butter of American primary care. Only about half of the pilots under the ACA actually saved money, and the potential for the model looks to max out quickly.

    Moreover, care in these models ends up reducing patient choice of doctor and procedure, and many doctors oppose them because they dictate care rather than leaving decisions to the doctor and patient. There is a reason that such models have only found a reasonably small niche in the current market.

    There is some potential for savings in some of the Medicare space, and it is nice that government programs are catching on, decades behind the private system, with some innovations that may help get better outcomes and reduce sky-high Medicare medical costs. But there is simply no realistic potential that this model will successfully revolutionize more than a small part of the system, and it does not have the potential to impact many of the system's most significant cost drivers.

  • Report this Comment On November 29, 2013, at 8:53 AM, awdahl wrote:

    This is indeed a major part of Obamacare. It is also a transformational element which, as noted in your article, will make major improvements in health care.

    We spend 50% more on health services than the next most expensive economy - Germany. Yet we rank 37th in World Health Organization standards. Hi cost and low quality will kill our economy if we don't change.

    Thanks for shedding some light on the topic.

  • Report this Comment On November 29, 2013, at 8:54 AM, Mathman6577 wrote:

    ACA is already negatively affecting small businesses in the healthcare sector.

    Bio-Reference Labs (NASDAQ:BRLI) stock plunged 20% in day due to reduced guidance going forward, in part due to the ACA.

    Check out a recent MF article which provides full details:

    http://www.fool.com/investing/general/2013/11/27/why-bio-ref...

  • Report this Comment On November 29, 2013, at 9:00 AM, drinoh wrote:

    We already know that staying relatively healthy means not being obese, not smoking, getting a little exercise, drinking little or no alcohol, and avoiding STDs and other acquired social ills like drug use. This is just a way to highly quantitate that and more in the patient, electronically track you, and ultimate have some type of coercion to make you tow the line from a health standpoint. Extra tax, fine, premium? My somewhat facetious advice is to be very careful what you tell your "provider" (used to be doctor). We are giving up privacy, confidentiality, and choice. You may decide that you don't want to try a particular medical treatment, drug, or procedure, as unfortunately some of those are promoted not by time-tested experience but rather by short-term junk science or push by industry. Note recent news on Statins. If you defer on these treatments, you will be labelled "non-compliant". If you choose to go "against medical advice", I can predict that your insurance may not pay at all. The whole point of this is to control the health of the population and manipulate it to what seems like a reasonable end, but can't work without teeth. And it might bite you.

  • Report this Comment On November 29, 2013, at 9:00 AM, Disgusted wrote:

    I find nothing good in obamacare. I will never comply with that abortion of a law. Nor do I want to subsidize people I don't know. We already paid taxes to take care of the indigent and now the leftists are coming after the taxpayers to cover their OVER PROMISING. The producers in this country should NOT be forced to pay for the lazy and pathetic. The ACA will only continue to destroy the greatest healthcare system in the world. Socialism has never worked before and it won't work now. We have to stop electing millionaires for political positions. They can afford anything. The rest of us have to struggle to make ends meet. Who in the hell are they to tell us what we can afford? I used to be a democrat until I figured out that the democrats can NOT govern. They stink at everything they do.

  • Report this Comment On November 29, 2013, at 9:24 AM, Michaeldee wrote:

    "Obamacare dares to suggest that health-care providers be rewarded according to how effective they are and how healthy they keep their patients...Initiatives supported include making care more accessible via extended hours (which has been shown to reduce overall health-care costs by 10.4% ) "

    That keeps patients healthy? Didn't think so.

    "The old system has been more reactive...." Yes, yes that's what insurance is. It is money that is put away, to be used in the event of an accident or emergency. Life insurance is for when you die (reactive), car insurance is for when you have an accident (reactive). Health insurance should be for when you aren't healthy.

    As soon as you start making it the responsibility of insurance companies to implement preventative measures "for the good of everyone," then you take the responsibility of...well, being responsible...from individuals. I won't have to worry about my own health, because my neighbors now have a vested interested in my health (i.e. his health insurance payments), and everyone else will take care of my health for me.

    Socialism at its best.

  • Report this Comment On November 29, 2013, at 9:25 AM, DevonShire123 wrote:

    The most revolutionary aspect of Obamacare is that it is sub-standard care at 10 times the price and in the end, you face the death panel. And no amount of propaganda from a fake media source like the MF is going to change that.

  • Report this Comment On November 29, 2013, at 9:26 AM, Littleeccy wrote:

    Yes all these health care workers who are going to work together to keep us healthy will all be government workers isn't that exciting? "not"

  • Report this Comment On November 29, 2013, at 9:31 AM, imrahil74 wrote:

    "In some cases, for example, patients are given more tests than they really need."

    If your doctor is having you test for things you don't need to test for, simply refuse the test. And if the doctor continually does this, change doctors. Of course this requires the patient to actually have some knowledge of their condition and body. This should be the case anyway because you should always be your own best advocate. If you take the time to research stocks and vacations and such, you should certainly research your health!

  • Report this Comment On November 29, 2013, at 9:41 AM, jbuggy1 wrote:

    This is such "hog wash", or perhaps such a "whitewash" is a better term. The Obama supporters are out in full force putting spin on this disaster. What about all the people who are losing their coverage because of Obamacare, and what about all the great doctors (who, by the way, deserve to make a good living for saving peoples lives) who are now leaving their profession? So they say millions more will have coverage, but there will be thousands fewer docs. available to see them. Wait times to see a doctor (if you can find one) will increase by weeks, or perhaps even months. We've seen the lack of success of similar health care programs around the world, but the dems refuse to learn from them.

  • Report this Comment On November 29, 2013, at 9:51 AM, Ioan wrote:

    That is straight BS. Greed and lawyers pushed medical field to become what it is. The PPACA is a control tool for citizen pocket, not good samaritan intention and you Dear Selena live on the Moon if you think Mr. Obama and present legislation is altruistic. High cost health insurance motivates people to preventive care?? Get lost.

  • Report this Comment On November 29, 2013, at 10:04 AM, bc33 wrote:

    In the continuous ranting against the ACA, people seem to forget that our health care system has been a mess for decades. Those who call it the "best in the world" simply can't be reading about other systems. It's more a statement of their belief that all things American are definitionally "the best" than a reflection of reality. Just commenting on one small aspect of the overall mess that is our medical insurance system, those of us who are small employers have watched rates skyrocket until offering coverage threatened the economic stability of our companies. My biggest beef with the ACA is that it continues to tie the expense of healthcare to employers, a model that started post-WW II and that has primarily benefited insurers. But having said that, the move away from a fee-for-service model (which is the thrust of this article) is a necessary part of any fix. It's not a revolutionary idea, but it is the first time it's been tried on this scale, at least in this country. I wish people would actually read nonpolitical analyses about other the performance of other systems and models so that we could have a thoughtful discourse about the changes that are needed. The ACA is just the beginning.

  • Report this Comment On November 29, 2013, at 10:12 AM, brilig wrote:

    Look to the future: the government will know everything about you. Not only your vital stats but your medical and personal info will be theirs. Soon there will be personal physical monitoring devices either worn or implanted that will relay all your "physical signals" (electrolytes, CBC, sperm count, etc.) to a government server that will be accessed by the insurance arm of the government for the purposes of determining what you should eat, when you should exercise, when you should sleep with you wife (girlfriend or significant other), etc. Good luck finding a Doc, I'll be retired!

  • Report this Comment On November 29, 2013, at 10:18 AM, nonnnexxx wrote:

    corporate , conglemerate? they are dems and cons... times come what a real outbreak

  • Report this Comment On November 29, 2013, at 10:25 AM, BambiB wrote:

    >> Instead, they'll see their rewards docked if patients are readmitted within 30 days

    So, suppose you have a patient that needs to be readmitted on day 20. Isn't the incentive to make them wait 10 more days if possible (and just hope they don't die in the meantime)?

    You can bet that Obamacare is going to be FULL of "unintended consequences" like this that result in people suffering and dying.

  • Report this Comment On November 29, 2013, at 10:32 AM, GuyG wrote:

    Don't swallow this swill spew. This is more media kissing up to Obama's Obamacare rip off and forcing Americans bo pay for non working peoples health care. Now they can get welfare and extended leave from the workforce and it's all paid for by the working people. Fact is you will pay more for coverage with a higher deductable to pay for these people.And the article is bull. For example, when did your insurance company and doctor actually do more tests than you really needed?! This never happens. They won't do any tests unless they are covered and the don't cover tests that could help you determine if you have illnesses or injury beyond a certain point. LIke getting an MRI or other costly tests might not be covered but be just the think you need to know what is causing the problem.

  • Report this Comment On November 29, 2013, at 10:59 AM, SLTom992 wrote:

    "more tests than they really needed"??? In whose book is this? These tests show not only the results of things that the patient is aware of and has come to the hospital for but things that he is totally unaware of and yet should be treated for.

    This is a staggering stupidity on the part of this author or his sources and demonstrates exactly everything wrong with Obama-care - people who know the least about medicine are ordering others how to perform their duties.

  • Report this Comment On November 29, 2013, at 11:03 AM, SLTom992 wrote:

    GuyG - Yes hospitals will perform many tests not absolutely required such as on blood and urine simply because the process is virtually automated and is cheaper and easier than specifying specific tests in every case.

    If you have your blood tested because you're in the hospital and don't feel good they not only check for bacterial infections but blood sugar levels etc.

    Otherwise I agree with you and your points.

  • Report this Comment On November 29, 2013, at 11:07 AM, SLTom992 wrote:

    BC33 - So you think that you can "fix" the health care system by destroying it? The real problem is the management of most of the medical system and not the system itself. It is with the educational system and not the medical system.

    Obama-care does absolutely nothing to fix this. What's more it does exactly the opposite. It interposes several more layers of bureaucracy and less personal contact.

  • Report this Comment On November 29, 2013, at 11:41 AM, svede wrote:

    The ACA is a fool's game making nothing more affordable for the people that actually pay for it. Good luck finding the shrinking pool of doctors too..

  • Report this Comment On November 29, 2013, at 11:49 AM, Barmil wrote:

    Before I am forced into this system I want to know the cost of the repairs to the system.

    I also want to know how it is going to be paid for, as if I didn't know already!

  • Report this Comment On November 29, 2013, at 11:57 AM, kingpuppy1 wrote:

    The whole plan is an scam to force as many people as possible on to government insurance as possible. The President can then say he was standing up for the small guy. This could not be further from the truth. This is just the President's attempt to put his stamp on this country. The only problem is that he has been operating on the fringes of the law the entire time. This is unconstitutional. But, he knows that by the time the courts deem his new laws to be unconstitutional that the system as it now stands will be past the point of repair. He knows that whenever government puts some thing this large in place it costs more time and money to undo it than to leave it alone. That is why this law must be stopped by any and all legal means necessary.

  • Report this Comment On November 29, 2013, at 12:07 PM, GhostdogWarrior wrote:

    Based on the comments this was an epic failure of an article.

    No one is buying the PR machine that is shilling for this hideous endeavor. dwightiam nailed it. All of a sudden the media is putting out stories about how great it is. LOL Does anyone reallly believe this stuff? Really?

    Have we really become indocrintated into this zomble slave all consumer universe?

  • Report this Comment On November 29, 2013, at 12:07 PM, mccroc wrote:

    The author,Selena Maranjian, must be being paid by the Obama cheerleaders to gin up support for a misguided policy!

    Unable to keep our Doctor, unable to utilize the best hospitals, unable to afford huge premium increases, makes any benefit listed by the author almost useless. Many Doctors are not accepting this package and hospitals are opting out.

  • Report this Comment On November 29, 2013, at 12:37 PM, SkepikI wrote:

    ^ You are missing the point here... the real revolutionary change is already done, we transferred billions of our tax receipts and future obligations at one fell swoop to people who weren't qualified to run a Popsicle stand and burned all the start-up money creating a mess. NOW they obviously have to fix the mess and we will be grabbed by the ankles and shook upside down for the money to fix it. SO when your Dr tells you to bend over and grab your ankles for inspection, WE WILL SAVE BUNDLES OF MONEY because you can say: sorry doc, I already had that done by the government and the ACA......

    This Selena, is the magic of preventative care making us more healthy. I can't believe you ignored this in your article.

  • Report this Comment On November 29, 2013, at 12:53 PM, sabebrush6 wrote:

    I heard there is one thing good about obamacare. Hang on a minute, I looking. Please wait, I'll find it. Shouldn't be too long. Hang on.

    No, wait ---- that's not it. I think - no that's not it. well, I thought I saw something real in this manual but I guess I missed it.

  • Report this Comment On November 29, 2013, at 12:56 PM, CaptAmericaa1 wrote:

    Unfortunately the obamacare system of rewarding/penalizing hospitals is making the good hospitals, the ones with resources, better, and the bad hospitals, the ones in the inner cities that struggle with resources, worse. One of those ideas that sounds good to people that don't really understand how the system works.

  • Report this Comment On November 29, 2013, at 1:53 PM, drjcm wrote:

    We spend way more on health care than other countries because of 2 things-- expectations are far higher for care, and the cost of providing it is enormously higher than other countries. Dialysis, for example, is given to 60 year olds here but not in many other countries, and in the US, instead of taking many meds to treat coronary disease a stent or bypass is provided. Neonatal intensive care in the US is over $150, 000 per patient, but in most of Europe tiny premies are called stillbirths rather than being given aggressive treatment. Meanwhile the cost of providing outpatient care is over double that of other countries not counting physician pay, and billing costs and other overhead averages well over 60% of the cost of going to the doctor. Obamacare will certainly cut services to the insured, with fewer heart surgeries or cataract surgeries (does anyone really need two eyes to see?) but overhead is likely to go up dramatically. We must remember that if the price is less than the cost eventually no service or product will be made, and so as overhead goes up price will inevitably go up. There are three aspects to a purchase-- price, quality, and availability, and it is easy to control any 2 of the 3, but impossible to control all 3-- we will be limiting availability to control price, with de facto rationing, or price will go up as is typical for government run projects since the government finds it impossible to say "no." Since a flood of primary care doctors will be retiring in the next 5 years and almost no one is in the pipeline to replace them, the amount we pay for health care is likely to explode over the next ten years.

  • Report this Comment On November 29, 2013, at 1:59 PM, GETRICHSLOW2 wrote:

    All a bunch of unconstitutional BS. Repeal or nullify is the only answer.

  • Report this Comment On November 29, 2013, at 2:21 PM, richard232323 wrote:

    Very disappointed with Motley Fool for printing this article, buying into this administrations sales pitch, are you being paid for this line of crap.

  • Report this Comment On November 29, 2013, at 2:34 PM, apallday wrote:

    I concur with the fool as I have already seen some of what is mentioned. I have switched my diabetes doctors, but with my records coming with me my outcome has improved my tests are being scheduled ahead of time, my A1C numbers are already improved, add to this my wait in the waiting room and my office visits did not take near as long as they had before. When I asked my clinic about this rather new phenomenon they said that because they will get more $$ for being efficient they are BEING MORE EFFICIENT!!! Rewarding good outcomes is a no brainer. GETRICHSLOW2 do you think a president with an expertise in CONSTITUTIONAL LAW may no more than you? The right leaning Supreme Court said it was NOT unconstitutional-so I have no clue what you are talking about. Dick Head232323 unless you work for a big insurer or have much of your investment money with BIG INSURANCE like the Koch's you wanting an inefficient system one that will cut you off when you are sick and then won't let you back in because of a pre existing condition is as stupid as a duck wanting a year round duck hunting season!! Quit listening to idiots like Rush "the drug addict limp boobs," & the Fox opinion propaganda channel and you WILL BE more informed.

  • Report this Comment On November 29, 2013, at 2:45 PM, Utopia wrote:

    Although not Sir Thomas More's island of perfect social and moral conditions the article does imagine a society presented by Karl Marx where all people live for the good of their neighbor.

    A nice thought but impossible to implement with government intervention.

    FROM each according to his ability TO each according to his need. Karl Marx

    The author, Obama, democrats in general and far too many unsuspecting minorities think this a virtuous principle.

  • Report this Comment On November 29, 2013, at 2:58 PM, midwestrunner67 wrote:

    While performance will in theory be rewarded, another subtly built into Obamacare is the fact that specialists will be paid far less, and generalists far more. Specialists, who incur additional training, skill, experience and liability, are not signing on. Good luck finding a qualified provider, your PCP will have a hard time finding a referral. I agree with the above post, there has been no thought nor effort given to finding additional providers for the new "onslaught" if it ever occurs- of additional insured. There is already ample documentation of the fact that medical spending has NOT decreased because of this tax, and will in fact continue to go up. The government has a long and glorious history of BOTCHING healthcare- VA, medicare, Medicaid- and making it inefficient, cumbersome, onerous and unworkable. This is no exception. Some ideas are (not new but) fantastic - cover pre existing! monitor insurance profits! etc but a repeal/restart would be far more effective and less expensive for Americans.

  • Report this Comment On November 29, 2013, at 3:06 PM, airjackie wrote:

    One only read the 1974 Universal Health Care Plan introduced by President Nixon. As both Romney and Obama used it. Just think if Nixon had stayed in office we would have had health care for 39 years already. The plan was cheered by Republicans as great as FDR's Social Security Act. Interesting to see the attacks on Obamacare as the Republicans said the Social Security Act would end our economy. One smart President is George W. Bush who used the same plan to form a Universal health care plan successfully in Africa.

  • Report this Comment On November 29, 2013, at 3:18 PM, Gman wrote:

    Obama when do you plan on telling the American Public about this? “While appearing on Newsmax TV's "Steve Malzberg Show" on Monday, November 26, 2013 . Time magazine’s senior political analyst Mark Halpern admitted that death panel are built into Obamacare and will be the mechanism used to control costs, Halperin went so far as to say that rationing is "going to be a huge issue," Stating it is "something else about which the President was not fully forthcoming and straightforward." With this clause in Obama Care the Government has taken the Life or Death decision out of the hands of the patient or family and put it squarely in the hands of the Government. This clause potentially exposes the patient or their families to hundreds of thousands of Dollars of “Life Ending Care Expenses”

  • Report this Comment On November 29, 2013, at 3:20 PM, wc259327 wrote:

    I recalled reading a WSJ article about a doctor who was using the medical home model because insurance company had promised better performance based reimbursement. In the article he says he had to hire more personnel to call patients, keep track of them, and made sure they took their meds. He said for all the time and money he put in, he was just barely breaking even. Then there was another WSJ article that reported that insurance companies were telling doctors to take reimbursement cut on patients using ACA plans. Put these 2 together, it sounds like fiscal ruin for doctors. Maybe a windfall for insurance companies.

  • Report this Comment On November 29, 2013, at 4:11 PM, RohanRider wrote:

    selena, this has got to be the biggest propaganda I have read coming from a small business site like the fool. Maybe this is "the Fooled" now. Stop the crap!

    So doctors wanting to keep their patients healthy is a NEW idea? As a PA I'm insulted! Also, doctors have little control over what a patient does outside the clinic and is generally due to a lack of self control. Now the government can simple say according to the metric, we will only pay you 30% due to the patient's health profile.

    You want the government to do something smart. Put a chip in the morbidly obese that doesn't let them "feed" in restaurants or buy high fat groceries if they get subsidized healthcare from the government. This would eliminate 75% of the diabetes in 5 years. This all can be done easily with existing technologies.

  • Report this Comment On November 29, 2013, at 4:54 PM, SkepikI wrote:

    Some of you "Long thinking" optimists particularly you Selena need to consider experience to date and how difficult it will be to get the long term right. AND just how long it will take before the longer term results will be even identifiable, let alone quantifiable. Of all the things this grand scheme must eventually execute, the most executable short run was the website. I wont call it simple, but as complicated as it was (is) there are numerous examples from ebay to amazon and everything in between where complex websites were effectively executed.

    The next most simple short run thing to get right was the promises to keep your Dr and keep your plan if you liked it. There were at least two effective ways to have executed promises associated with those: Grandfather plans for a decade, OR never promise what you fully intended not to deliver in the first place.

    Also essentially simple is executing to keep information confidential and the "Navigators" honest, above board and vetted at least as well as members of the armed services.. we have done this for at least 6 decades. Eminently executable.

    ALL OF THESE SCREWED UP ROYALLY!!!

    The real complicated stuff still awaits!!!! How complex by comparison is it to get all the policies right and fend off the unwarranted loss of confidential information, from now to forever?

    How complicated is it to make sure the jump in premiums experienced actually gets suppressed in the long run?

    None of us will know for up to 10 years if the Nimrods who fumbled the easily executable stuff will contain costs, keep improving health care and allay the doubts of the realists.

    What then will those of you who are advocates still, in the face of the real results of Larry, Moe and Curly fixing health care do to repair things? Apologize profusely? Offer to pay to fix it? Work on the the next Ponzi scheme to push it off to 2050?

  • Report this Comment On November 29, 2013, at 6:42 PM, MzTerry wrote:

    Reichwing Nutjobs whine so much about Obamacare as tho there's nothing "positive" about it ... But then that's how you think when you watch is FOX NEWS 24/7 to stroke that bigot streak {";~D}>:

  • Report this Comment On November 29, 2013, at 6:44 PM, MzTerry wrote:

    Reichwing Nutjobs watch FOX(keepUstupid)NEWS 24/7 ... and they're programmed to think Obamacare is evil ... and never question why Republicans never offer an alternative ...{";~D}>:::

  • Report this Comment On November 29, 2013, at 6:45 PM, MzTerry wrote:

    THE FUNNY THING IS ... the Individual Mandate (requiring everyone to purchase their own healthcare insurance) was invented by REPUBLICANS in 1993 during the Clinton administration ... Bill Clinton's healthcare plan required "employers" to provide 100% of healthcare insurance for employees ... but REPUBLICANS (being the protector of Corporate America that they are) countered with the "Individual Mandate" taking the burden (or a very large chunk of it) off the employers and forcing the "employees" to pay a large chunk of their own healthcare insurance out of their bi-weekly paychecks ...

    Republican Governors even included the Republican Individual Mandate in the Healthcare laws of the states they governed ... And finally, in early 2009, REPUBLICANS urged President Obama to include the "Individual Mandate" in the Affordable Care Act ... And the moment he did, REPUBLICANS betrayed the President claiming he was forcing individuals to buy their own healthcare insurance :::

  • Report this Comment On November 29, 2013, at 7:21 PM, Mathman6577 wrote:

    @MzTerry: the GOP did propose a plan. The problem is that Nazi Pelosi and company repressed it and passed a law that nobody read. And the GOP is not obligated to fix anything that King Obama messed up anyway.

  • Report this Comment On November 29, 2013, at 7:42 PM, Gman wrote:

    Obama when do you plan on telling the American Public about this? “While appearing on Newsmax TV's "Steve Malzberg Show" on Monday, November 26, 2013 . Time magazine’s senior political analyst Mark Halpern admitted that death panel are built into Obamacare and will be the mechanism used to control costs, Halperin went so far as to say that rationing is "going to be a huge issue," Stating it is "something else about which the President was not fully forthcoming and straightforward." With this clause in Obama Care the Government has taken the Life or Death decision out of the hands of the patient or family and put it squarely in the hands of the Government. This clause potentially exposes the patient or their families to hundreds of thousands of Dollars of “Life Ending Care Expenses”

  • Report this Comment On November 29, 2013, at 7:49 PM, USMC6569 wrote:

    I always wonder if the people that claim that the US health system is horrible have ever tried any other countries health care system or talked to just regular people in those countries about their health care system. I've done both and I can tell you there is a reason people that can afford it come to the US for major health care problems. Our health care system may not be perfect but it is head and shoulders above any other country with our population size. Comparing the health care of countries like Switzerland to the United States is like comparing a winning little league team to any major league team. The only thing they have in common is that they both play baseball.

  • Report this Comment On November 29, 2013, at 8:04 PM, Mathman6577 wrote:

    @USMC: good point about Switzerland and friends. My motto is if someone wants to live in a country like that "have a safe trip".

  • Report this Comment On November 29, 2013, at 8:05 PM, impishgrin wrote:

    Who is this author? Jay Carney's sidekick? It's as if she's been living on another planet for the last 40 years where unicorns prance through honey glazed clover under eternally blue skies. None of these ideas are new. There is no "new medical world" - just tired old socialist dogma with some new lipstick. ACOs were tried ad nauseum back in the 90s (especially in California). ACO is just a euphemism for HMO - a local network of doctors and hospitals that a patient is required to use. HMOs came out in the 1970s and created a firestorm of backlash when people found out about all the restrictions. So the name and organizational structure was slightly changed in the 90s, but then ACOs failed too. Read David Dranov's book, Code Red, for the entire history of the American healthcare system. All this is in there.

    The rest of the article is pure pie-in-the-sky. The author seriously believes that electronic preventive test reminders are going to improve the health of the population? What about all the time in between tests that much of America spends abusing their bodies on things like beer and pizza? Is a little electronic light going to go off alerting you that you can't eat that extra slice because your cholesterol will spike during your next mandatory check-up? We'll seriously need "health police" running around, intruding into our lives to pull off the author's dream. Is this what the citizens of "the land of the free" want?

    I'll tell you how to get the nation healthier - bring back phys-ed in school and run the kids to exhaustion every day. Run them so much they start to love the high and never want to stop. Then they'll take the habit into adulthood and they'll be able to chow on pizza and beer with no ill effects because their metabolism is so high. Simple old, tried and true philosophy.

    Oh, and these "medical homes" are scary. One quote from the article kind of sums them up: "Meanwhile, the hospital won't be reimbursed according to how many services they provide you. Instead, they'll see their rewards docked if patients are readmitted within 30 days..." So this is supposed to be some patient centered, perfect world? The unintended incentive of this cost control measure is for hospitals to delay follow-up care to patients until the 30 day threshold has passed. What if they really need it? What if a mistake was made, as in so many complex medical procedures? Who should decide these matters? You and your doctor... or some utopian, ivory tower government bureau filled with socialist egg-heads who've never seen the light of day in 5 years? Don't buy any of this nonsense. Wake up people! Wake up!

  • Report this Comment On November 29, 2013, at 8:11 PM, rdmcdonald48 wrote:

    "The Most Revolutionary Aspect of Obamacare" is that it may just be the final act of a government out of control that will draw this nation into another real "revolution".

  • Report this Comment On November 29, 2013, at 8:22 PM, dmanyeah wrote:

    Please can you make it anymore obvious that your a Liberal with an agenda to make something that is bad to look good. Revolutionary....no its just another reason for a doctor not to take you in their practice unless you are healthy! Why would a doctor take in a patient who is obese or unhealthy because that only brings down their numbers on keeping people healthy...you cant force healthy on those who are not healthy! Just more control on what we cant control expect for creating bad bevahior

  • Report this Comment On November 29, 2013, at 8:22 PM, byetore wrote:

    The Most Revolutionary Aspect of Obamacare = It doesn't work ....fool.

  • Report this Comment On November 29, 2013, at 11:54 PM, BADGNUS4U wrote:

    This sounds like one of those pie-in-the-sky reports written to impress your college professor. Sounds great, but out of touch with reality. Once the flood gates open up and all the Medicaid folks with free healthcare start showing up at the doc offices, they will be too busy to call and see if they took their meds. The key words in the report centered around keeeping the overall costs down. Believe me that will be done by rationing service... maybe not in year one, but after that, you can expect less services (delayed appointments, etc). A left-leaning professor might give this report an A. Those more with the real world experience would call it an "incomplete".

  • Report this Comment On November 30, 2013, at 12:21 AM, BobbyBouchet wrote:

    Just registered 5 mins ago

    I have been coming here for 6 years

    I so much appreciated this site till THIS particular article

    I can go to Yahoo for this type of political spin/drivel

    It is so sad to see this here

    I can put into words how disappointed I am but it wouldn't seem right

    This published article should have been read by an editor and rejected for not being up to Fool standards!

    I read an awful lot..and this is just my opinion..but I stand by what I said.

    Is it possible I can now trust just 2 places to give me straight facts?

    I am very disappointed.

    I'll debate any who wish to on the facts of the article but so many others have provided good arguements against this authors points that it hardly seems likely I need to do so to an educated audience such as the Fool draws.

    This is distressing

    sorry

  • Report this Comment On November 30, 2013, at 12:42 AM, skypilot2005 wrote:

    "If you like your health plan, you can keep it. If you like your doctor, you can keep them." President OBama.

    And the lies continue........

    The truth is the A. C. A. is nothing less than a huge transfer of wealth.

  • Report this Comment On November 30, 2013, at 5:06 PM, rdsbobby wrote:

    The Obama propaganda machine is up and running how much have they paid MF? Are you part of the half billion dollars spent on the ACA website? But what else would you expect from a company located in the Great Socialist republic of Alexandria VA. I have never felt my doctor EVER had anything but my best interests in mind. My doctor NEVER over prescribed tests, medications, or procedures under my private health plan. So what exactly is MF suggesting about my doctor? My CY 2014 rate increase is the biggest increase in my health insurance in 30 years. Want to comment on that MR? I USED to be a MF subscriber.

  • Report this Comment On December 01, 2013, at 3:50 PM, foolishgold wrote:

    I am so disappointed in this article. Maybe this is an early April Fool's??? I am a physician and was thinking about subscribing to this service, but I am afraid this article has turned me off so completely that I cannot bring myself to subscribe to this service.

    So many physicians are going to flee, (or never go into medicine) because of this bad idea that was translated into a bad law. I laughed when I read "Obamacare may seem complex". 2,400 pages of convoluted laws. Have you tried to read it? I have. It is a disaster for healthcare, for this country, and this economy. Pelosi was right, you have to pass it to find out what's in it. We sure are finding out now. I'm sorry for what is happening to my beloved profession. I am sorry that the MF service has turned itself into such a leftist tool. I am sorry that I will have to shop elsewhere for a stock advisor service.

  • Report this Comment On December 01, 2013, at 9:11 PM, NOTvuffett wrote:

    All I know is that I lost my insurance. To get a policy to comply with Obamacare will cost me several thousand more a year- and I will have higher out of pocket costs. So what is the point? Really at my stage of life and my personal circumstances, I only need catastrophic coverage. Now thanks to the left-tarded geniuses in govt., I don't have that anymore.

    These guys can bite my a$$, I will not comply. Maybe if 50 million people said this law is stupid and we will not abide by it, it would confer the point.

    foolishgold, I feel your pain. This is America where people are entitled to different opinions, but this is over the top. Not only was Obamacare over 2000 pages and passed in the dead of night, there have been over 10,000 pages of regulations relating to it. The law gives almost dictatorial powers to the HHS secretary. foolishgold, I have already had people contact me asking for capital or expertise to establish off-shore medical facilities.

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