Monday, December 9, 2013

Deep Currents, Surface Storms - Healthcare

Until very recently, it seemed that Storms is all we could see or hear in the Healthcare fight. Skies are clearing a bit now, with the website working, but the forecast seems to say - Expect More Storms.

What's going on at a deeper level, the level of the Deep Currents? To get into that domain, let me pose some questions. Try to answer them for yourself, and then I will give you my answers, which are obviously not yet provably true. They are my Deep Current Forecasts - what is really going to happen in 6 months to a years time:
  • By October 1, 2014, how many enrollees will we have (private, Medicaid)?
  • What's the forecast for private and Medicaid enrollees at the end of 2015?
  • What percent of the private enrollees will be under '35? Will this be enough for experts to label the risk pool stable?
  • How much will 2015 Exchange premiums increase over 2014 levels?
  • What does market research (if conducted) show is the percentage of folks (whose 2013 policies were cancelled) that think they ended up with a bad deal?
  • Has employer-sponsored insurance in 2014 (total employees covered) moved up, down, or stayed the same, relative to 2013 levels?
  • What's the forecast for employer-sponsored insurance in 2015?
  • What percent of people covered under Obamacare are experiencing access or other quality problems (access to specific doctors or hospitals) and conclude the healthcare system has deteriorated?
  • Do a majority of people label Obamacare a success, a failure, or say it's too soon to tell?
  • Did healthcare cost growth remain moderate in 2014? What's the forward forecast?

There's no way to win a straight-on argument with Conservatives about Obamacare; so I recommend getting Conservative friends or acquaintances to take a stand on some or all of the above questions, and then reconvene in early October, 2014, to see who was right. Here are my answers:
  • By October 1, 2014, there will be 10-12 million enrollees (4-5 in private, 6-7 in Medicaid).
  • The end of 2015 forecast is: 20 million enrollees (10 private, 10 Medicaid).
  • 25% of enrollees will be under 35, enough to label the risk pool stable. A fairly unknown fact is that the ACA calls for a single risk pool in each state, combining on and off-Exchange signups.
  • The average 2015 premium increase (compared to 2014) will be below 5%.
  • 20-25% of people, who were "forced into Obamacare by having their old policies cancelled, will feel they are worse off than before.
  • Total number of people with employer-sponsored insurance will have risen slightly from 2013 levels; and the forecast for 2015 is for a 2-3 million (1-2%) drop-off (well below the 80 million Storm Surge numbers we are hearing now).
  • 20-30% of enrollees will report some quality concerns with healthcare service, but very few of these will prefer to return to the old system.
  • A slim majority will label Obamacare a success by October 1, 2014; but people expect these numbers to continue to improve.
  • Yes. Healthcare costs will have continued their slowdown in 2014, rising 1% on a real per capita basis, below the rate of GDP growth, giving us negative Excess Cost Growth (How much cost growth exceeds GDP), and the forward forecast is for more of the same. The CBO continues to lower its Medicare/Medicaid forecasts in both their 10 year and Long Range Budget Outlooks.
For the moment, let's assume my predictions turn out to be closer to the mark than the current Conventional Wisdom. Why have others so badly missed the mark? The answer is simple, yet full of psychological complexity: People can only see what their lenses allow them to see. Lenses are formed by perspective, ideology, and level of consciousness development.

If you absolutely expect and know you will see a turkey, you will almost always see a turkey. Even when most people can see the emerging bird life is certainly a swan, folks will defend their forecasts, and will choose not to see what is emerging. When the swan's outlines become undeniable, we move to denial, and no longer look at, or talk about this "bird life' any more.

Sometimes, someone operating at a lower level of consciousness, will not be able to see how a complication or paradox in the situation might, in fact, transform into an elegant outcome later on (many cannot see that the Ugly Duckling will become the lovely and elegant swan a bit further down the road).

Corrupted lenses, shaped by emotion and ideology. An undeveloped awareness that does not allow someone to "read" the currents and complexities  of the present situation. 

An Integral Leader has learned the personal mastery skill of clearing the lenses of perception and, like the fisherman wearing polarized lenses to enable seeing below the sunlit surface, he or she can see what is moving beneath the surface of things.

That's enough for today. Tomorrow I will finish this Healthcare section, by looking at why the President let legislators craft key parts of the bill and also why he hasn't fired Kathleen Sebellius, or anyone else on the ACA team.

See you tomorrow.

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