N Engl J Med. 2012 Oct 18;367(16):1479-81. doi: 10.1056/NEJMp1210763. Epub 2012 Oct 10.
The shortfalls of "Obamacare".
Source
Project HOPE, Bethesda, MD, USA.
Some supporters of the ACA characterize it as “market-friendly” — presumably because it encourages exploration of a reimbursement system with better incentives than the current one — but they fundamentally misunderstand what it takes to be market-friendly.4 Having Medicare choose which pilot project should become the law of the land or which bundled-payment strategy should be used to pay for services does not bring market forces into play.
What is needed are reforms that create clear financial incentives that promote value over volume, with active engagement by both consumers and the health care sector. Market-friendly reforms require empowering individuals, armed with good information and nondistorting subsidies, to choose the type of Medicare delivery system they want. Being market-friendly means allowing seniors to buy more expensive plans if they wish, by paying the extra cost out of pocket, or to buy coverage in health plans with more tightly structured delivery systems at lower prices if that's what suits them. If market-friendly Medicare reform is your aim, a good place to look is the plan proposed by Senator Ron Wyden (D-OR) and Representative (and vice-presidential candidate) Paul Ryan (R-WI) — not the ACA.5
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