Health IT

Advice to fans and foes of Obamacare: Stop overreacting and start implementing

We’ve been through the planning and the ratifying phases of Obamacare. A behavioral economist says it’s time to turn to the difficult task of making it all work.

Everyone needs to chill out. Whether you are celebrating or sorrowing over the President’s reelection and what it means for the Affordable Care Act.

“The impact of ACA is probably not going to be as significant as opponents or proponents expect it will,” said Professor Douglas Hough, PhD.

Douglas Hough, PhD is an Associate Professor of behavioral economics in healthcare, and healthcare economics at the Johns Hopkins Carey Business School.

“Yes, we are going to have 26 – 37 million more people insured, but that does not guarantee that they will have access to healthcare.”
He also doubted the impact of preventive care.

“People stick with their defaults, and if the default is. ‘I haven’t gotten an annual physical so far,’ he’s not going to change that behavior now.”

“The explosion in demand will be for preventative care and that won’t be met as well as proponents expected,” he said.

He also soothed opponents’ fears of tax collectors checking for proof of health insurance.

“The impact of the mandate will be amazingly benign,” he said. “Those who don’t have insurance will get it and those who don’t want it, they will be convinced that they should have it.”

“The fear of individual mandate being the first step to socialized medicine is not true.”

Hough thinks implementing insurance exchanges will be easy compared to a wide rollout of accountable care organizations.

“The successful examples of integrated care at Geisinger and Mayo and Cleveland have not encouraged everybody to create ACOs,” he said.

Hough said that the trouble the healthcare sector has had with implementing medical records is just one example of the many operational problems facing doctors and hospitals.

“I don’t remember banks and restaurants having trouble automating their payment system, but with healthcare it just seems the whole integration of info system that seems to me an insurmountable problem,” he said.

Hough said that incentives to change are different for doctors and patients and that financial incentives don’t work in the long term.

“People incorporate the incentive structure into day-to-day living and it’s not effective after a few years,” he said. “The other part is that most financial incentives are short-term, and when they go away, people regress.”

Hough’s book, “Irrationality in Healthcare” coming out next spring and discusses what really motivates behavior change among individual patients and physicians.

“We’ve gone through the trauma of getting the ACA passed and ratified, now is execution,” he said. “Then the really hard part is doing an equally sterling job of controlling cost.”