Six Ways to Save Obamacare

Only President Obama can save Obamacare.

Obamacare is not going to be repealed – not now and not in the future. However, there is real risk it could collapse under its own weight. If that happens, the President’s credibility will collapse as well. Whether or not you support this President, this could seriously harm the health of our citizens and America’s fiscal stability.

The President will not succeed until he faces this reality: the challenge of Obamacare is not a political issue, it is a management issue. Playing politics–no matter how successfully–cannot solve management problems.

To save Obamacare, the President should:

#1: Replace the politicians with professionals. President Obama is a superb politician, but he needs to surround himself with experienced leaders who possess the capabilities he lacks. That means replacing HHS Secretary Katherine Sebelius (also a fine politician) with an experienced health care leader who has successfully created large-scale systems serving millions of people. My first recommendation is George Halvorson, who built Kaiser Permanente as its Chair and CEO. Other candidates include Dr. William Brody, MD, PhD, who currently heads the Salk Institute, and Lois Quam, who built Optum Health for UnitedHealth Group and was Hillary Clinton’s head of global health at the U.S. State Department.

#2: Fulfill the promises that “No one would lose their current health plan” and “You can keep your doctor.” The promises Obama made to build public support for the law are simply not true today. Already, two million people have had their health insurance cancelled, and the number could rise as high as 16 million. The law set uniform standards for all Americans at a very high level, knocking out high deductible plans and forcing levels of coverage that many people don’t want or need. The President needs a quick fix by asking for Congressional approval to exempt all existing health plans for the next three years rather than forcing people into more expensive plans on the exchanges. Then HHS should notify participants in these plans they can keep their plans until January 1, 2017, providing adequate time to adapt to Obamacare.

#3: Turn into a consumer-friendly website. The problem with the government exchange site is not a technical problem, but a management problem. Until this week, no one has been in charge of the overall system, leaving the techies working at cross purposes with each other and the federal bureaucrats trying to control them. Is anyone surprised this led to mass chaos? Worse yet, no one thought through what consumers wanted and how to make the system easy for them to navigate. Secretary Sebelius has acknowledged that HHS never did “end-to-end” testing of the system. Nor did HHS run pilot tests in any states. Can you imagine Apple not bothering to test the complete system before launching the iPad?

#4: Slow down Obamacare’s implementation. After this false start, trying to force all Americans to choose a plan by January 1, 2014 is a formula for disaster. The President needs to take the pressure off by delaying the effective date of the individual mandate to July 1, 2014 or January 1, 2015. The latter is the new effective date of the employer mandate, which has already been delayed a year. Even the most skilled professionals can’t fix this system overnight, so don’t force an unrealistic timetable that causes frustration and chaos.

#5: Fix the problem of adverse selection before it spirals out of control. The underlying premise of Obamacare is to force high premiums on healthy young people to pay for the high cost of unhealthy older people. Early indications are that this isn’t working, as high cost patients are signing up but young people are not. Many will simply opt out by paying a modest penalty for not carrying insurance – less than $100 in year one. To correct this problem, Obamacare should be modified to permit healthy and young people to enroll in high-deductible plans. This could lead to upward rate adjustments for the older population which better reflects their share of the costs. The President won’t like this adjustment but it is inevitable, so he is better off being proactive than waiting for another crisis that could further derail Obamacare.

#6: Change the subject from insurance access for disease care to healthy living. For the past five years all the energy has gone into providing insurance access for all Americans – a worthy goal. Little has been done to address the real driver of health care costs: the declining health of the American people. More than 50% of health care costs are lifestyle-related, yet 95% of our efforts and the reimbursement that goes with it is for downstream care. By giving everyone full access to downstream care, there is no incentive to keep yourself healthy. In fact, the Affordable Care Act specifically prohibits charging less to healthy individuals, as most employer-based plans do. The only sustainable way of controlling costs is to incentivize people to take responsibility to keep themselves healthy with the support of their health care team, which should include health and wellness practitioners. For its part, HHS needs to move forward with the reimbursement shift for providers from “fee for service” plans to “paying for value” delivered to its patients, an essential step in shifting the focus.


Our health care system urgently needs to be fixed, but in its current form Obamacare is not what the doctor ordered. Republican efforts to repeal it altogether are a distraction that only serves to divide the country. In the three and one-half years since the Affordable Care Act was passed, the President has been unable to build support among the general population, nor is HHS ready to implement it in its original form. Instead, the President should take a pragmatic approach to give a new management team time develop a viable implementation plan that gives consumers time to adapt and incentives for staying healthy.