A better Obamacare conversation
Obamacare is the Obama administration's singular legislative achievement, a major win squeezed out of a tough fight with an opposition Congress. Years later, the fight continues. The president's political opponents disparage the health-insurance reform law; his allies defend it. If your understanding of Obamacare comes from politicians, you mostly hear either that it's great and should be built on or that it's a travesty and should be scrapped.
What if we listened to medical experts instead? Gilbert Welch, who wrote Overdiagnosed, recently highlighted a problem with the law: insurers now pay in full for screening tests, as part of Obamacare's emphasis on preventive care. But diagnostic tests—those motivated by actual symptoms—tend to go in the deductible and co-payment columns. So, this happens:
A woman over 40 can have a free screening mammogram. But if she notices a breast lump and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram. That could cost $300. So the woman at lower risk for cancer — the one with no signs or symptoms of the disease — has an incentive to be tested, while the woman at higher risk — the one with the lump — faces a disincentive.
