Obamacare — another way we forego innovation

Here’s something I haven’t seen discussed anywhere:  I’ve read numerous times that O’care will stifle innovation in healthcare technology.  But to bring healthcare costs down, we need innovation in heathcare delivery and innovation in insurance product design.  My own thought is that staff-model HMOs should have become more mainstream, but Kaiser Permanente, which is a staff-model HMO, is the largest insurer in California (or at least one of the largest), and their costs aren’t exceptionally lower than their competitors. 

Nonetheless, I still think that the only solutions in this area will come from providers and hospitals working together.  And, pretty reliably, it’s small firms that are the most innovative. 

For instance, the hospital down the road from me is building up its network of doctors.  I’d love to see them develop a prepaid healthcare offering, in conjunction with an insurer (presumably not one of the big players) providing reinsurance and out-of-network benefits.  But it’s not really feasible in the employer-based system, since we’re only one small part of the metro area, and there aren’t enough employers who would buy a product that only a small part of their workforce could use. 

Moving to exchanges makes this worse — the reports are, at least, that only the largest insurers in a given state are finding it worthwhile to participate in an exchange.  Maybe it’s not the worst thing about Obamacare, but it’s definitely a missed opportunity.