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You realize of course that what you describing is essentially Medicare?
I think your suggestion is a good one but the big problem is Medicaid - what to do about the large number of people who cannot afford any insurance, private or government? O'care greately expanded Medicaid but AHCA was cutting it back. The Pubs and Dems are not going to agree on Medicaid, and the only way ACA reform gets passed is through a bipartisan effort.
Other things that can happen to "fix" ACA:
- Allow insurance to be sold across state lines
- Put prescription drugs on the bargaining table for Medicare
- Put limits on drug advertising
- Require all providers to publish their prices
- Require each provider to charge the same price to everyone. No more bargaining behind your back. Provider can choose whatever they want to charge, but that price is what you then pay regardless of whether you have insurance or not.
- Disallow 0-deductible insurance (many group policies are 0-deductible).
- Disallow co-insurance that is less than 15% (need this to keep people from over-using insurance)
- Get rid of the personal mandate and replace with AHCA incentives.
Re: Selling insurance across state lines
It's a dated, time- worn concept that did not fly in the early 90's when is was the basis for Hillarycare, in 2008 when Mc Cain pitched it, in 2012 when Romney pitched it and right now because it is a Trump initiative.
Selling insurance across state lines is legal today and is specifically enabled within the ACA and yet few takers.
The ACA established a national baseline for all health insurance products, Essential Services. States have been free to go beyond this baseline and most do. No two states have the same regulations beyond Essential Services.
As a part of the negotiation with the Freedom Caucus, Trump threw the federal standard for Essential Services under the bus and expected each state to develop their own as they had before the ACA. It was not enough of a bone to get the Freedom Caucus to support the bill and it died.
The theory is that an out of state insurer would be exempt from state regulations while selling insurance in a state other than their own. Back in the late 70's SCOTUS determined banks would be exempt from state credit card laws when selling across states. And so most credit cards are issued from South Dakota and Delaware that have no Usury Laws. Banks are free to charge any interest rate they choose.
Insurers, in theory, would also likely circle their wagons in those states with the least amount of regulation and sell junk plans to consumers who don't realize all insurance is not alike.
In reality, it's all about networks. If an out of state insurer does not have a networked of healthcare providers and hospitals in the states they operate in, they are not going to be competitive with insurers with well honed networks.
No healthcare insurer is going to be in a position to offer higher reimbursements to healthcare providers and hospitals and lower premiums to consumers and survive.
When politicians and the media that feeds off them, talk about selling insurance across state lines, it's clear evidence they do not know what they are talking about. When the politition happens to be an MD, it is assumed they are also experts about health insurance. It's nonsense.
Percentages be damned. It would be just another giant scheme. Figure out the numbers and you will see that there is NO WAY that approx. 51% of the population of this country can pay for 100% of all the health care with a 2.2% increase in taxes. I wish I could remember where I read it (maybe here and someone still has the link), but it read that it would cost each TAX-paying citizen approx 30K per year to just break even with such a plan. I don't know about you but an additional 20K a year in taxes means this family starts eating Alpo bought on double coupon day. That's the problem with your idea. As always, it's a noble idea but the devil is in the details, and the single payer system just doesn't work financially with a progressive tax system where not everyone pays..... You want single payer...then every SINGLE person must pay. Plain and simple....
Bingo! Other countries already know that, and tax accordingly. I just posted on that.
I would take some elements of the Swiss system. Regulate insurance so for example deductibles are standardized. Cap premium costs to a percentage of income. The Swiss use 8% but I would recommend 10% so that no one pays more than 10% of income for insurance.
I would include a provision similar to the Swiss that if you make substantial life style changes that have positive health results a portion of the premium you paid is rebated.
We could do that within the current ACA structure
I like the idea of everyone having skin in the game. Not sure about percentages. Who feels the bite more, the guy making $25,000 a year with 5 dependents or the single woman making $500,000 a year?
The concept of Group Health Plans does not exist in Switzerland. There are no employer subsidies.
The Swiss define a national base of Essential Services that must be covered by private insurers regardless of age, sex, health condition and so on.
A critical difference is that the cost of healthcare is less than in the US because government own/ operates most hospitals. Government regulates the price of prescription meds. MD comprised Compariative- Effectiveness Panels determine treatment protocols. And of course, the Swiss population is healthier than the US population.
A quantum leap in the right direction would be to reward healthy living. Reducing premiums for people who don't use it. Why is a person who eats healthy, keeps their body mass in check, doesn't excessively drink or smoke, ball-and-chained to the other 80%???
Fact is many pre-existing conditions aren't really that pre-existing at all but brought on via exceptionally poor life choices. Being diagnosed with a random neurological disease is entirely different from heart failure cause McDonalds and cigarettes are food groups.
Stop all the pharmaceutical companies from charging 1000+ times what it cost to make the drugs would be a good start. Trump should do to them what he did to Boeing, saying, I think they should make money, just NOT that much. They dropped their prices on the contract if I remember right.
The general public will never know what went down with Boeing.
The design specs were far from finalized. Easy enough to say " we will pay $x and make it happen, when specs are not final.
There is also the matter of leverage. Look at how much more Trump intends to spend on defense. What percentage of that pie will Boeing get?
If Trump were serious about Big Pharm, he would be a champion for allowing Medicare to negotiate/ regulate prices. Leverage? Buy meds from Canada.
It's a dated, time- worn concept that did not fly in the early 90's when is was the basis for Hillarycare, in 2008 when Mc Cain pitched it, in 2012 when Romney pitched it and right now because it is a Trump initiative.
Selling insurance across state lines is legal today and is specifically enabled within the ACA and yet few takers.
The ACA established a national baseline for all health insurance products, Essential Services. States have been free to go beyond this baseline and most do. No two states have the same regulations beyond Essential Services.
As a part of the negotiation with the Freedom Caucus, Trump threw the federal standard for Essential Services under the bus and expected each state to develop their own as they had before the ACA. It was not enough of a bone to get the Freedom Caucus to support the bill and it died.
The theory is that an out of state insurer would be exempt from state regulations while selling insurance in a state other than their own. Back in the late 70's SCOTUS determined banks would be exempt from state credit card laws when selling across states. And so most credit cards are issued from South Dakota and Delaware that have no Usury Laws. Banks are free to charge any interest rate they choose.
Insurers, in theory, would also likely circle their wagons in those states with the least amount of regulation and sell junk plans to consumers who don't realize all insurance is not alike.
In reality, it's all about networks. If an out of state insurer does not have a networked of healthcare providers and hospitals in the states they operate in, they are not going to be competitive with insurers with well honed networks.
No healthcare insurer is going to be in a position to offer higher reimbursements to healthcare providers and hospitals and lower premiums to consumers and survive.
When politicians and the media that feeds off them, talk about selling insurance across state lines, it's clear evidence they do not know what they are talking about. When the politition happens to be an MD, it is assumed they are also experts about health insurance. It's nonsense.
You beat me to it. Selling across state lines sounds great as a talking point, but it's nothing more than just a talking point. We should have Medicare for all. And if the right wing still cries about it, then Medicare for all should be piloted for 2 years in the states that want to participate. My 2 cents
Risk pools are limited to each state. Same with provider pools. Small risk pools are more expensive and more volatile. If insurance companies can be cross-state, they can have larger risk pools which will even out costs. Same with the provider pools - insurance companies that have a limited set of providers (hospitals, doctors, etc.) can be more expensive depending on the providers. People will have more options if restrictions were loosened up.
The ACA specifically enables selling insurance across state lines, yet insurers rarely embrace this? Why is this?
Premiums have many dependencies including provider networks.
The fewer healthcare providers and hospital beds vs a local population, the more leverage healthcare providers and hospitals have and vice- versa.
Selling insurance across state lines is legal today and is specifically enabled within the ACA and yet few takers.
I did not realize that. Thanks for the update.
Quote:
In reality, it's all about networks. If an out of state insurer does not have a networked of healthcare providers and hospitals in the states they operate in, they are not going to be competitive with insurers with well honed networks.
No healthcare insurer is going to be in a position to offer higher reimbursements to healthcare providers and hospitals and lower premiums to consumers and survive.
Hence my suggestion for single pricing (each provider sets his/her/its own price, but once set, everyone pays that regardless of insurance status or carrier). This would remove networks and flatten insurance as well as increase transparency to the patient. Right now it is difficult to get accurate pricing because the provider needs to check with your insurance company before giving a price.
Because of networks, only insurance companies can drive prices downward. But with single-pricing and price transparency, consumers will drive it down. Insurance companies won't like it but too bad for them. Their system is not free-market enough. If it were, prices would be falling.
I think single-payer is the way to go but I also realize it is a hard sell and it will easier to put in place things to make private insurance work better.
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