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That is my issue with it. If we had some way to manage costs...I'd support it. Obamacare simply doesn't do it. I think that they are noble in their attempt to insure everyone...they are just going about it in the wrong way and in their error...they're going to make their own system unsustainable.
I think the system was unsustainable before healthcare reform. We have a system that is designed to inflate costs at every level, with no controls on the pricing and very little transparency. We already are devoting too large of a share of our economy to healthcare (which incorporates insurance costs as well as healthcare costs), and when one sector of the economy is using too many resources, those resources aren't available to other segments of the economy. This is one key part of the off-shoring problem. With babyboomers poised to become increasingly dependent on healthcare, which will drive healthcare to consuming an ever-increasing part of our economy, healthcare reform had to be an absolute priority at this time.
While I totally concur with you that the ACA doesn't do much in the way to manage costs, it moves us closer to a single-payer model, where government has the power to manage costs. This may not be a good thing, because how they manage costs can lead to sub-par care, but, frankly, I don't think there's any way to get around government stepping in and slashing healthcare costs brutally in about 2 decades. At that point, it will be necessary in order to save the national economy.
You're right, of course. But many folks do not care because they believe it's okay for others to foot their medical bills. The world owes them. They never really see the actual cost of the treatment. All they know is that there is a big cloud that rains money down when they are in need.
Of course, the folks seeding that cloud see their costs go up, but will simply have more chains attached to their ankles with little say in the matter. That's "equality."
I think newberry is pointing out that the actual cost of treatment in the United States is grossly inflated, and that inflation is a result of the insurance model we designed to meet our healthcare needs, which is actually unique in the world.
Democrats have of course have a price control mechanism the Independent Payment Advisory Board. Republicans have fought its implementation and call it a Death Panel. The only difference between Ryan Care and the ACA is the IPAB. With Ryan care you let the insurance company decide what procedures are done with IPAB its the government.
The IPAB is basically a large negotiation department which on paper looks fine but all insurance companies have these and they aren't remarkably effective. These are the groups that work for companies that need their expertise to survive yet they still allow 3000 dollar MRI's to come through as a "reasonable" cost.
Nothing is more effective at truly managing costs than the patients themselves. More regulations and the federal checkbook aren't needed to purchase high deductible plans for everyone. If I want to purchase a high-deductible plan in my home state of Virginia without the assistance of my employer it is around 200 monthly for a healthy, sub-30, individual because the state of Virginia coupled with a litany of lobbyists have added mountains of covered risks like acupuncture and aroma therapy sessions which most would probably regard as unnecessary. The state of Idaho has the cheapest high ded plans in the country for a healthy individual...around 55-60 monthly which are actually less than my employer sponsored high ded plans. The reason for this discrepancy is because the state of Idaho doesn't mandate any covered risks beyond catastrophic events (car wrecks, cancer, terminal disease, loss of limbs, etc.)
Now should I, currently as a Nebraska resident or previously as a Virginia resident, be barred from purchasing my plan from the state of Idaho...and if so, why? Interstate boundaries and employer tied healthcare are relics of wage controls during WW2 and they are responsible for a good deal of the ills we see today.
Costs aren't really that high if a market mechanism is injected. Federal and state regulations have protected legal monopolies which artificially support exorbitant prices and the government subsidizing the system does nothing to alter it's inefficiencies.
I think newberry is pointing out that the actual cost of treatment in the United States is grossly inflated, and that inflation is a result of the insurance model we designed to meet our healthcare needs, which is actually unique in the world.
Exactly.
Health insurance is the issue...not treatment. We have built a system that fosters legal protection of exorbitant prices and horrendous inefficiency.
Health insurance is the issue...not treatment. We have built a system that fosters legal protection of exorbitant prices and horrendous inefficiency.
For the sake of profit.
Insurance in other countries is rarely as profitable as it is in the United States.
I think one step to reforming our system that could have been easily taken and was not was to introduce transparency into the system. If medical providers had to submit their prices to a website that was open to the public, and people could compare and shop around, then competition would have leveled prices. More than that, if how providers billed were standardized, so that the bill you get from the Mayo Clinic is broken down the same way that the bill you get from Brigham is broken down, then price inflation would be more easily controlled.
I think newberry is pointing out that the actual cost of treatment in the United States is grossly inflated,...
Of course it is. But what is being done is compounding the problem, not making it better.
Two hundred years ago the "common man/woman," for the most part, could afford the health care of the time without the aid of insurance companies, governments, etc. And we call what we have "progress"? Bureaucracy most often worsens that which it attempts to improve upon.
In my line of work as an underwriter with a major healthcare insurer, I have the opportunity to see a lot of interesting aspects of healthcare pricing and how adjustments are made. I'm not a fan of Obamacare but I'm willing to admit that it will do a few good things. Covering people up until the age of 26 on their parents plan is a good thing...so is mandating providers to pay 80% of their earnings on healthcare claims as opposed to admin costs and salary...
However, the issue that I have most with the ACA is that it does nothing to address the real issue. The major issue in this isn't that people don't have insurance...that is just a symptom of the problem. The real issue is that healthcare costs in and of themselves are artificially inflated because no market mechanisms exist. Regulations inhibit shopping...it is literally impossible to purchase Blue Cross Blue Shield of Idaho if you are a resident of Nebraska...which really doesn't make sense. People file healthcare claims these days for everything...literally everything...it's tantamount to filing an auto claim for an oil change. Healthcare, whether it is paid by a single payer or by individuals shouldn't be as expensive...medical providers charge exorbitant figures to insurers because they know insurers have the contractual obligation to pay their percentage. The system as it currently exists fosters nothing but misbilling and overappropriating figures because they know the revenue stream is consistent. Now with the federal government effectively shoring it up...the revenue stream is even more sturdy which will do nothing but increase the pool of patients to build up this broken system.
You want cheaper healthcare.......tell your medical provider that you're paying out of pocket and watch how they respond.
Here's a real world example with myself. I currently live in Lincoln, NE and Bryan healthcare is one of the biggest in the area. I have been having some nerve issues in the lower back and left leg. Bryan ordered that I get an MRI w/o a contrast agent to determine the extent of my injury. This MRI from Bryan Medical was 3200. Now...I do have very good healthcare as I work for an insurer but I told the doctor that I didn't want to file a claim...I advised him that I would pay out of pocket. He looked me and gave me a business card for another diagnostic company...Great Plains Diagnostic Imaging. So, I called this company and they gave me a quote for an MRI w/o contrast agent and consultation for 600 dollars. Now I understand that 600 dollars is also expensive but this goes to show that healthcare itself isn't nearly the cost that is charged to insurers. Obamacare will do absolutely nothing to break down the ponzi scheme that is medical billing...it will simply inflate it and expand the pool.
Excellent post. Thank you for sharing. Although I am not in the medical field, I understand exactly what you're saying, and it makes perfect sense to me.
Claiming an oil change on your auto insurance is a profound metaphor that really puts the issue into perspective
Except that's not going to happen with the high deductibles on the ACA. My guess is most people will end up on the Bronze plan which will average $4500 deductible.
Most people will end up on the Bronze plan that has on average $4500 deductibles. These are not a lot different than current catastrophic plans. One of the main reasons rates have gone up on the ACA is because now everyone can get insurance and the one and two million caps have been lifted. If you really wanted to bend the cost curve you would have to force everyone onto high deductibles. Every single ACA plan has people paying up to $6,250 out of pocket or $12,400 for a family. I don't see people running down to the clinic with every sniffle or money come raining down.
All of them will run down to the clinic with a sniffle ONE TIME. After they receive the bill in the mail, they will curse Barack Obama for everything he is worth. Instead of delayed gratification, it will be delayed Empty Bank Accountification. At that point, they will realize that they have been snookered into something that doesn't work for them (or else fined for NOT being snookered!!). Afterall, how many average American's actually rack up $4,500 - $6,250 in medical bills every year?
ACA is a feel good measure that simply will not work in reality. Insurance companies enriched, the populace disenfranchised. Wait and see.
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