Debate Now An Unhappy Birthday for Obamacare?

[Sun Devil 92]

Unless you are prepared to provide evidence of those claims, making them in this thread is against the rules.

Oh.....wait.......my bad. The thread rules state that no links or data are needed to support opinions. However...if you do use links and data...you need to provide a summary in your own words.

That's awesome!

Was there something here that justified our taking the time to read it. If so, I missed it.

Given all the time you are wasting in this thread......probably. You missed it? I'm shocked.

I do appreciate Greenbeards posts and have learned a great deal from them. It has pointed me to some topics I was not aware of. When you do something similar instead of wasting our time with your commentary, I'll be just as appreciative.

Greenberg, unlike me, is patient and may actually care what you do and don't appreciate. That dude is a straight-up authority on this shit. He's got the facts at his fingertips. He doesn't work his ass off trying to drag you into the weeds in hopes that you'll get bored to death.

I put this thread to bed on page one. As far as I am concerned...the rest is just idle chatter. Feel me?

Very well put. Nothing the OP is stating makes sense. You have more people with more insurance and her contention (that she admits she has no data to backup) is that clinics are closing.

Not sure what you are talking about......or who.

I posted this a few pages ago.......

Q A Why Have Rural Hospitals Been Closing - ABC News

Fourth Georgia Hospital Shuts Down As The State Continues To Refuse Medicaid Expansion ThinkProgress

It is not for sure that this is due to Obamacare. However, as Greenbeard has pointed out, you either adapt or go away. And if these places are tooooooooooooo dependent upon Medicare and those payments get cut....well, good-bye.

Can't help that.

 

[Sun Devil 92]

Was there something here that justified our taking the time to read it. If so, I missed it.

Given all the time you are wasting in this thread......probably. You missed it? I'm shocked.

I do appreciate Greenbeards posts and have learned a great deal from them. It has pointed me to some topics I was not aware of. When you do something similar instead of wasting our time with your commentary, I'll be just as appreciative.

Greenberg, unlike me, is patient and may actually care what you do and don't appreciate. That dude is a straight-up authority on this shit. He's got the facts at his fingertips. He doesn't work his ass off trying to drag you into the weeds in hopes that you'll get bored to death.

I put this thread to bed on page one. As far as I am concerned...the rest is just idle chatter. Feel me?

Very well put. Nothing the OP is stating makes sense. You have more people with more insurance and her contention (that she admits she has no data to backup) is that clinics are closing.

The thread topic is:

THE QUESTION TO BE ANSWERED:

Do you still support Obamacare in its entirety or are you ready to support those who want to repeal it in favor of a different and potentially better system? Why or why not? If you choose to repeal, what would a better system look like?

The information in the OP provides some background that prompted the thread topic.

The topic is just as stated and assumes no 'right or wrong' answer to the question posed.

I'd love to see a continuing conversation about our health care system.

I don't support Obamacare......never have.

Not for many of the reasons blathered about by the far right.

A better system would have it's goals fully defined.

As an example, there would need to be a frank discussion about all the money we spend on end-of-life care.

This article talks about the issue from a specific POV....but it does point out that this is a difficult conversation.

One that we never addressed in our Obamacare hate-fest.

 

[Greenbeard]

This was from late 2012. It was the most non-partisan article I could find. I did find something in Forbes that essentially quoted H&HS saying differently...but (as I've said) I really am going to believe those morons....???

The morons who oversee Medicare and Medicaid and thus track the number of participating physicians? Yeah, why would they know?

The reality is, even as the number of doctors opting out of Medicare (which remains vanishingly small) has grown slightly, the number of doctors joining the program has been larger. Thus the net increase in docs who take Medicare patients.

Q A Why Have Rural Hospitals Been Closing - ABC News

Fourth Georgia Hospital Shuts Down As The State Continues To Refuse Medicaid Expansion ThinkProgress

The dawning realization that having a large uninsured population is detrimental to the financial health of health care organizations (which, of course, any provider organization can, and will, tell you--who do you think has been the biggest proponent of Medicaid expansion in the remaining holdout states?). Even with its relatively paltry reimbursement rates, compared to Medicare and commercial payers, Medicaid reimbursement replacing self-pay for the uninsured is a huge boon for hospitals. Which is why hospitals in Medicaid expansion states are doing fantastically well, and those in non-expansion states...aren't.

Even Georgia (with its idiotic ideological opposition to Medicaid expansion) is looking for ways to bring in additional Medicaid funding without, you know, connecting it explicitly to the dreaded Obamacare:
Georgia Weighs Medicaid Experiment (But Not Expansion)

Without altering their opposition to expanding Medicaid under the Affordable Care Act, Georgia officials now say they’re thinking about asking the federal government for more Medicaid money to help the state’s struggling rural hospitals and its big “safety net” hospitals like Grady Memorial in Atlanta.

The outlines of the plan are unclear. State health officials say they will seek permission from the feds to “experiment” with Medicaid in a way that would shore up rural and safety net hospitals. But there are no plans to expand Medicaid, they said.

That’s too bad, rural hospitals officials say

Monty Veazey, head of the nonprofit Georgia Alliance of Community Hospitals, says expansion represents the last and best hope for many hospitals.

“There’s no question,” he said. “It’s the only way to do it or they will close.”

Larger regional hospitals are no longer looking at merging with or buying struggling smaller hospitals, Veazey said, and many counties don’t have the tax base to generate more funding for the hospitals.

He said he hopes that, if the state does obtain a Section 1115 waiver, it will ultimately use the waiver to expand Medicaid. He added that his group plans to work with other hospitals and business leaders in the coming months to create a proposal for the governor to consider.

Why? Because what they've been doing is killing their hospitals. Killing their own hospitals to spite Obama. I don't know of a better definition of insanity.

]A better system would have it's goals fully defined.

That aim has been clearly defined. Shift the delivery system to one that is paid for and delivers value, not service volume. Reward quality. Insure the uninsured. Find, implement, and scale delivery models that contain costs without compromising quality. Bring market dynamics to the health sector.

This isn't rocket science, though you're trying very hard to make it somehow incomprehensible. These things are all happening now. It's not an accident, it's not a coincidence. The ACA has thrown the gauntlet, the industry is rising to the challenge. Things are getting measurably better.

As an example, there would need to be a frank discussion about all the money we spend on end-of-life care.

That was attempted during the debate over health reform in 2009. The result was the coining of the phrase "death panel."

 

[TheGreatGatsby]

I would love a repeal of Obamacare. But a return to the free market? We'd have to repeal a lot more than just Obamacare.

 

[Greenbeard]

I would love a repeal of Obamacare. But a return to the free market? We'd have to repeal a lot more than just Obamacare.

Free markets = high deductibles.

And yet it seems "proponents" of free market health care despise high deductibles. They like the slogan, not the reality. That's by far the biggest challenge free market folks face.

Everybody, right or left, wants a low-deductible plan that has every provider in their area in-network. Problem is, that's the antithesis of free market health care.

 

[TheGreatGatsby]

I would love a repeal of Obamacare. But a return to the free market? We'd have to repeal a lot more than just Obamacare.

Free markets = high deductibles.

And yet it seems "proponents" of free market health care despise high deductibles. They like the slogan, not the reality. That's by far the biggest challenge free market folks face.

Everybody, right or left, wants a low-deductible plan that has every provider in their area in-network. Problem is, that's the antithesis of free market health care.

Free markets = lower (competitive) pricing.

 

[Greenbeard]

Free markets = lower (competitive) pricing.

Yes, that is the slogan. Understanding why is a little more important than being able to parrot it.

On the provider side, competition means people directly buying your services--you lower prices to attract that service volume. But people directly pay for your services when the price of those services falls below their deductible. The higher the deductible, the more services fall below it and are subject to direct consumer price sensitivity. Deductibles, of course, have been on the rise, which means consumers have more skin in the game now than ever.

On the insurer side, competition brings down premiums by incentivizing insurers to offer the lowest premiums, something they accomplish in part by bargaining down provider reimbursement rates (insurer expenses, of course, are the provider services they need to pay for--negotiating better prices with the providers lowers their expenses and allows them to offer more competitive premiums). That's done by excluding, or threatening to exclude, providers who demand unreasonably high reimbursements. Narrow or tiered networks are thus the way insurers respond to competition and keep premiums down. This is happening in the exchanges and that's why premiums for exchange plans are up to 20% cheaper than equivalent coverage in the much-less-competitive employer space.

In other words, this is happening. Markets, perhaps for the first time, are emerging and prices are responding.

 

[dblack]

I would love a repeal of Obamacare. But a return to the free market? We'd have to repeal a lot more than just Obamacare.

Free markets = high deductibles.

And yet it seems "proponents" of free market health care despise high deductibles. They like the slogan, not the reality. That's by far the biggest challenge free market folks face.

Everybody, right or left, wants a low-deductible plan that has every provider in their area in-network. Problem is, that's the antithesis of free market health care.

Free market advocates have been recommending high-deductible health insurance, combined with HSAs, consistently over the last twenty years or so. And our opponents have consistently tried to regulate them out existence. Before ACA, high-deductible, low-premium insurance offered a cost effective alternative to the costly full coverage insurance pushed by regulators and insurance agents. The radically lower premiums allowed people to use the savings to pay for the bulk of their health care out-of-pocket.

Those people are now complaining because ACA has given health insurance companies the excuse, and the opportunity, to raise the premiums on the few high-deductible plans remaining (most didn't survive regulatory muster) to prices comparable to the old full coverage insurance. So now we're responsible of the higher deductible but no longer get the savings to pay for it. It's another giant 'fuck you' from the whores in Congress who sold us down this river.

 

[Greenbeard]

Free market advocates have been recommending high-deductible health insurance, combined with HSAs, consistently over the last twenty years or so. And our opponents have consistently tried to regulate them out existence. Before ACA, high-deductible, low-premium insurance offered a cost effective alternative to the costly full coverage insurance pushed by regulators and insurance agents. The radically lower premiums allowed people to use the savings to pay for the bulk of their health care out-of-pocket.

Fascinating narrative.

I hope you're sitting down. In 2009, six years ago (and before the ACA), HDHP plans paired with HSAs had an average premium of $3,829 or about $319/month for single coverage.

Meanwhile, the average single-coverage premium for a bronze-level plan (i.e., a high deductible plan that can be paired with an HSA) in the exchanges this year (2015) for a 40-year-old is about $261/month.

That's a premium 18% lower now than the average from six years ago.

 

[dblack]

Free market advocates have been recommending high-deductible health insurance, combined with HSAs, consistently over the last twenty years or so. And our opponents have consistently tried to regulate them out existence. Before ACA, high-deductible, low-premium insurance offered a cost effective alternative to the costly full coverage insurance pushed by regulators and insurance agents. The radically lower premiums allowed people to use the savings to pay for the bulk of their health care out-of-pocket.

Fascinating narrative.

I hope you're sitting down. In 2009, six years ago (and before the ACA), HDHP plans paired with HSAs had an average premium of $3,829 or about $319/month for single coverage.

Meanwhile, the average single-coverage premium for a bronze-level plan (i.e., a high deductible plan that can be paired with an HSA) in the exchanges this year (2015) for a 40-year-old is about $261/month.

That's a premium 18% lower now than the average from six years ago.

You're comparing apple and oranges and you know it. Send your documents back to your handlers with shit stains on them.

 

[Greenbeard]

You're comparing apple and oranges and you know it. Send your documents back to your handlers with shit stains on them.

Sorry, which part of "high deductible premiums are lower now than they were pre-ACA" supports the bullshit narrative you made up?

 

[TheGreatGatsby]

Free markets = lower (competitive) pricing.

Yes, that is the slogan. Understanding why is a little more important than being able to parrot it.

On the provider side, competition means people directly buying your services--you lower prices to attract that service volume. But people directly pay for your services when the price of those services falls below their deductible. The higher the deductible, the more services fall below it and are subject to direct consumer price sensitivity. Deductibles, of course, have been on the rise, which means consumers have more skin in the game now than ever.

On the insurer side, competition brings down premiums by incentivizing insurers to offer the lowest premiums, something they accomplish in part by bargaining down provider reimbursement rates (insurer expenses, of course, are the provider services they need to pay for--negotiating better prices with the providers lowers their expenses and allows them to offer more competitive premiums). That's done by excluding, or threatening to exclude, providers who demand unreasonably high reimbursements. Narrow or tiered networks are thus the way insurers respond to competition and keep premiums down. This is happening in the exchanges and that's why premiums for exchange plans are up to 20% cheaper than equivalent coverage in the much-less-competitive employer space.

In other words, this is happening. Markets, perhaps for the first time, are emerging and prices are responding.

When you use the term 'insurer' you're really talking about so-called managed health plans. If you allowed for real insurance to be in the market; meaning you build-up your accounts and truly get 'incentivized' for getting in early, then one can have great health care when they actually need it. Otherwise, the market should be based upon what people pay out of pocket. Those are the two factors that should be influencing price and not the nonsense regulations that artificially drive prices way up. You have people having to pay two day's pay for a regular five minute doctor's visit the way the system is now.

 

[dblack]

You're comparing apple and oranges and you know it. Send your documents back to your handlers with shit stains on them.

Sorry, which part of "high deductible premiums are lower now than they were pre-ACA" supports the bullshit narrative you made up?

Seriously, who pays you to propagandize here and at the other boards where you distribute this crap?

 

[dblack]

You're comparing apple and oranges and you know it. Send your documents back to your handlers with shit stains on them.

Sorry, which part of "high deductible premiums are lower now than they were pre-ACA" supports the bullshit narrative you made up?

Seriously, who pays you to propagandize here and at the other boards where you distribute this crap?

Is it some insurance industry promotional campaign? You a Kaiser goon?

 

[Sun Devil 92]

You're comparing apple and oranges and you know it. Send your documents back to your handlers with shit stains on them.

Sorry, which part of "high deductible premiums are lower now than they were pre-ACA" supports the bullshit narrative you made up?

The one where I could get a 70 a month policy for my kids and can't get one for under 300 now ?

 

[Greenbeard]

When you use the term 'insurer' you're really talking about so-called managed health plans. If you allowed for real insurance to be in the market; meaning you build-up your accounts and truly get 'incentivized' for getting in early, then one can have great health care when they actually need it. Otherwise, the market should be based upon what people pay out of pocket. Those are the two factors that should be influencing price and not the nonsense regulations that artificially drive prices way up. You have people having to pay two day's pay for a regular five minute doctor's visit the way the system is now.

Managed care was a market response to rising costs. Back when it was the market standard to pay providers whatever "usual, customary and reasonable rates" they charged, most states moved in the direction of directly setting (or at least) overseeing provider--particularly hospital--prices for expensive services to control costs.

Those heavy-handed regulatory systems gradually faded away, except in Maryland, in no small part because with the emergence of managed care strategies it was thought the market could do a better job than the regulators. So instead of bureaucrats scrutinizing prices, they relied on private actors in the marketplaces to determine reimbursement rates for high-cost services through negotiation.

As long as insurers continue to exist (and that's not necessarily a given in the long run) it doesn't matter what kind of product you buy from them--HMO, PPO, POS, EPO, whatever--those insurers are going to negotiate rates with health care providers. And the more successful they are in bargaining those rates down, the lower the premiums they can offer.

This is true even if the move to HDHPs/HSAs continues (which it's likely to--I pointed that out 4-5 years ago as a likely outcome of the ACA). Greater consumer price sensitivity for services priced under or near the individual's deductible will put downward pressure on the prices of such services. And there will be more and more of those services so affected as deductibles climb. That's good!

But there are always going to be services with costs and prices above the deductible and the bulk of spending and revenue is going to remain locked up in those services. You're not going to be able to rely on people directly shopping around various providers for those services the way people will with lower-priced services, outside of certain limited schemes like reference pricing. That's where the insurer-provider negotiation remains critical.

The better bargain an insurer can get on health care prices, the lower they can price their own insurance products. And if you've got well-functioning insurance markets in place where individuals price shop for plans on their own, then that incentive to offer the most competitive premiums is big.

That's why competition is important and these are the dynamics that have already started to emerge. Look no further than earlier this year.

Here's a first: January hospital prices lower than a year ago

The prices that health insurers paid to acute-care hospitals declined in January compared with the same month a year ago, a first since federal officials began to collect such data.

“This appears to be a combination of the public sector pressure, but an even more fierce change on behalf of the private payers,” said Paul Hughes-Cromwick, a senior health economist at the Altarum Institute Center for Sustainable Health Spending.

“Insurers are trying to figure out how they can save healthcare cost by lowering the hospital bill, so they are more aggressively bargaining with hospitals and more aggressively investing in programs that lower hospital utilization rates,” said Neraj Sood, director of research and associate professor in health policy and economics at the University of Southern California.

 

[Foxfyre]

When you use the term 'insurer' you're really talking about so-called managed health plans. If you allowed for real insurance to be in the market; meaning you build-up your accounts and truly get 'incentivized' for getting in early, then one can have great health care when they actually need it. Otherwise, the market should be based upon what people pay out of pocket. Those are the two factors that should be influencing price and not the nonsense regulations that artificially drive prices way up. You have people having to pay two day's pay for a regular five minute doctor's visit the way the system is now.

Managed care was a market response to rising costs. Back when it was the market standard to pay providers whatever "usual, customary and reasonable rates" they charged, most states moved in the direction of directly setting (or at least) overseeing provider--particularly hospital--prices for expensive services to control costs.

Those heavy-handed regulatory systems gradually faded away, except in Maryland, in no small part because with the emergence of managed care strategies it was thought the market could do a better job than the regulators. So instead of bureaucrats scrutinizing prices, they relied on private actors in the marketplaces to determine reimbursement rates for high-cost services through negotiation.

As long as insurers continue to exist (and that's not necessarily a given in the long run) it doesn't matter what kind of product you buy from them--HMO, PPO, POS, EPO, whatever--those insurers are going to negotiate rates with health care providers. And the more successful they are in bargaining those rates down, the lower the premiums they can offer.

This is true even if the move to HDHPs/HSAs continues (which it's likely to--I pointed that out 4-5 years ago as a likely outcome of the ACA). Greater consumer price sensitivity for services priced under or near the individual's deductible will put downward pressure on the prices of such services. And there will be more and more of those services so affected as deductibles climb. That's good!

But there are always going to be services with costs and prices above the deductible and the bulk of spending and revenue is going to remain locked up in those services. You're not going to be able to rely on people directly shopping around various providers for those services the way people will with lower-priced services, outside of certain limited schemes like reference pricing. That's where the insurer-provider negotiation remains critical.

The better bargain an insurer can get on health care prices, the lower they can price their own insurance products. And if you've got well-functioning insurance markets in place where individuals price shop for plans on their own, then that incentive to offer the most competitive premiums is big.

That's why competition is important and these are the dynamics that have already started to emerge. Look no further than earlier this year.

Here's a first: January hospital prices lower than a year ago

The prices that health insurers paid to acute-care hospitals declined in January compared with the same month a year ago, a first since federal officials began to collect such data.

“This appears to be a combination of the public sector pressure, but an even more fierce change on behalf of the private payers,” said Paul Hughes-Cromwick, a senior health economist at the Altarum Institute Center for Sustainable Health Spending.

“Insurers are trying to figure out how they can save healthcare cost by lowering the hospital bill, so they are more aggressively bargaining with hospitals and more aggressively investing in programs that lower hospital utilization rates,” said Neraj Sood, director of research and associate professor in health policy and economics at the University of Southern California.

We had occasion to see the amounts shown as the 'cost of various medical procedures done over the last year and, because we have something of an inside track on access to people who know about that stuff, we asked about it. We were told that what is shown as the cost and what actually gets billed bear no relationship to each other. The hospital charges whatever the entity (insurance company, government, patient) will pay. Patients without insurance are charged considerably less than are those with insurance.

So I don't trust the government or any of their surrogate sub groups to give us honest information about much of anything.

. . .The chart from which your reporters drew the data mentioning Baptist Health Louisville lists only charges. In the health care industry, what we call charges often bears little resemblance to what we actually get paid. In many cases the amount of money paid to a provider may well be lower for a hospital listing a higher charge than for one charging less. As counterintuitive as that sounds, significant variations come into play based on the reimbursement rates health systems negotiate with insurers. Charges are also significantly reduced for those patients without insurance. There is a potential that your reader would see the chart that was provided and make a decision regarding where to seek service based upon the charges, which in turn could actually cost them more. . . .
Letter Hospital costs​

 

[Greenbeard]

We had occasion to see the amounts shown as the 'cost of various medical procedures done over the last year and, because we have something of an inside track on access to people who know about that stuff, we asked about it. We were told that what is shown as the cost and what actually gets billed bear no relationship to each other. The hospital charges whatever the entity (insurance company, government, patient) will pay. Patients without insurance are charged considerably less than are those with insurance.

This is true. Hospitals, left to their own devices, devise charges that are way, way above their actual costs. Insurers will negotiate either a percentage of those charges (usually less than half of the full charge) or apply some negotiated version of their own payment methodologies.

Writing off bad debt from charity cases, however, is a little bit of a different story. If the implication is that hospitals can or would subsist on the rates they may (or may not, they certainly don't always do that) cut a self-pay patient: you guys have been posting link after link about hospitals, generally rural and in non-Medicaid expansion states, that have closed because they've tried to do just that. Medicaid doesn't pay great, but

There is a balance here. Hospitals actually do need a fair amount of revenue to do the things they do. Not as much as they charge, nor as much as they'll take when unchecked, but they're not going to keep their doors open if everyone pays the rates of a hard-luck case.

 

[TheGreatGatsby]

When you use the term 'insurer' you're really talking about so-called managed health plans. If you allowed for real insurance to be in the market; meaning you build-up your accounts and truly get 'incentivized' for getting in early, then one can have great health care when they actually need it. Otherwise, the market should be based upon what people pay out of pocket. Those are the two factors that should be influencing price and not the nonsense regulations that artificially drive prices way up. You have people having to pay two day's pay for a regular five minute doctor's visit the way the system is now.

Managed care was a market response to rising costs. Back when it was the market standard to pay providers whatever "usual, customary and reasonable rates" they charged, most states moved in the direction of directly setting (or at least) overseeing provider--particularly hospital--prices for expensive services to control costs.

Those heavy-handed regulatory systems gradually faded away, except in Maryland, in no small part because with the emergence of managed care strategies it was thought the market could do a better job than the regulators. So instead of bureaucrats scrutinizing prices, they relied on private actors in the marketplaces to determine reimbursement rates for high-cost services through negotiation.

As long as insurers continue to exist (and that's not necessarily a given in the long run) it doesn't matter what kind of product you buy from them--HMO, PPO, POS, EPO, whatever--those insurers are going to negotiate rates with health care providers. And the more successful they are in bargaining those rates down, the lower the premiums they can offer.

This is true even if the move to HDHPs/HSAs continues (which it's likely to--I pointed that out 4-5 years ago as a likely outcome of the ACA). Greater consumer price sensitivity for services priced under or near the individual's deductible will put downward pressure on the prices of such services. And there will be more and more of those services so affected as deductibles climb. That's good!

But there are always going to be services with costs and prices above the deductible and the bulk of spending and revenue is going to remain locked up in those services. You're not going to be able to rely on people directly shopping around various providers for those services the way people will with lower-priced services, outside of certain limited schemes like reference pricing. That's where the insurer-provider negotiation remains critical.

The better bargain an insurer can get on health care prices, the lower they can price their own insurance products. And if you've got well-functioning insurance markets in place where individuals price shop for plans on their own, then that incentive to offer the most competitive premiums is big.

That's why competition is important and these are the dynamics that have already started to emerge. Look no further than earlier this year.

Here's a first: January hospital prices lower than a year ago

The prices that health insurers paid to acute-care hospitals declined in January compared with the same month a year ago, a first since federal officials began to collect such data.

“This appears to be a combination of the public sector pressure, but an even more fierce change on behalf of the private payers,” said Paul Hughes-Cromwick, a senior health economist at the Altarum Institute Center for Sustainable Health Spending.

“Insurers are trying to figure out how they can save healthcare cost by lowering the hospital bill, so they are more aggressively bargaining with hospitals and more aggressively investing in programs that lower hospital utilization rates,” said Neraj Sood, director of research and associate professor in health policy and economics at the University of Southern California.

Indeed, there were increased costs and/or worries of increased costs with fat Americans living longer. But let's be real; managed health care as we know it is the result of the lobbyists garnering political power and getting politicians in their back pockets. All these things that are mandated are not free market and arguably not Constitutional. I have no problem with managed care as a segment of the market. But it's taken over and literally regulated away choice. The fact that what direct medical options I choose is hardly up to me is atrocious and has stripped me of basic rights.

 

[Sun Devil 92]

When you use the term 'insurer' you're really talking about so-called managed health plans. If you allowed for real insurance to be in the market; meaning you build-up your accounts and truly get 'incentivized' for getting in early, then one can have great health care when they actually need it. Otherwise, the market should be based upon what people pay out of pocket. Those are the two factors that should be influencing price and not the nonsense regulations that artificially drive prices way up. You have people having to pay two day's pay for a regular five minute doctor's visit the way the system is now.

Managed care was a market response to rising costs. Back when it was the market standard to pay providers whatever "usual, customary and reasonable rates" they charged, most states moved in the direction of directly setting (or at least) overseeing provider--particularly hospital--prices for expensive services to control costs.

Those heavy-handed regulatory systems gradually faded away, except in Maryland, in no small part because with the emergence of managed care strategies it was thought the market could do a better job than the regulators. So instead of bureaucrats scrutinizing prices, they relied on private actors in the marketplaces to determine reimbursement rates for high-cost services through negotiation.

As long as insurers continue to exist (and that's not necessarily a given in the long run) it doesn't matter what kind of product you buy from them--HMO, PPO, POS, EPO, whatever--those insurers are going to negotiate rates with health care providers. And the more successful they are in bargaining those rates down, the lower the premiums they can offer.

This is true even if the move to HDHPs/HSAs continues (which it's likely to--I pointed that out 4-5 years ago as a likely outcome of the ACA). Greater consumer price sensitivity for services priced under or near the individual's deductible will put downward pressure on the prices of such services. And there will be more and more of those services so affected as deductibles climb. That's good!

But there are always going to be services with costs and prices above the deductible and the bulk of spending and revenue is going to remain locked up in those services. You're not going to be able to rely on people directly shopping around various providers for those services the way people will with lower-priced services, outside of certain limited schemes like reference pricing. That's where the insurer-provider negotiation remains critical.

The better bargain an insurer can get on health care prices, the lower they can price their own insurance products. And if you've got well-functioning insurance markets in place where individuals price shop for plans on their own, then that incentive to offer the most competitive premiums is big.

That's why competition is important and these are the dynamics that have already started to emerge. Look no further than earlier this year.

Here's a first: January hospital prices lower than a year ago

The prices that health insurers paid to acute-care hospitals declined in January compared with the same month a year ago, a first since federal officials began to collect such data.

“This appears to be a combination of the public sector pressure, but an even more fierce change on behalf of the private payers,” said Paul Hughes-Cromwick, a senior health economist at the Altarum Institute Center for Sustainable Health Spending.

“Insurers are trying to figure out how they can save healthcare cost by lowering the hospital bill, so they are more aggressively bargaining with hospitals and more aggressively investing in programs that lower hospital utilization rates,” said Neraj Sood, director of research and associate professor in health policy and economics at the University of Southern California.

Indeed, there were increased costs and/or worries of increased costs with fat Americans living longer. But let's be real; managed health care as we know it is the result of the lobbyists garnering political power and getting politicians in their back pockets. All these things that are mandated are not free market and arguably not Constitutional. I have no problem with managed care as a segment of the market. But it's taken over and literally regulated away choice. The fact that what direct medical options I choose is hardly up to me is atrocious and has stripped me of basic rights.

Managed care showed itself early on to be nothing than businessmen taking money out of a fixed pie.

Consequently, the quality of care went down.