Debate Now An Unhappy Birthday for Obamacare?

[Greenbeard]

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.

I don't really know what we're talking about anymore. Covered benefits? Benefit design? Your provider network?

This all came up because I was talking about the incentive in a competitive insurance market for insurers to negotiate down the price of provider services (which is happening).

Insurers, once properly incentivized, have only so many ways to lower their costs and ultimately your premiums.

1) Their can make their enrollees smarter shoppers, by offering things like HDHPs/HSAs and price transparency tools. Massachusetts now requires insurers to provide these kinds of tools, telling people what procedures will cost at different health care providers in their areas.

2) They can't turn away or boot people with health issues anymore, so getting and keeping people healthy becomes a key part of their business model. That means greater emphasis on wellness, as well as more supports for people with chronic health conditions. This also gets into the realm of paying providers for their actual results (value-based purchasing), which is increasingly taking root.

3) They can be smarter when they contract with health care providers. There are huge differences in price between providers in the same market--point (1) above will help to attack that problem but, like I said, the stuff below your deductible (even if it's a high deductible) is only the tip of the iceberg. That means insurers have to get serious about pushing back against overpriced provider services. Competition with other insurers does seem to be pushing many of them to do this.

That's how insurers can contribute to bending the cost curve (though ultimately much of the hard work will be done on the health care provider side) and so that's how competitive insurance markets can hope to achieve better cost results.

 

[dblack]

Or is it WellPoint? Yeah... probably WellPoint.

 

[Foxfyre]

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.

I don't really know what we're talking about anymore. Covered benefits? Benefit design? Your provider network?

This all came up because I was talking about the incentive in a competitive insurance market for insurers to negotiate down the price of provider services (which is happening).

Insurers, once properly incentivized, have only so many ways to lower their costs and ultimately your premiums.

1) Their can make their enrollees smarter shoppers, by offering things like HDHPs/HSAs and price transparency tools. Massachusetts now requires insurers to provide these kinds of tools, telling people what procedures will cost at different health care providers in their areas.

2) They can't turn away or boot people with health issues anymore, so getting and keeping people healthy becomes a key part of their business model. That means greater emphasis on wellness, as well as more supports for people with chronic health conditions. This also gets into the realm of paying providers for their actual results (value-based purchasing), which is increasingly taking root.

3) They can be smarter when they contract with health care providers. There are huge differences in price between providers in the same market--point (1) above will help to attack that problem but, like I said, the stuff below your deductible (even if it's a high deductible) is only the tip of the iceberg. That means insurers have to get serious about pushing back against overpriced provider services. Competition with other insurers does seem to be pushing many of them to do this.

That's how insurers can contribute to bending the cost curve (though ultimately much of the hard work will be done on the health care provider side) and so that's how competitive insurance markets can hope to achieve better cost results.

Just taking one point from your post, I say FOUL on the focus on keeping people healthy. If that was the case they would have been looking for ways to increase the healthcare that is actually AVAILABLE to the people. They would have promoted policies that make routine health maintenance affordable instead of a lot of authoritarian rules, regulations, and mandates that have diminished the access to healthcare for many as well as greatly increase the cost for many. Those who lost trusted doctors and even hospitals because of Obamacare aren't feeling the love in concern for their healthcare.

All the insurance in the world does not deliver healthcare. Having doctors available and able to see patients at a reasonable cost delivers healthcare.

 

[Greenbeard]

Just taking one point from your post, I say FOUL on the focus on keeping people healthy. If that was the case they would have been looking for ways to increase the healthcare that is actually AVAILABLE to the people. They would have promoted policies that make routine health maintenance affordable instead of a lot of authoritarian rules, regulations, and mandates that have diminished the access to healthcare for many as well as greatly increase the cost for many.

What do you think has been happening?

Evidence-based preventive care is carved out of cost-sharing (even catastrophic, i.e. sub-bronze, plans have to offer primary care visits outside the plan's deductible). One of the new features they rolled out on healthcare.gov last open enrollment period was the ability to sort plan offerings by the medical management programs they offer (e.g., heart disease, diabetes, asthma, high blood pressure, etc) to better connect people to plans that meet their needs.

New primary care models that increase capacity and improve delivery are being rolled out. We just had a record residency Match Day and most of the growth was due to new money being put into training additional primary care doctors.

Meanwhile, just last week you had another announcement of new funding for community health services:

Health and Human Services Secretary Sylvia M. Burwell announced today approximately $101 million in Affordable Care Act funding to 164 new health center sites in 33 states and two U.S. Territories for the delivery of comprehensive primary health care services in communities that need them most. These new health centers are projected to increase access to health care services for nearly 650,000 patients.

That's not an isolated event, it's emblematic of the ongoing funding being poured into primary care. The PricewaterhouseCoopers brief on the ACA at 5 years that I've already referenced tallies some of the investments the ACA is making in expanding access to primary care:

Not to mention that ACOs are now being paid to keep people healthy, hospitals are being paid to keep healthy (which is why most of them have or are rolling out population health management strategies).

Keeping people healthy is the name of the game now.

 

[dblack]

Rent-seeking corporatism is the name of the game.

 

[Foxfyre]

Rent-seeking corporatism is the name of the game.

I tend to agree. Greenbeard appears to have some pretty well written propaganda at his disposal--no idea all the different places he may be posting it--but experience trumps propaganda every single time. When what they tell you is the way it is doesn't jive with what you and others are experiencing, it just doesn't quite meet the smell test.

 

[Greenbeard]

I tend to agree. Greenbeard appears to have some pretty well written propaganda at his disposal--no idea all the different places he may be posting it--but experience trumps propaganda every single time. When what they tell you is the way it is doesn't jive with what you and others are experiencing, it just doesn't quite meet the smell test.

What are you disputing? That more primary care docs are being trained now than before? That billions have been poured into building primary care capacity? That payment has shifted to reward wellness?

Please. I realize you find it deeply suspicious that I can provide links to support my points (as opposed to say making up unlinkable "facts" on the fly that fall apart under scrutiny) but that's the difference between us. I have reasons to believe the things I do, and they're not limited to an experience in a hospital cafeteria in Albuquerque.

 

[Foxfyre]

I tend to agree. Greenbeard appears to have some pretty well written propaganda at his disposal--no idea all the different places he may be posting it--but experience trumps propaganda every single time. When what they tell you is the way it is doesn't jive with what you and others are experiencing, it just doesn't quite meet the smell test.

What are you disputing? That more primary care docs are being trained now than before? That billions have been poured into building primary care capacity? That payment has shifted to reward wellness?

Please. I realize you find it deeply suspicious that I can provide links to support my points (as opposed to say making up unlinkable "facts" on the fly that fall apart under scrutiny) but that's the difference between us. I have reasons to believe the things I do, and they're not limited to an experience in a hospital cafeteria in Albuquerque.

I and others have provided links that quarrel with your links. And at no time have I limited my experience to a hospital cafeteria in Albuquerque.

 

[Greenbeard]

I and others have provided links that quarrel with your links. And at no time have I limited my experience to a hospital cafeteria in Albuquerque.

Unless my eyes deceive me, this is thread is still active. Some of us are in still in the middle of a conversation.

If you've got something that quarrels with what I'm saying, post it. I'm guessing it's yet another contentless op-ed but I'd be delighted to be proved wrong on that.

 

[Foxfyre]

I and others have provided links that quarrel with your links. And at no time have I limited my experience to a hospital cafeteria in Albuquerque.

Unless my eyes deceive me, this is thread is still active. Some of us are in still in the middle of a conversation.

If you've got something that quarrels with what I'm saying, post it. I'm guessing it's yet another contentless op-ed but I'd be delighted to be proved wrong on that.

I have already posted quite a bit that quarrels with what you have posted. And have given my reasons for quarreling with it. I don't know what else anybody can expect more than that.

Obamacare was supposed to make healthcare more affordable. For most people it hasn't done that. Obamacare was supposed to make healthcare more secure. It has done that for some but at the cost of bigger deductibles and prohibitively large deductibles and high copays for many, if not most. Obamacare was supposed to make healthcare more accessible, but in many if not most cases, it has resulted in the opposite of that.
Is Obamacare Working

 

[Greenbeard]

I have already posted quite a bit that quarrels with what you have posted. And have given my reasons for quarreling with it. I don't know what else anybody can expect more than that.

Engagement perhaps? This is the debate forum.

Obamacare was supposed to make healthcare more affordable. For most people it hasn't done that. Obamacare was supposed to make healthcare more secure. It has done that for some but at the cost of bigger deductibles and prohibitively large deductibles and high copays for many, if not most. Obamacare was supposed to make healthcare more accessible, but in many if not most cases, it has resulted in the opposite of that.
Is Obamacare Working

Since your article is almost entirely about the exchanges, I'm going to assume that's what you're talking about.

Saying the exchanges aren't helping people to afford their insurance is nuts: something like 85% of exchange buyers are getting financial assistance for premiums and many of them are getting help with the out-of-pocket costs your article references (which makes the citing of silver out-of-maxes--which aren't deductibles, by the way--somewhat irrelevant to your point).

You talk about "prohibitively large deductibles," apparently without realizing there didn't used to be limits on how large deductibles our out-of-pocket spending can be. Most plans in the individual market prior to the ACA had actuarial values below the ACA's minimum, meaning people had to pay for more of their care out-of-pocket than they do under the ACA. I still remember the Ohio Department of Insurance using a plan with a $25,000 deductible as their gauge for what plan premiums ought to be to criticize the ACA. Now we're taking issue with a ~$6,000 deductible being the max for an individual--in plans that only a minority of shoppers even bought? Most people have more generous plans that that.

As for accessibility, I thought you were arguing earlier in the thread that health care utilization was going up, meaning that more people are getting more services. Yes?

 

[Foxfyre]

I have already posted quite a bit that quarrels with what you have posted. And have given my reasons for quarreling with it. I don't know what else anybody can expect more than that.

Engagement perhaps? This is the debate forum.

Obamacare was supposed to make healthcare more affordable. For most people it hasn't done that. Obamacare was supposed to make healthcare more secure. It has done that for some but at the cost of bigger deductibles and prohibitively large deductibles and high copays for many, if not most. Obamacare was supposed to make healthcare more accessible, but in many if not most cases, it has resulted in the opposite of that.
Is Obamacare Working

Since your article is almost entirely about the exchanges, I'm going to assume that's what you're talking about.

Saying the exchanges aren't helping people to afford their insurance is nuts: something like 85% of exchange buyers are getting financial assistance for premiums and many of them are getting help with the out-of-pocket costs your article references (which makes the citing of silver out-of-maxes--which aren't deductibles, by the way--somewhat irrelevant to your point).

You talk about "prohibitively large deductibles," apparently without realizing there didn't used to be limits on how large deductibles our out-of-pocket spending can be. Most plans in the individual market prior to the ACA had actuarial values below the ACA's minimum, meaning people had to pay for more of their care out-of-pocket than they do under the ACA. I still remember the Ohio Department of Insurance using a plan with a $25,000 deductible as their gauge for what plan premiums ought to be to criticize the ACA. Now we're taking issue with a ~$6,000 deductible being the max for an individual--in plans that only a minority of shoppers even bought? Most people have more generous plans that that.

As for accessibility, I thought you were arguing earlier in the thread that health care utilization was going up, meaning that more people are getting more services. Yes?

Maybe you should have your computer checked because it must have linked to a different website than the one I posted and is obviously showing different words than the ones I have typed here?

 

[Greenbeard]

Maybe you should have your computer checked because it must have linked to a different website than the one I posted and is obviously showing different words than the ones I have typed here?

Please make a point and defend it. I'm begging you.

 

[Foxfyre]

Maybe you should have your computer checked because it must have linked to a different website than the one I posted and is obviously showing different words than the ones I have typed here?

Please make a point and defend it. I'm begging you.

Okay, my point is I'm not in the mood to waste my time defending points I am accused of making that I didn't make, accused of posting what I didn't post, or repeating myself again and again. And I find discussions that are nothing but endless copy and paste or links to be about as much fun and interesting as watching paint dry.

I accept you have argued that Obamacare is wonderful and is delivering as advertised and you think all of us who aren't buying into that are stupid, ignorant, blind, or whatever characterization is placed on us.

I'm not going to just automatically agree with highly partisan or self-serving sources when I can read what people who don't have a dog in the fight who disagree with those likely biased sources are saying coupled with healthcare professionals who I can talk with up close and personal and who are telling me pretty much the polar opposite of what you have argued.

The best we are going to do is to agree to disagree.

 

[Greenbeard]

I'm not going to just automatically agree with highly partisan or self-serving sources when I can read what people who don't have a dog in the fight who disagree with those likely biased sources are saying coupled with healthcare professionals who I can talk with up close and personal and who are telling me pretty much the polar opposite of what you have argued.

I honestly don't know what you're taking with issue with. I posted a link from the National Residency Match Program on the results of Match Day this year (record number of new residencies, most of the new ones in primary care). Is that what you don't believe? Are they making it up?

I posted a link from HHS (ooh, evil!) about $100 million they just awarded to community health centers to build more primary care capacity. Is that made up? Did they not give them those grants? Have they not been giving millions to health centers over the past five years?

I posted a link to PricewatershouseCoopers, which in this capacity is a consulting firm. Are they making up what the ACA is spending on primary care? Are their observations incorrect in some way?

I posted a link to the models of primary care transformation the CMS Innovation Center has been funding. Do those awardees not exist? Are they not revamping primary care? Is it a conspiracy?

Like I said, I don't know what you're taking issue with because you don't explicitly take issue with anything. If you've got a problem with those sources or what's in them, what is it? You don't like the results, obviously. But unfortunately reality doesn't bend to what you feel it should look like.

I think the issue is that you rarely directly respond to anything. You implied earlier urgent care capacity in your city decreased, when the number of urgent care clinics in your city has demonstrably gone up 25% since the ACA's first open enrollment period 2 years ago. You say cleanliness in your hospitals has gone down, when patient experience surveys from your hospitals suggest the exact opposite ("I meant in the cafeterias!" you protest--I'll give you that as a response, even if it was breathtakingly absurd).

Maybe the perceptions of you and your friends aren't quite the whole story on what's happening, even in your own city.

 

[dblack]

Rent-seeking corporatism is the name of the game.

I tend to agree. Greenbeard appears to have some pretty well written propaganda at his disposal--no idea all the different places he may be posting it--but experience trumps propaganda every single time. When what they tell you is the way it is doesn't jive with what you and others are experiencing, it just doesn't quite meet the smell test.

The shills for ACA are simply doing their job. We all have to make a living. But it doesn't mean any of us have to give it any credence.

 

[Luddly Neddite]

I am asking where the savings came from. That was the question I asked...pure and simple.

I know I don't always ask clearly.

So I'll keep trying.

Their cost sharing has dropped....does that mean things cost less or someone else is picking up the tab.

Don't try to read anything into it. It is just a question.

A critical thing to understand here (and in all things) is that health care in America doesn't cost $3 trillion because health care in America costs $3 trillion. It costs $3 trillion because those who fork over that money can be convinced or coerced to do so. "Cost" is used synonymously with "price" at times but price is just what people can be made willing to pay, and actual underlying cost tends to creep up as incentives for efficiency and wise use of resources disappear.

As for Medicare Part D, what HHS (and I guess by extension me) is talking about is a benefit change that saves millions of Americans on direct costs because it covers more of their prescription drug costs. Has the cost they used to pay but are now free of descended upon the taxpayer (as opposed to coming out of the puffed up "costs" that drug manufacturers pass on to payers)? Maybe, I don't really know--Medicare Part D isn't really my thing. But if it has the impact for the taxpayer has been minimal, since total per beneficiary Medicare spending is actually declining, which is not something that happens for Medicare. Even as the donut hole has been closing.

My scrip prices, and other costs, have gone down with ACA but for those who are not aware of it, Medicare is insurance for which you pay a premium.

Medicare started out much as ACA has - some problems that needed to be addressed. The difference was that congress wanted to fix what was wrong in order to benefit all Americans. As we all know, ACA has been passed more times than any other law and I've read the Repubs plan to waste even more tax payer's money in their insane campaign to take affordable health care insurance away from us.

For those who have not seen the documentary or read the book, Money Driven Medicine is a real eye opener.

 

[Ringel05]

I support the ACA for selfish reasons, the wife makes lots of money making sure health providers (hospitals) are in compliance.......

 

[dblack]

I support the ACA for selfish reasons, the wife makes lots of money making sure health providers (hospitals) are in compliance.......

Heh.. you and Liz Fowler.

If you've got a piece of the action, it's not a bad gig.

 

[Ringel05]

I support the ACA for selfish reasons, the wife makes lots of money making sure health providers (hospitals) are in compliance.......

Heh.. you and Liz Fowler.

If you've got a piece of the action, it's not a bad gig.

She actually fell into it by accident, she worked medical records before she went into government contracting so she knows medical coding, admin and Gov-speak, perfect for what hospitals need to meet Meaningful Use requirements but no, she's not making the type of money Fowler is making. Alas......