CDZ Can we have a serious discussion of how to fix the Affordable Care Act?

[gipper]

Time to put in the Public Option like we should have done in the first place

So you ARE voting for Trump.

 

[gipper]

Just to establish that the ACA is not doing great, I give a list of links that one can read to see the nature of the problems.

Sky rocketing insurance premiums so far, not reducing
Obamacare Insurance Premiums Set to Skyrocket Yet Again

It appears that enrollments are shrinking.
It’s official: Obamacare debuts with more canceled plans than enrollments

Aetna appears to be withdrawing from the ACA exchanges
Aetna pulling back from ObamaCare in blow to health law

And the Co-ops are steadily declining as well.
The Ruins: Two More Obamacare Co-Ops Collapse, Only One-Third Remain (For Now)

But what are the successes?

Millions of people now have insurance that never did. A great amount of stress on the public hospitals for free (uninsured care) has been lifted.

From Wikipedia:

Annual or lifetime coverage caps on essential benefits were banned.[73][74] Prohibits insurers from dropping policyholders when they get sick.[75]

A partial community rating requires insurers to offer the same premium to all applicants of the same age and location without regard to gender or most pre-existing conditions (excluding tobacco use).[76][77][78] Premiums for older applicants can be no more than three times those for the youngest.[79]

Preventive care, vaccinations and medical screenings cannot be subject to co-payments, co-insurance or deductibles.[80][81][82] Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contraceptive methods, breastfeeding support/supplies and domestic violence screening and counseling.[83]

The law established four tiers of coverage: bronze, silver, gold and platinum. All categories offer the essential health benefits. The categories vary in their division of premiums and out-of-pocket costs: bronze plans have the lowest monthly premiums and highest out-of-pocket costs, while platinum plans are the reverse.[60][84] The percentages of health care costs that plans are expected to cover through premiums (as opposed to out-of-pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum).[85]

Insurers are required to implement an appeals process for coverage determination and claims on all new plans.[75]

Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated​

These are some serious benefits to the American people that the health insurance industry fought for decades. This is good stuff, but what is discouraging people from signing up?

Seems to me that, since the GOP abstained from helping to construct the ACA, the leftwing radicals got to monopolize the product.

One size fits all plans that force men to take pregnancy coverage, the exclusion of Catastrophic care plans with very high deductibles that can be combined with health savings accounts to cover most if not all of the deductibles and other costs were ignored and not included.

What do you think could be done, reasonably to reform the ACA?

There is no way to fix Obamacare. You can't fix something so complex, so convoluted, and so corrupt. It needs termination, but I suspect it will continue for decades, like most government programs.

The federal government is far too corrupt and incompetent to resolve HC. Clearly Obamacare is proof of this. It is nothing if not a sop to big hospital, big insurance, and big pharma.

So what do you do with the 9 million people already on some insurance connected with ACA?

And do you roll back the laws that prevent insurance companies from abusing their customers?

I do not have the answers and I was in the insurance business for a long time.

I do believe getting the federal government completely out of the HC business, would be a good start.

 

[JimBowie1958]

I do not have the answers and I was in the insurance business for a long time.

I do believe getting the federal government completely out of the HC business, would be a good start.

And that only ends up with a single payer system instead.

 

[Dekster]

Perhaps the government blew a huge opportunity to fund a UHC system during the recession. If instead of dumping houses it swept up for less than 50 cents on the dollar, perhaps they should have rented or held onto them to create a revenue stream that could have been used to finance better healthcare.

 

[oldsoul]

Here's how I look at it, and always have:
Once upon a time the US had the best health care system in the world. Why do I say that? The richest of the rich (i.e. The Saudi Royal Family, Sadam Hussein, Castro, and the British Royal Family to name a few) came to the US when they needed the best healthcare available. Was it flawed, yes. Were some people "left behind"? Sure. Did the US train doctors from around the globe? Absolutely. Fact is, as flawed and imperfect as our system was before the ACA it was still far better than any other I've ever hear of.
So, there were a few million people who, for whatever reason, didn't have healthcare insurance. Deal with that, don't change the whole system. A great example is the Auto industry. There was, and still is, shortcomings in safety and efficiency. Using the model of the ACA we should scrape the whole thing and start over. In the real world, what we do is identify specific areas to improve, and find/make ways to accomplish this. Unfortunately, this is something big government is loath to do, when it doesn't out right refuse to even try.
Therefore, here is what I would propose:

• Phase out the ACA
• Allow people who have been denied private insurance, due to pre-existing conditions, to purchase public insurance with a premium, until such time they would qualify for private insurance (most pre-existing condition provisions have a "sunset" on them).
• People who cannot afford private insurance (i.e. premium would be greater than 15% of gross income) are given monthly subsidies for a period of time (5 years for example).
• Allow people and businesses to purchase insurance plans from anywhere they want (across state lines, or even internationally) as long as said plans meet minimum requirements. (I am not a doctor nor an insurance expert so I cannot comment on what those requirements should be)
• Let the market forces dictate rates.

Pretty simplistic, I know, but I believe in the KISS (Keep It Simple, Stupid) theory of planning and government, less to fuck up or go wrong.

 

[320 Years of History]

as flawed and imperfect as our system was before the ACA it was still far better than any other I've ever hear of.

Are you well familiar with Cuba's health care system?

• Health in Cuba
  
• Primary Care in Cuba
  
• The Cuban Health Care System and Child Health Outcomes: An Admirable Accomplishment with Lurking Questions

I'm not outright calling their system better or worse than ours, but I am saying that Cuba does a damn fine job of providing it's citizens with quality health care and Cuba does it at a fraction of the proportionate cost that we do here in the U.S., and that alone suggests we are doing something wrong with the way we manage the delivery of health services to U.S. citizens.

 

[oldsoul]

as flawed and imperfect as our system was before the ACA it was still far better than any other I've ever hear of.

Are you well familiar with Cuba's health care system?

• Health in Cuba
  
• Primary Care in Cuba
  
• The Cuban Health Care System and Child Health Outcomes: An Admirable Accomplishment with Lurking Questions

I'm not outright calling their system better or worse than ours, but I am saying that Cuba does a damn fine job of providing it's citizens with quality health care and Cuba does it at a fraction of the proportionate cost that we do here in the U.S., and that alone suggests we are doing something wrong with the way we manage the delivery of health services to U.S. citizens.

I must admit, I did not take the time to read the entirety of any of your links. They do seem to be quite indepth and I have no inclination to dive that deep into Cuba's health care system. It would appear as though we could learn a thing or two from them, at least at a cursory look. However, there are a couple of points I think need to be made.

I am saying that Cuba does a damn fine job of providing it's citizens with quality health care

That may well be true of some metrics, however, maternal mortality is WAY higher. More than off sets the difference in infant/toddler mortality. Causes me to wonder how many other metrics would have such a disparity.

Cuba does it at a fraction of the proportionate cost that we do here in the U.S

That may be true, but it would be hard to tell for sure, seeing as our economies, and political systems share little in common.

alone suggests we are doing something wrong with the way we manage the delivery of health services to U.S. citizens

I wouldn't go that far. The graph below comes with no scale I could find, but it does a good job of graphically showing the difference in research expenditures by nation.

The Most Innovative Countries In Biology And Medicine

Here is a map of where all of the registered clinical trials are running. Even when you combine all of Europe, the US still runs more trials.
Studies on Map - ClinicalTrials.gov

What countries have lead the world in medical research and innovation in the past 20 years? - Quora
Or maybe it suggest we are leading the world in research. Just another possibility. That research has to be paid for by someone. Research that most, if not all countries, including Cuba, benefit immensely from at little or no cost to them.

 

[Fair&Balanced]

as flawed and imperfect as our system was before the ACA it was still far better than any other I've ever hear of.

Are you well familiar with Cuba's health care system?

• Health in Cuba
  
• Primary Care in Cuba
  
• The Cuban Health Care System and Child Health Outcomes: An Admirable Accomplishment with Lurking Questions

I'm not outright calling their system better or worse than ours, but I am saying that Cuba does a damn fine job of providing it's citizens with quality health care and Cuba does it at a fraction of the proportionate cost that we do here in the U.S., and that alone suggests we are doing something wrong with the way we manage the delivery of health services to U.S. citizens.

I must admit, I did not take the time to read the entirety of any of your links. They do seem to be quite indepth and I have no inclination to dive that deep into Cuba's health care system. It would appear as though we could learn a thing or two from them, at least at a cursory look. However, there are a couple of points I think need to be made.

I am saying that Cuba does a damn fine job of providing it's citizens with quality health care

That may well be true of some metrics, however, maternal mortality is WAY higher. More than off sets the difference in infant/toddler mortality. Causes me to wonder how many other metrics would have such a disparity.

Cuba does it at a fraction of the proportionate cost that we do here in the U.S

That may be true, but it would be hard to tell for sure, seeing as our economies, and political systems share little in common.

alone suggests we are doing something wrong with the way we manage the delivery of health services to U.S. citizens

I wouldn't go that far. The graph below comes with no scale I could find, but it does a good job of graphically showing the difference in research expenditures by nation.

The Most Innovative Countries In Biology And Medicine

Here is a map of where all of the registered clinical trials are running. Even when you combine all of Europe, the US still runs more trials.
Studies on Map - ClinicalTrials.gov

What countries have lead the world in medical research and innovation in the past 20 years? - Quora
Or maybe it suggest we are leading the world in research. Just another possibility. That research has to be paid for by someone. Research that most, if not all countries, including Cuba, benefit immensely from at little or no cost to them.

That, of course, is the main reason our healthcare is so much more expensive than in other countries. Medical advances, almost ALL come research hospitals in the US, someone has to pay for that research.

 

[320 Years of History]

It would appear as though we could learn a thing or two from them

That's a reasonable take-away for a cursory look. When you have the time, give a few of them a full read. Cuba's not got everything right, but that they have found a way to deliver the majority of care that most folks need -- and really, what most folks need like routine checkups, broken bones healed, and antibiotics, and so on, from health care does not need to be all that expensive -- and do it at a fraction of the cost.

I wouldn't go that far. The graph below comes with no scale I could find, but it does a good job of graphically showing the difference in research expenditures by nation.

There's no question that in terms of the scope of possible services and treatment modalities, the U.S. is far and away in the lead. In terms of the number of folks who actually need a lot of that comparatively esoteric treatment, it's not that many folks, but we all are paying for the innovation of having those abstruse treatments and modalities available.

Of course, making choices about that sort of thing is not easy. When "you" need the treatment, you are glad it's there, but when "you" pay for it being available and "you" never need it, it's a cost that "you'd" rather not bear.

 

[Greenbeard]

the exclusion of Catastrophic care plans with very high deductibles that can be combined with health savings accounts to cover most if not all of the deductibles and other costs were ignored and not included.

That's silly. Even conservative think tanks like the Manhattan Institute have admitted that HSAs are flourishing under the ACA.

Initial skepticism from HSA advocates was understandable; but based on our current research, it appears that the Obama administration was true to its word and that HSAs (at least for the moment) remain widely accessible on public exchanges. The report finds that, far from becoming obsolete under the ACA, high-deductible plans are widely available—98 percent of uninsured Americans have access to at least one HSA-eligible plan. Moreover, these plans also make up about 25 percent of total offerings on Obamacare exchanges. We also found that they remain significantly less expensive than traditional plan designs, offering savings of about 14 percent, on average.

Indeed, depending on who you ask, the wide availability of high deductible plans for purchase is one of the things that needs to be "fixed" about the ACA.

Hard to agree on fixes when everyone has opposite diagnoses of what the problem is supposed to be.

 

[320 Years of History]

Causes me to wonder how many other metrics would have such a disparity.

With all due respect, that's something you'd need to research.

I don't really care for the point of my discussing Cuba is to show that decent health care can be provided for a comparatively modest sum of resources.

 

[320 Years of History]

That may be true, but it would be hard to tell for sure, seeing as our economies, and political systems share little in common.

??? Hugh? Do you doubt the ability of economists, accountants and so on to be able to isolate the cost of providing health care services? If so, why?

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

 

[320 Years of History]

What countries have lead the world in medical research and innovation in the past 20 years? - Quora

Off Topic:
How good a reference is Quora? I don't know. What I do know is that it's designed as public Q&A board. I don't often seen answers on it that are supported with highly credible references (documents, not people), although occasionally I do.

I know it comes up on research results lists when I'm looking for high level info rather than something rigorous.

 

[Holos]

not doing great

Your own research is disproving your conclusion.

Sky rocketing insurance premiums so far, not reducing

Payed insurance (premiums) are distancing themselves from previous requirements, and the distance isn't reducing because the payment for insurance is becoming unnecessary and unwanted.

It appears that enrollments are shrinking.

Enrollment is only required when people cannot provide for their own health. More people providing for their own health means less enrollments, since the programs {facilities, medication, professional help} following from assisted care come to be needless.

Aetna appears to be withdrawing from the ACA exchanges

When so many people achieve provision of health by their own independent studies and work, after a necessary ACA, not only the programs following assisted care come to be unrequited but insurance companies aggregating the varieties of those programs also come to be unnecessary.

And the Co-ops are steadily declining as well.

Again, when people come to provide for their own health, without the necessity of an external, state facilitated provider, social and communal programs designed to assist with the provision aren't necessary.



Overall national success because people are increasingly and steadily achieving independence in relation to their health and their work.

 

[eflatminor]

Pass

 

[oldsoul]

That may be true, but it would be hard to tell for sure, seeing as our economies, and political systems share little in common.

??? Hugh? Do you doubt the ability of economists, accountants and so on to be able to isolate the cost of providing health care services? If so, why?

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

Actually it does matter. Do you really believe that Castro and his regime is being totally honest about both the cost and the level of quality care given to his people? If you do, then I would say you are deluding yourself. Communist regimes are notorious for being inaccurate, at best, with information they allow to be disseminated. Therefore , I stand by my assertion.

 

[320 Years of History]

That may be true, but it would be hard to tell for sure, seeing as our economies, and political systems share little in common.

??? Hugh? Do you doubt the ability of economists, accountants and so on to be able to isolate the cost of providing health care services? If so, why?

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

Actually it does matter. Do you really believe that Castro and his regime is being totally honest about both the cost and the level of quality care given to his people? If you do, then I would say you are deluding yourself. Communist regimes are notorious for being inaccurate, at best, with information they allow to be disseminated. Therefore , I stand by my assertion.

It may come as a surprise to you, but merely accepting what Cuba's government says isn't the only way to perform an economic assessment of their healthcare system and its outcomes. I provided you with a few reference sources that have each documented how they obtained data and that identified their analytical methodologies. Additionally, material qualitative differences don't rely only on data from Cuba itself.

In addition to the content I provided here, you may also want to examine each of the following and their references and methods:

• http://ipa-world.org/uploadedbyfck/Report on WHO PAHO Child Health Workshop at Cuba.pdf
  
• https://www.google.com/url?sa=t&rct...ba.pdf&usg=AFQjCNGj0viQ22AKySkaJoqBUPAiOUVr6Q
  
• https://www.google.com/url?sa=t&rct...&id=49&usg=AFQjCNHi8y5PBRjLAvBdwKuqmrbCNd2_8w
• https://www.google.com/url?sa=t&rct...n2.pdf&usg=AFQjCNG3Eybo32lkSMqWUOp9lpFWdrGA_g
  
• https://www.google.com/url?sa=t&rct...to.pdf&usg=AFQjCNEhLoBCz28NAEWEed0qTgeuhHn7GQ

 

[oldsoul]

That may be true, but it would be hard to tell for sure, seeing as our economies, and political systems share little in common.

??? Hugh? Do you doubt the ability of economists, accountants and so on to be able to isolate the cost of providing health care services? If so, why?

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

It doesn't matter what economic or political system is in place. The cost of providing a good or service is accurately measurable.

Actually it does matter. Do you really believe that Castro and his regime is being totally honest about both the cost and the level of quality care given to his people? If you do, then I would say you are deluding yourself. Communist regimes are notorious for being inaccurate, at best, with information they allow to be disseminated. Therefore , I stand by my assertion.

It may come as a surprise to you, but merely accepting what Cuba's government says isn't the only way to perform an economic assessment of their healthcare system and its outcomes. I provided you with a few reference sources that have each documented how they obtained data and that identified their analytical methodologies. Additionally, material qualitative differences don't rely only on data from Cuba itself.

In addition to the content I provided here, you may also want to examine each of the following and their references and methods:

• http://ipa-world.org/uploadedbyfck/Report on WHO PAHO Child Health Workshop at Cuba.pdf
  
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjPqcXrm9XOAhXLFR4KHRM8DO0QFggcMAA&url=https://www.american.edu/clals/upload/The-Curious-Case-of-Cuba.pdf&usg=AFQjCNGj0viQ22AKySkaJoqBUPAiOUVr6Q
  
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjPqcXrm9XOAhXLFR4KHRM8DO0QFggmMAE&url=http://www.medicc.org/mediccreview/pdf.php?lang=&id=49&usg=AFQjCNHi8y5PBRjLAvBdwKuqmrbCNd2_8w
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&cad=rja&uact=8&ved=0ahUKEwjPqcXrm9XOAhXLFR4KHRM8DO0QFghHMAU&url=http://www.scielosp.org/pdf/medicc/v15n2/a11v15n2.pdf&usg=AFQjCNG3Eybo32lkSMqWUOp9lpFWdrGA_g
  
• https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0ahUKEwjPqcXrm9XOAhXLFR4KHRM8DO0QFghQMAY&url=http://www.ascecuba.org/c/wp-content/uploads/2014/09/v12-sixto.pdf&usg=AFQjCNEhLoBCz28NAEWEed0qTgeuhHn7GQ

As I stated before, I have no desire, nor intention, of diving that deep into the healthcare system of Cuba. I concur that there may, indeed, be some thing(s) that one could learn from their system. Likewise we could learn thing(s) from Canada, many countries in Europe, and more. I do not, however, think that their system, in any way, can be transferred directly to improve our own. We simply expect our system to do far more research and development than is even possible in Cuba.

 

[320 Years of History]

I do not, however, think that their system, in any way, can be transferred directly to improve our own.

Most certainly, it a "copy/paste" of Cuba's HC system is not feasible. Ditto Canada's model. Strategies and tactics used there, however, bear out consideration for applying to our system. Of course, that does require doing the sort of "deep dive" that you don't want to do.

 

[oldsoul]

I do not, however, think that their system, in any way, can be transferred directly to improve our own.

Most certainly, it a "copy/paste" of Cuba's HC system is not feasible. Ditto Canada's model. Strategies and tactics used there, however, bear out consideration for applying to our system. Of course, that does require doing the sort of "deep dive" that you don't want to do.

I can agree with that. It's just not how I choose to spend my time. I leave it to people who have the desire.