Obamacare and affordability

[LoneLaugher]

"Falling for it" is not an accurate way to describe what has happened.

Given the choice between doing nothing and doing something that regulates the unfair practices that insurance companies engage in......the American people chose the latter.

Those of us who accept this watered down attempt are not blind to its flaws. But we know that we won't get fucked as hard or as often moving forward.

I think you are. Especially to the grave constitutional precedents it sets. What we 'pay' for PPACA will be much more devastating than the immediate financial hit. What you're 'falling for' is the idea that it is better than doing nothing. It's not. It's much, much worse.

Sigh..........

It is not possible to be fucked more by insurance companies than we already have. Look at the way other nations do this. We are alone on this. We fucked it up long ago. Change is due.

And....the constitution lives.

 

[dblack]

Can you tell me how much corporate health care insurance cost add to health care costs? I do not believe those costs are what is driving the runaway medical cost increases.

Exactly. We can monkey around with these insurance schemes all we want; we can rearrange who is paying for what, socialize this or that expense, push everyone around into "pools" (and in the process make the insurance industry a boatload of money), etc, etc... But if we don't get health care prices under control, none of it will matter. Eventually, we'll run out of money to pay for it.

Of course, at some point, the whole thing will collapse in on itself - which I know many here suspect is the goal of PPACA. I think it's less deliberate than that. I think it's simply collusion between the health care lobby (insurance, doctors, big pharma, all of them) and the government to keep their gravy train alive for a bit longer. At our expense.

Here is a site that shows that of the total increase 5 percent is due to private insurance. Seems to me we are doing everything to effect that and nothing to effect the real problem. I may be wrong and would like to be shown why.

http://www.unitedhealthgroup.com/hrm/UNH-Health-Care-Costs.pdf

I can't show you why. I think you're right. All I've been able to get out of them is vague promises that relinquishing control of our health care to the state (and its corporate partners) will, eventually, achieve nirvana for all. Essentially, "Just trust us!"

 

[dblack]

It is not possible to be fucked more by insurance companies than we already have. ...

While I might quibble (I think things will get considerably worse, especially for those of us who aren't yet ready to acquiesce to insurance industry demands), it's not the immediate specifics of the health insurance situation I'm worried about. It's the precedent set going forward and the long term effects it will have on the shape of our nation. It's our accelerating movement (and PPACA is a huge leap) toward corporatist government as the new standard that bothers me. It's the next power-bloc that decides they need to mandate behavior via a 'partnership' with government.

 

[Greenbeard]

Bottom line, how does this bill contain the rising cost of medical care?

You've asked this before but don't seem to have ever seen the answer so I'll post it again.

Obamacare doesn't take just one approach to cost containment. It accepts that incentives are broken at pretty much every level of the health care system and proceeds from there.

If your pet issue is overutilization/poor shopping for health services by consumers and patients, you'll be pleased to know the law is a boon for consumer directed high deductible plan-HSA pairs. It reduces the tax incentive for employees and employers to have overly generous benefit designs. It adds new transparency requirements for hospitals to make public a list of their charges for items and services they provide.

If you think costs increases can be traced to the insurance side, the ACA places limitations on the portion of premium revenue that can be spent on non-medical things (like the executive compensation liberals complain about). It brings new insurers into markets that have been devoid of competition, in part by seeding the creation of new homegrown (and consumer-operated) plans and in part by allowing existing insurers to sell across state lines in new markets. It forces competition on price and quality (not risk-culling); since a significant component of premium prices is affected by the reimbursements insurers negotiate with providers (i.e. prices), they'll have new impetus to put the brakes on increases in them.

It fixes deficiencies in existing insurance markets to ensure that consumers have the information and the structure needed to make meaningful choices and send clear price signals--shopping in the new marketplaces is going to make it very easy to see what you're getting with a new plan, what the prices are (and even your own likely expenses under a given plan), how the choices stack up in terms of quality, etc. The ACA also offers states grants to develop new insurance premium oversight mechanisms that, when used aggressively, have shown potential in being able to help hold down rising costs.

If you think costs are being driven on the provider side, the ACA is making a huge push to address the problems in organization and care coordination, etc that drive costs on the provider side. It would take way too long to go through all of what it's doing on that front but a major strategy in the ACA is to use Medicare reform to drive change by

(1) shifting the way Medicare pays for services away from encouraging high-volume, low (or mediocre) value service provision, and
(2) promoting and assisting health care providers in delivering better care more efficiently and less expensively, while holding them accountable for quality outcomes.​

You can see some of what's coming down the pike in results (i.e. slower cost growth, higher quality scores) from this private sector pilot in Massachusetts that incorporates some of these principles: http://www.usmessageboard.com/healt...-reform-model-lowers-costs-improves-care.html. The arrangement described in that thread saw savings of 10 percent in the second year for providers who switched to it from traditional fee-for-service models, all while quality rose. Similarly, CalPERS has been piloting an accountable care organization for a little over 40,000 of its members in California. Per member costs fell 1.6% for participating members, vs costs rising 10% for non-participating members from 2010-2011, saving CalPERS $37 million.

More importantly, there are some early indicators that providers have already begun to reorganize care delivery in response to the ongoing and coming reforms, accounting for some of Medicare's current record-low cost growth--and offering some promise that we might be entering a new era of cost containment. Obamacare tackles the biggest cost drivers, not just in Medicare but in the entire health system: the inflationary payment mechanisms and flawed delivery systems that have plagued the health system for decades.

If tort reform is your issue, the ACA offered federal money and assistance to help states find innovative ways to reform their own tort laws (the GOP Congress has refused to fund that provision of the law). Those who push for blunt force approaches to tort reform, like national caps on damages, miss the fact that many, many states have already tried caps on damages and the like. If there's money to be saved through tort reform and we're going to protect the rights of patients, we're going to have to get smarter about how we do it by trying new approaches (e.g. health courts). That's why we need states to start experimenting with new strategies.

Those who say the law does nothing to rein in costs are just being silly: it goes after cost drivers at every level of the system. There's more to be done in the future but it's a hell of a start.

 

[dblack]

You've asked this before but don't seem to have ever seen the answer so I'll post it again.

Yep, it's the same diversions and talking points. Thanks for posting it. Again.

If your pet issue is overutilization/poor shopping for health services by consumers and patients ...

Nope. Gotta stop you right there. Every time I point out how insurance is killing consumer incentives, you recast it to this 'over-utilization' nonsense, which is an entirely different issue. The problem isn't people getting too much health care - it's that they're not paying for it with their own money. There's virtually zero downward price pressure from health care consumers. They're either insured and don't care how much they're paying, or they're taking whatever they can in the way of handouts. In either case, patients rarely, if ever, express concerns about price because they genuinely don't care. They've got no reason to.

To fix this, we don't need to take over everything with government and micromanage everyone's health care. We just need to get rid of all the incentives encouraging people and businesses to over-insure.

To make this worse, well, we should do exactly as we're doing with PPACA, and obligate everyone to board the sinking ship. Double down on a failed model and socialize the costs under the bed so the neighbors won't see.

If you think costs increases can be traced to the insurance side, the ACA places limitations on the portion of premium revenue that can be spent on ...

Yes, and now on to the core conceit of PPACA. The sales pitch has it that once we sick the federal regulators on those big bad insurance companies, truth and justice will prevail. By now, most have acknowledged that the insurance lobby wrote this bill. Even if we're pretending otherwise, who do you think will have more influence in the halls of the new regulatory regime? Taxpayers or insurance industry lobbyists? Is their any fucking chance we'll win that tug-o-war?

 

[Greenbeard]

If your pet issue is overutilization/poor shopping for health services by consumers and patients ...

Nope. Gotta stop you right there. Every time I point out how insurance is killing consumer incentives, you recast it to this 'over-utilization' nonsense, which is an entirely different issue.

Your pet issue is poor shopping for health services. Read rest of sentence from that perspective.

 

[dblack]

If your pet issue is overutilization/poor shopping for health services by consumers and patients ...

Nope. Gotta stop you right there. Every time I point out how insurance is killing consumer incentives, you recast it to this 'over-utilization' nonsense, which is an entirely different issue.

Your pet issue is poor shopping for health services.

No, it's not. The consumers aren't making poor decisions. Given the incentives in place and the insurance scheme foisted on us the status quo, consumers are making the right call. This is an important distinction because looking at it as 'poor shopping' implies consumers are the bad actors (and should no doubt have their bad habits corrected by authoritarian government). The problem is with the tax and regulatory policies that have painted us into the corporate insurance corner in the first place. PPACA only exacerbates the problem problem of distorted incentives by further alleviating people of responsibility for their own health care.