Greenbeard
Gold Member
Bottom line of the bill Romney signed:
Romneycare has been successful at what it set out to achieve (which did not include systematic cost control). If there's a complaint on that front it's that it wasn't ambitious enough--but wouldn't we have to pin that timidity on the state leadership at the time?
1. Give consumers MORE control over their health care spending. Current group health care model is about the worst way to control spending.
If you want people out of the group market you're going to need a viable alternative and a mechanism for making that transition happen. We're about to have both.
People like the group market not just because their employer is paying for part of it but because they implicitly understand that 1) they're getting a better deal and better treatment than folks who are buying it on their own, and 2) they're protected in a way those people aren't (i.e. the consumer protections in place in the group markets).
Enter the exchanges. The individual market is getting more competitive, less scary, and much more consumer friendly, removing the need for folks to cling to the group market. The SHOP exchanges for small businesses, depending on how a state wants to structure them, can give employers the opportunity to pursue defined contribution approaches: give employees some amount of money toward an insurance plan of their choice and if the employee wants a more expensive one then they pay the difference. Exchanges--both kinds--stand to give consumers more control, period.
2. Increase the competition in the marketplace. See above, current model has plenty of competition BUT not across state lines.
This has become a euphemism for a deregulatory and nonsensical approach to insurance markets. If you actually mean what those words say--and not what conservatives and Republicans generally mean when they use them--then you'll want to at least start the same way the ACA is: providing new avenues for insurers to sell plans nationwide, creating opportunities for willing states to merge their insurance markets to create interstate exchanges, seeding new consumer-operated nonprofit insurance cooperatives, and providing baseline consumer protections in all states so that states themselves can be more comfortable allowing out-of-state plans into their markets.
3. Keep the competition IN THE MARKETPLACE, not in mandates be they whatever.
I don't know what this means.
4. End ALL subsidies in health care. Start with Medicare. Destroy it.
That depends on whether or not we're concerned with distributional aspects of health care delivery. If we want poor people, old people, and sick people to get access to care when they need it, then there's going to be some sort of subsidy.
5. Limit regulations as now the insurance companies write the laws in most states.
Benefit mandates in the past have been more or less costless to the state governments that pass (or are coerced into passing) them. This will not be the case in the future. States can't just pad consumers' or the federal government's contribution to their insurance plans in exchanges; if they add on benefit mandates above the minimum essential benefits package, the state is responsible for paying for those benefits. That means there's now a countervailing pressure against tacking on benefit mandates to satisfy this or that lobby.