Yes, Virginia, There Are Alternatives to Obamacare

Image credit: Wall Street Journal
Image credit: Wall Street Journal

by James A. Bacon

The Affordable Care Act (AKA Obamacare) is arguably the worst legislative train wreck foisted upon the United States in the country’s 237-year history — ranking right up there in the scale of self-inflicted disasters with the invasion of Iraq for non-existent Weapons of Mass Destruction. So far, it looks like Obamacare, which was designed to expand medical insurance coverage for Virginians and other Americans, has had the net effect, after throwing the health care industry into turmoil, of reducing medical insurance coverage.

In the first month only 1,023 Virginians navigated the tortuous process for signing up for coverage in the federally administered health care exchange, reports the Times-Dispatch. There is no official tally for the number of Virginians who have seen their individual health plans canceled due to stringent regulations requiring all plans to meet inflated, one-size-fits-all federal standards, but it’s a good bet that it’s way more than 1,000.

Some anecdotal data: CareFirst Blue Cross Blue Shield sent notices to more than 70,000 customers in Virginia, Maryland and Washington, D.C., that their plans don’t comply with the law. The Fairfax County Water Authority warned in October that it would likely drop insurance for its 400 employees. The University of Virginia and UPS had dropped coverage for employee spouses.

Admittedly, the numbers will change. More people — including those who lost health plans they were promised they could keep — will sign up in the exchanges as the “glitches” in the system are worked out. Yet the exchanges are fraught with risks, including the potential that the young and healthy won’t sign up, driving the exchange pools into a death spiral; the prospect that inadequate IT security resulting in identity theft will deter people from participating; and the likelihood, thanks to postponed enforcement of eligibility standards, that widespread cheating will run up the costs of subsidies.

Perhaps we can finally put an end to the conceit that an all-knowing federal government is capable of re-engineering one-sixth of the economy. Some  important lessons learned:

  • As American society and the economy grows increasingly complex, lawmakers and bureaucrats cannot possibly have all relevant information. There are so many moving parts, and they interact in so many unseen ways, that there are always unintended consequences.
  • People will game the system. They will find loopholes and they will exploit them. The more complex the legislation, the greater the number of loopholes.
  • Government at all levels, but especially the federal government, is ruled by special interests. All the big special interests — hospitals, physicians, Big Pharma — managed to protect their interests in the legislation. Individuals did not; they’re the ones getting screwed.

So what’s the alternative?

Defenders of Obamacare respond, what’s the alternative? The Republicans, it is commonly said, have nothing to put in its place. That’s just not true.

A good place to start is to scrap the tax preference for obtaining medical insurance through the workplace, an artifact of World War II wage and price controls. The fact that most people obtain their insurance through a third party creates perverse incentives that ripple throughout the entire system. Reforming health care starts with scrapping the preference.

But how do you extend the tax break for medical insurance to everyone without adding to the nation’s deficit woes? Ramesh Ponnuru and Yuval Levin offer one approach in today’s Wall Street Journal:

The first step of a plan to replace ObamaCare should be a flat and universal tax benefit for coverage. Today’s tax exclusion for employer-provided health coverage should be capped so that people would not get a bigger tax break by buying more extensive and expensive insurance. The result would be to make employees more cost-conscious; and competition for their favor would make insurance cheaper.

That tax break would also be available—ideally as a refundable credit sufficient at least for the purchase of catastrophic coverage—to people who do not have access to employer coverage. This would enable people who now choose not to buy insurance to get catastrophic coverage with no premium costs. It also would give those who want more-comprehensive coverage in the individual market the same advantage that people with employer plans get.

Capping deductions for expensive health plans will offset the cost of extending the deduction to new people, thus making the proposal budget neutral.

That’s only a partial solution, of course. Free marketeers still have to wrestle with the problem of pre-existing conditions. Avik Roy sketches out an approach in Forbes. The problem with pre-existing conditions occurs, he says, when insurance is discontinuous and an individual has to seek a new plan. The solution is to give people ownership of their health plans, make those plans portable and allow people to sign long-term contracts that will lock in coverage even if their health condition changes.

Those solutions aren’t perfect but they have a lot fewer moving parts and a lot less to go wrong. When Obamacare goes down in flames, perhaps we could give them a try.

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40 responses to “Yes, Virginia, There Are Alternatives to Obamacare”

  1. ideas are not legislation.

    you cannot have 40 repeal votes and no alternative and talk about “ideas”.

    Virginia could do what Jim is advocating – just like Massachusetts and other states have.

    why do we blame ObamaCare and talk about ideas – that Virginia has chosen not to do ?

    but the idea that the free-market is going to solve the pre-existing condition is – of which about 1 in 2 Americans have – is living in a dream world.

    how many seniors could get free-market insurance with MediCare?

    we talk about passing debt on to the kids.

    If there was no Medicare – the vast majority of seniors in the US would be faced with selling their homes and other assets to pay for their health care.

    anyone who calls ObamaCare a disaster needs to be as honest about Medicare.

    Are both ObamaCare and Medicare equivalent disasters?

    why is Medicare not?

    $500 per month is what it costs to insure each of 50 million seniors.

    why would it cost more than that for younger people?

    1. DJRippert Avatar

      “of which about 1 in 2 Americans have”

      One out of two Americans have pre-existing conditions that prevent them from getting health insurance?

      I’ll bite – where did THAT come from?

  2. re: ” how many seniors could get free-market insurance WITHOUT” MediCare?

    “pre-existing conditions” are like telling auto insurance companies they don’t have to insure bad risk drivers.

    what does “assigned risk” mean? is that some nasty socialist concept?

  3. Les Schreiber Avatar
    Les Schreiber

    The problem for free marketeers is there is no market for health care services. When one goes to a doctor or has a medical procedure there is no price information available. Prices vary widely in the same area and amongst the states. Last spring “Time” magazine devoted an entire issue to health care and this was one of the most significant findings. You can’t have a market without price signals.
    Where is the value added by the insurance industry?? Recently my wife and I have been denied drugs prescribed by faculty member at UVA hospital.Talk about “death panels “, its your local insurance company. In countries that have private insurance companies,they are regulated as public utilities are here or in some ,such as Switzerland, they are not for profits
    The problem of pre-existing conditions is not solved by making health insurance portable.The risk pool is still not large enough. As is the case with all insurance , the larger the pool the better. Portability would only work if all employers were required to cover all their employees and even then the pool would not be big enough to cover all.
    There are as many models for health insurance as there are developed countries. Its just that the political system has too many interest and political types that would rather make political points by screaming “Socialism” than solving problems.
    America spends more on health care than any other industrial country a has some of the worst results. I would like to see a serious program from Eric “the Putz”Canter and his band of Tea party anti thinkers.Its easy to be against something,but difficult to become part of a serious conversation.

    1. virginiagal2 Avatar

      The pool is large enough if you cover everyone – including pre-existing conditions. Employer coverage ignores pre-existing conditions – and you get adverse selection in that coverage precisely because people go to employers to seek insurance – yet the employer market is sustainable.

      1. you make an excellent point. both employer-provided, the Federal FEHB that Congress gets – and Medicare do not deny pre-existing conditions and one would think that because they do cover-pre-existing that they’d be much more expensive.

        Medicare covers 50 million for about 500.00 a month per covered – and virtually all of folks 65 years of age have some kind of “pre-existing” condition.

  4. “You can’t have a market without price signals.” So true.

    Look at the difference between Lasik and most other medical procedures. Which is subject to price-cutting and price advertising. Look at metro areas where there is more competition among hospital owners. Insurance, while protecting from bankruptcy, distorts pricing. About the best one can do is go to a member provider. I don’t know what the answer is.

    Obama’s big lie has come back to bite him big time. He was crystal clear that anyone happy with his/her policy could keep it. And it wasn’t for a one-year extension. But that was never true as he needs relatively young and healthy people to pay subsidies for those with preexisting conditions and greater rates of consumption. He would have never seen the ACA on his desk had he told this to the public. And since the economy has been crap for many, especially young adults, few would sign up for the expensive, subsidizing plans. But this is not Cantor’s fault. This one lives at 1600 Pennsylvania Avenue.

    Why is this different from Social Security and Medicare? Why isn’t health care reform just another Ponzi Scheme? Why so many younger people voted for Obama is beyond me.

    1. what kind of price signals do folks on Medicare or TRICARE or Government FEHB get?

      1. The Blue Cross/Blue Shield FEP provides financial incentives to use preferred providers. By using such a provider for my allergy shots, I save more than 50% of the provider’s fees. Don’t know about Medicare or TRICARE.

        1. I save if I use generics… and I do…. and Medicare pays only 80% – and that encourages thinking about costs but maybe not well known – and the reason why there are things like Lasik – is that Medicare does not cover optical or dental or hearing… you’re on you’re own for those things.

  5. Peter Galuszka Avatar
    Peter Galuszka

    Les is right, these alternatives are simply silly. As I have said a zillion times on this blog, health care isn’t a free market capitalism item. It is a vital SERVICE. It cannot be measured in widgets. It is not a productivity factor. Sick people are too preoccupied with pretending their health care is like buying a mutual fund.

    The basic problem with Obamacare is that it tries too hard to kiss the ass of free market capitalism. Obamas should have told the conservatives to suck eggs.

    The answer: Single payer universal coverage.

    Sorry, Jim, this is the 21st century and it’s time for the U.S. to join the rest of the advanced industrial nations.

    1. Just what America needs… a single-payer system like the UK’s, where patients left in the hall on gurneys die of dehydration!

      1. try Singapore. tell me what’s wrong with that one – or Germany for that matter.

    2. Peter, people are angry because they are losing their existing policies and seeing their hours reduced. What do you think would be occurring if we were moving to single payer? There is no evidence people are willing to accept less for broader coverage.

  6. Peter Galuszka Avatar
    Peter Galuszka

    So what? Try this:

    BY the way the wash examiner link doesn’t show anything.

    We can sit around all day and come up with examples of death in hospitals. My opinion is that the U.S. health care system is in tremendous need of improvement. The rich don’t have to worry; the poor and middle class do.

    BTW, Jim, have you ever in your life had to go out and buy individual health care coverage on your own, personally? Can you answer that?

    1. Yes, I did check the market for individual health insurance about a year ago. I found it far more affordable than I had expected. I didn’t have any pre-existing conditions (other than hypertension, which is treatable with medication) so my experience was not the same as someone else’s might have been. Anthem had a great policy but in the end I decided it was cheaper to stick with my spouse’s corporate policy.

    2. Everybody agrees the current system needs reform. The question is how to reform it.

      1. no. the question is what do the visceral opponents have as an alternative?

        if ObamaCare is so bad – where are the real alternatives?

        at one time the Heritage folks, New Gingrich and the GOP supported the individual mandate. that was a step in the right direction as every single OECD healthccare program including Singapores – is based on individual mandate – i.e. you set aside money for your health care – everyone does.

        Healthcare – back in Clintons’s era was threatening to destroy out economy. We’ve had 20 years to think about it.

  7. DJRippert Avatar

    Free markets work best when they fulfill the need for predictable, discretionary items which are fungible and where there is symmetric information flow.

    Let’s talk about these four things:

    Predictable. Buying a house is predictable. You can buy a house at the time of your choosing. Even though houses are quite expensive you can make the decision to purchase a house whenever you want. Health care is often unpredictable. A man clutching at his chest on the sidewalk cannot postpone getting health care until a better time. He cannot spend the next few weeks comparison shopping among cardiologists.

    Discretionary – Powerboats are discretionary. Nobody asserts that people have a right to own powerboats. Nobody believes that it would be cruel and inhuman to live a life devoid of ever owning a powerboat. Health care would be a lot easier if it were widely viewed as discretionary. If you need a heart bypass but can’t afford one – you die. However, that’s not how we view health care. We think everybody should have access to adequate health care. So, problem one – how to pay for health care services for those who can’t afford health care services? The only answer is to take money away from some people and give it to others to pay for their health care. That naturally upsets the people from whom the money is taken. Beyond that, it breaks the free market system. Some people are getting something for nothing while others are getting nothing for something.

    Fungible. Food is a de-facto right in America. If you can’t afford food the government will give you food stamps. If you can afford food you can buy the stuff with your own money. So, why not just give poor people health care stamps to redeem at the local health care store? For one thing – food costs are predictable. Given a certain amount of money almost everybody will be able to avoid starvation. Given a certain amount of money some people will be able to buy the health care they need and some will not. Food is fungible. If the store is out of pears I can eat carrots. Going to an abortion clinic while having an asthma attack is not so useful. Food is simple. I know what an apple is. I spend as much or as little as I want to get the quality of apple I desire (and am willing to pay for). Health care is too complex for most people to make their own decisions. So, you rely on a doctor who decides how you should consume health care. However, the doctor is more worried about being sued for missing something than over-spending. Unlike with food, the person really making the buying decisions in health care is not the ultimate consumer.

    Symmetric information. I can understand enough about cars to keep the dealer honest. I know the make, model, horsepower, price at other dealers, etc. I can learn enough about cars to make an informed decision. I can attain essentially a measure of symmetry in understanding between myself and the dealer. Virtually nobody can learn enough about cancer to attain a level of symmetry with the oncology group. You can’t comparison shop when you can’t understand what you are being told.

    Health care does neatly fit in a free market system.

    1. You’re right, the *current* market does not fit neatly into a free market system. But all of the issues you mention can be dealt with.

      1. DJRippert Avatar

        Absolutely. There is no such thing as a free market. There are only degrees of freedom. The market for some products – like stocks – gets pretty close to a free market. However, even there, governments regulate a requirement for independent audits in order to facilitate information symmetry between buyer and seller. Other products, like nuclear weapons, only exist under markets completely controlled by government.

        Obamacare is a failure for health reform because it isn’t health reform. It is insurance reform. There is nothing in Obamacare that will make medical costs go down. They will go up. However, once the mess is sorted out, more people will have insurance.

        So, let’s stick with insurance reform for a minute.

        Insurance is a very difficult product to manage in a free market – especially when the view is that everybody is entitled to affordable insurance. Think about it. The government wants to tell an entire industry that it can’t match its prices to its costs. Otherwise, people with pre-existing conditions couldn’t buy insurance that they could afford. The government is telling an entire industry that it can’t decline customers. Otherwise, your insurance would get canceled after you had a serious illness.

        At what point is the government imposing so many regulations that the hybrid market is less efficient than just having the government run the insurance system itself?

        The weight of regulation is so great that insurance companies are becoming de-facto government agencies that can’t really compete with each other anyway.

        1. the govt tells every insurance company that offers plans to Federal Employees – that they cannot cancel them.

          As far as I know there are a dozen or more major companies who continue to offer insurance to Federal employees.

          but don’t the same rules apply to private companies who offer health insurance?

          in terms of the “govt” ….. “telling” … “insurance companies”.

          who decides that insurance companies cannot sell across state lines?

          and who tells insurance companies they must take assigned risk drivers?

          how many Seniors could get insurance – at any price – if not for Medicare?

          where in the world – on the entire planet – do insurance companies willingly, without govt encouragement – insure those who have conditions?

          no where.

          we’re living in a delusional free market world here.

          the only places in the world where all citizens in a country have legitimate access to affordable insurance – are countries that are directly involved in healthcare.

          the rest of the world – truly a free market – offers healthcare only selectively to those who are wealthy and not sick.

          in terms of ObamaCare “affordability” – it was never intended to redduce healthcare costs overall in the first cut.

          it was intended to make health insurance available to all citizens.

          there’s plenty of room for reform.

          there’s plenty of room for other legislative proposals.

          but you can’t be a critic, and side with the political opponents -who offer nothing. Well you can.. but really what is being accomplished?

  8. Peter Galuszka Avatar
    Peter Galuszka

    Jim you negate yourself you could fall back on your wifle’s policy. You do not understand that millions of almericans do not have that luxury and it diminishes your credibility

    1. DJRippert Avatar

      Peter – that’s quite unfair. You don’t have to experience something to understand it. I have never been in a war but I know that I don’t want my sons to be sent off to battle.

      The fact that Jim has a health insurance policy through his wife’s employer doesn’t mean he can’t understand the issue. By that measure neither Congress nor President Obama are qualified to make decisions on the matter.

  9. I did notice that myself.

    You know why folks in the Fredericksburg commute to NoVa – even GS-5s?

    for the same reason. The only way to get affordable (and that’s questionable now) health insurance is to work for the government or a large corporation.

    If you are self-employed or working in a small business or as a tradesman or retail sales – you are screwed.

    and more properly put – we are screwed – because the uninsured get care .. they get last-minute heroic care are premium prices and we pay for it.

    Employer-provide health insurance in the 21 century makes no more sense than a defined benefit pension tied to one company yet what exactly would happen if we did what Jim (and Mitt Romney) recommended and take away the tax-free status for employer-provided health insurance?

    how many people tossed off their employer policies would be able to find equivalent in the “free market”?

    Jim – did you actually check the independent policy for what it covered relative to what your wife’s insurance covers?

    most independent policies are pretty crummy once you get past the “affordable” part of it.

  10. Peter Galuszka Avatar
    Peter Galuszka

    entirely fair question. I do thank jim for his honesty

  11. One should be careful in making broad categorical over the top statements like Obamacare is the worst legislative train wreck since Iraq. Think about it (100,000 plus deaths).

  12. DJRippert Avatar

    This is the “logic” of Obamacare:

    “The only way to end that discriminatory system is to bring everyone into the system and pay one fair price. That means that the genetic winners, the lottery winners who’ve been paying an artificially low price because of this discrimination now will have to pay more in return.”.

    The speaker is one of the geniuses who designed Obamacare. The lottery winners are those in good health.

    Today, I have filed suit against the Washington Redskins for discrimination. They have repeatedly refused my requests to be added to the team as the starting strong safety. Essentially, they are insisting that only the lottery winners (big, fast, well coordinated) are acceptable as strong safeties.

    Thanks to Obamacare’s decision that entities cannot discriminate in favor of people with inherent physical attributes I expect to be playing safety within a few weeks (I have to learn the defensive playbook first). I will be the only 54 year old player in the NFL. As far as the opposing teams – champagne corks could be heard popping inside the homes of every NFC East quarterback.

    1. virginiagal2 Avatar

      That actually isn’t what it means. At all.

      Employer insurance includes people with pre-existing conditions – probably a higher percentage than they would if insurance wasn’t tied to employment, because people seek out employment to get health insurance.

      Yet their pooled risk generally results in a reasonable rate. The idea of including pre-existing conditions, if everyone gets insurance, is simpy doing the same thing to the individual insurance market.

  13. Medicare is one price to all no matter their genetics. So is the Federal Health Care Benefit program that Congress gets.

    In every other OECD country on the planet – it is the same.

    you buy insurance for your car because you simply don’t know if you are destined to have an accident – no matter how careful you are – and of course the state encourages you to consider that possibility.

    the mortgage company also encourages you to insure against things in the future you can’t know – and they won’t take no for an answer.

    folks who are so ignorant as to believe they’ll never need health care and don’t need to save for it like they would a pension are really no better than those who would not buy auto insurance if the state did not require it.

    this is about being financially responsible – to not gamble with others money which is what you’re doing if you choose to not get health insurance.

    this is like saying you don’t need to save for your retirement until just before you retire… it’s dumb.

  14. I have never believed – from the beginning that ObamaCare was anything other than a tortured compromise that was the result of running a partisan legislative gauntlet.

    but we knew that our health care system is broken so bad that it consumes 17% of our GDP and is projected to consume 1/3 of our GDP while every other OECD country on the planet pays less than 1/2 what we do and they cover everyone.

    the question is – not why you are opposed to ObamaCare but what legislative alternative do you support and if you can only say you oppose Obamacare and “ideas” – what is your solution?

    we can get rid of ObamaCare and go back to a broken system that is only going to get worse but again – what do you support?

    it’s a dysfunctional system that arbitrarily creates winners and losers and there is no way to fix/re-construct it without damaging some of the winners.

    is that is our bottom line – that no one can be affected by reform? – then we are locked in to something that we know is doomed and we are apparently incapable of agreeing to do anything about it other that stand by and watch it – ultimately damage even more people until a majority of people in this
    country – through changing jobs and pre-existing conditions – have no health care and the rest that do – spend 4 times as much for it than a billion other people in the OECD countries.

    it’s pretty bad when the default position is – to defend something that is as bad as the current system is if we roll back ObamaCare.

    and it’s unconscionable for opponents to have no legislative alternative – not just feckless – cowardly and no excuse for it.

  15. mgarfield1 Avatar

    Re: Obamacare

    We need to take a less myopic view of PPACA and health care financing overall. Keep in mind the following:

    I. No one would consider it appropriate or even constitutional to strip away employer subsidized health care, Medicare or Medicaid. That constitutes 80-90% of all people insured.

    A. None of these people want to negotiate or play any part in reducing the cost of health care, except for whining about it out loud.

    II. A huge portion of the health care dollars are in administrative costs within hospitals and insurance companies

    III. Financing anything through insurance generally costs 1.5-3 times the open market prices. Try and get a quote on a a scratched auto bumper with and without insurance.

    IV. We spend double what everyother industrialized country spends on health care an fail to cover 10-15% of the population

    V. Tax credits can only help the people that can already afford health care

    VI. Physician salaries (NOT reimbursements) constitutes 5% of the health care dollar

    VII. If your house was on fire, would it make sense to have several private fire departments from which you could shop around and get the best value for your dollar. How about if you are hit by a bus and your intestines need to be repatriated.

    VIII. PPACA consolidates the financing of health care through insurance, incentivises escalating costs (By limiting profit by percentage), adds more administrative costs, defers rules and management to the government through the IPAB, increases the exposure of patients to medical bankruptcy (Bronze plans are 10K deductibles with 40% coinsurance payments)–giving you, government run, privately financed health care.

    iX. The cost escalations on the PPACA are already on an unsustainable trajectory. The only way to bend the cost curve is through the government run IPAB. However, being a Government run programs it is incentivised by campaign contributions , money and power, not by reasonable review of individual needs.

    X. The only way to manage and contain all the above is to bring everyone under the same umbrella. That means Universal health care. Remember we already pay double what every other county pays for socialized healthcare so i doubt we need to cut doctors’ salaries, and it is hard to argue that we cannot afford it.

    A. In order for this to not favor bureaucrats, we need to start to shape and control this now. The PPACA WILL COLLAPSE SOON after its full implimentation. There are likely contingency plans in place for this likely scenario. We need to devise a plan keeping doctors in control and minimizing lobbying from the most exploitative components of the health care industry.

    B. If we created a tiered system in which immediate needs were fully funded for all and higher tiers would allow more freedom of choice. We could possibly have a system in which resources could be diverted from the medicaid patient with recurrent non-parasitic uncomplicated pruritus ani to the disabled patient with cancer.

    C. Individuals and employers could contribute to raise your tier and therby increase your access to the elective care.

    D. Doctors could be reviewed in ONE central database to confirm or refute their upper tier reimbursement fee schedule. Doctors with an average of a 2 hour wait would see a lower tier fee schedule, as would doctors that regularly do not address patients questions and concerns.

    E. Under the Universal coverage umbrella there could be a “Free market”of patients willing to pay more and doctors that can refuse or limit lower tier reimbursements

    F. Fair billing practices could be normalized such that hospitals could no longer “unbundle” charges so as to create the massive discrepancies we see across the county. Rather fees would be adjudicated by a central authority and would be placed on higher tiers based on satisfication as measured by the doctors and patients that use the facilities. This means keeping but severely modifying the objective of IPAB (The death panels, for some of you)

    Summary: there is not and there will never be a “Free market Health care system”; Our present system is not sustainable; What type of system we move to, is being chosen for us; We need to consider if we want to hold to our ideals and let the system take off without our input or if we are prepared to make some compromises and prepare for what seems imminent to me.

    1. virginiagal2 Avatar

      You have some factual errors here.

      ” defers rules and management to the government through the IPAB, increases the exposure of patients to medical bankruptcy (Bronze plans are 10K deductibles with 40% coinsurance payments”

      Bronze plans do not have 10K deductibles. According to the website, the maximum out of pocket for an individual is 6350 – and when you hit out of pocket, you are no longer required to pay deductibles or coinsurance. Your out of pocket is where insurance kicks in at 100%.

      This decreases – not increases – the risk of medical bankruptcy. I have had cancer, I have always had very good insurance, and I have seen individual bills for over 6350.

      ” The only way to bend the cost curve is through the government run IPAB. However, being a Government run programs it is incentivised by campaign contributions , money and power, not by reasonable review of individual needs.”

      This is also incorrect. The IPAB is trying to identify inefficient and ineffective care, which is a good thing. And it seems to be going by actual science, or at least trying to. However, it’s not primarily for reducing cost and it is not used for individual care.

      There are multiple ways to bend cost curves for insurance. The only one fully blocked is excluding people who may actually use health insurance.

      You can put together provider networks and negotiate with them for reductions in fees. This also means limitations on who a patient can see.

      You can limit what you cover – this is allowed, to some degree, with Obamacare – you don’t have to cover everything, but you do have to cover core services. One of the sticky issues is that the scope of healthcare is expanding exponentially, but our ability to pay for it is not.

      You can work to eliminate ineffective or futile care – that is allowed and encouraged, but you get pushback.

      You can cut into the insurance overhead – this includes profits, so the incentive for this is not always there.

      What we need to remember is that the main problem is not the cost of insurance – it’s the cost of healthcare. Insurance costs are primarily the cost of reimbursing for that health care.

      1. re: factual errors.

        that is a huge problem right now. There’s not only errors of fact, there is misinformation and disinformation – and it gets propagated even by people who think they have gathered facts and are publishing them.

        It started quite some time ago with “death panels” then went on to say that people would be seeing Government doctors… etc, etc.

        It never was about disputes over facts. it was/is an ideological war where facts and truth are the enemies.

  16. mgarfield1 Avatar

    12.7 k for family coverage on a bronze plan
    Never said IPAB was an individual death panel. But they will be re-calibrating RVUs and price adjusting procedures that they feel are overused with minimal patient and doctor input. At least half of the appointed IPAB members must have no direct involvement in the provision or management of the delivery of items and services under Medicare. They will curtail reimbursement on many procedures, which will deter the utilization of those procedures. If the reimbursements do not offset the risk in undertaking the work on a patient those aspects of health care will become unavailable. This is why today it is rare to find an independent OB/GYN. They cannot afford to provide care with the reimbursements paid by insurance plans. The only way they exist at all is because the hospitals make so much money on the deliveries that they can cover the expenses to run the OBGYN practices an Med-Mal insurance.
    Moreover, colleagues of mine are reporting fee schedules on PPACA plans paying in NY city below the cost of supplies for CPT codes including biopsies and draining infections. If that is your bronze plan it won’t matter what your deductible is, you will never get to a doctor.
    If people cannot afford the 12.7 K medical bill PER YEAR they will go bankrupt!! I do not have the stats in front of me right now but a large portion of medical bankruptcies today involve people that have health insurance with deductibles much lower than 6k individual and 12.7k family.
    I have the highest deductible I could find on my young family plan and it is not as high as the PPACA bronze plan. Which I will soon be forced into.

    1. re: ” At least half of the appointed IPAB members must have no direct involvement in the provision or management of the delivery of items and services under Medicare. They will curtail reimbursement on many procedures, which will deter the utilization of those procedures. If the reimbursements do not offset the risk in undertaking the work on a patient those aspects of health care will become unavailable. This is why today it is rare to find an independent OB/GYN. ”

      How are you conflating Medicare rules with OB/GYN?

      reading the rest – are these facts ? they sound like mostly anecdotal data and even then – what “might” be….

      no good.

  17. mgarfield1 Avatar

    “in terms of ObamaCare “affordability” – it was never intended to redduce healthcare costs overall in the first cut.

    it was intended to make health insurance available to all citizens.”

    More misinformation? Obama claimed to reduce health insurance by $2500/year. If he did not mean the first year, than the statement is useless as most plans have increased 25-200% since the passage in 2010. Why would I want a bill that increases my fees by $5000, but gives me theoretical unrealized $2500 discount, at some point in time after rates continue to skyrocket?
    If PPACA can stay intact, IPAB will be resetting rates to lower costs on Medicare patients. The private plans will follow suit and maybe cost will go down. If PPACA continues to have enrollment problems, then the problems cascade into massive costs for PPACA plans and costs will never go down. The the government gets to offer us Medicare for all to “fix” the problem they just created. Theoretical and opinion. I know. Not intended to misrepresent anything, just an opinion.

  18. the cost of health care versus the cost of health insurance.

    All insurance now days pays on a per procedure basis – the more procedures ordered, the higher the reimbursement levels.

    that’s what increases the costs of health care and ObamCare was never intended to address that issue.

    the issue it was addressing was to provide insurance to people who did not have it – at rates they could afford – by helping them pay for it relative to their income.

    are you including these credits in your narrative here?

    It’s one thing to have an opinion – but you are also making assertions here that do not seem to have good evidence

    the primary way that ObamaCare reduces costs is by creating bigger pools of insured – which need to moderate premiums and is seen in the larger employer-provided plans as well as the Govt FEHB and Tricare.

    If Medicare can cover 50 million for $500 a month – or 12K a year per couple and it has a 20% co-pay – then why is that not possible for younger demographics?

    what the website needs is not only a comparison tool between the plans offered but also a column that allows you to put in the specifics for what you have right now and I’m betting you can’t get something for nothing and if the bronze plan costs you more – it’s got more and your plan has things like lifetime caps or does not have to guarantee renewal.

    you have to compare apples to apples – you have to WANT to compare apples to apples.

    no disrespect, but we’ve see way too much of apples to oranges these days.

  19. mgarfield1 Avatar

    ” If Medicare can cover 50 million for $500 a month – or 12K a year per couple and it has a 20% co-pay – then why is that not possible for younger demographics?”

    Because you are adding about 30% admin costs by using the least cost saving mechanism to administer health care financing–Insurance companies. Health is not insurable event, thus treating it as one is ridiculously wasteful. Moreover, by destabilizing the last vestiges of competition you assure that the insurance companies will now have greater leverage to charge it’s customers more, pay its providers less for greater profit. Before you tell me how PPACA limits profit, let me remind you that the PPACA cannot implement any cuts to hospital reimbursements until 2020. 15% of $100 is $15. But if we can make $100 worth of health care cost $1000 then insurance can keep $150, rather than $15 for the same care. In other words there is nothing stopping hospitals from charging more and justifying the increases with new and more expensive medical products (This has been occurring long before the PPACA), that insurances will gladly pay for while raising rates and cutting reimbursements. So there is an actual incentive to raise the cost of care and raise the cost of insurance built into this law.

    “no disrespect, but we’ve see way too much of apples to oranges these days.”

    There is no disrespect in your statement, just the assumption that I should be happy paying twice as much for oranges when I wanted an apple. And If I don’t want the governments approved fruits at all, I am fined by the IRS.

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