Why was that even necessary? Da fuk?
What business gets a 20% margin for administration and compensation? Where’s all that free market (blessings and peace be upon it!) competition?
ACO’s are a shot in the dark. They are basically retreads of the HMO’s that came in the 80s and probably won’t be that much more successful. There’s always hope, but the overall decline of the ACO in the vein of the HMO is likely. Even studies about what they hope to achieve through them are honest on that fact. See here, top of page 7.
When they go into how they are different from an HMO, they go “Well, HMO’s focused on the short term and we’ll focus on the long-term.” I can imagine the marketing guy’s fist-pump that went behind that statement.
The Medicare/Medicaid readmission penalties aren’t really something a government or private organization can really help. If I am an idiot and ignore my doctor and come back in a week with the same issue, the hospital suffers? (Or, possibly, turns me away to prevent a readmission penalty.) In areas that have people who are used to ER-when-sick style care, this is going to hurt hospitals over the next couple of years and not drop costs at all. The culture of waiting to the last minute for health care won’t vanish simply because the government and the hospitals want it to.
Additionally, the penalties of hospitals/doctors for repeated assessments are ONLY FOR MEDICARE AND MEDICAID. IPAB and similar parts of the ACA don’t deal with the mandated insurances from the private sector. it won’t reduce costs for the average forced consumer, only for the government. There MIGHT be some rollover effects, but I haven’t seen anyone say how that would happen.
New York’s for-profit ban isn’t going to last much longer. That’s the third attempt to allow them through in the last two years.
The great majority of Americans live near a for-profit hospital, actually. Roughly 1/5th of hospitals in the US are for-profits and they are clustered in large metropolitan areas. You can go find a not-for-profit hospital, but most people will take what fits in with their lives as a convenience over a statement, especially when they “just” need something quick and simple. They tend to get more choosey when it’s something like cancer treatment.
The high prices charged for the uninsured was part of the run-away train on costs over the last 20 years, primarily driven by Medicare/Medicaid and insurance companies. Instead of paying the average rate for an area, Medicare/caid and insurances started negotiating at percentage discounts. So, to continue making money, hospitals jacked up the rates. As the percentage to pay wanted to drop from the insurance companies, the rates at the hospitals climbed. (“We are paying you 60%. We want to pay you 45% of your list price, now.”)
Yes, and the Canadian system, after working through some kinks they were having with wait times in the 90s, works out fairly well. And, for certain government-posted doctors, they pay a wage, not a per-service commission. A good wage, to boot.
The problem is that if you are penalized for trying to diagnose something, you will always go with the lowest common denominator. Is that temperature and headache the early stages of meningitis or the common flu? Why send away for the test when that’ll penalize you. Give some antibiotics and hope for the best.
Cost savings because a test wasn’t paid for! Woo!
The “Specialist bias” of US health care isn’t going away just because the ACA accepts Physician Assistants and Nurse Practitioners as PCPs. The reason we are having a crash in PCPs is because insurance companies destroy what they are paid per visit. What would you rather do? Make $250 an hour doing surgeries or $60 an hour talking to patients when you have $300,000+k of medical schooling to pay off? And that is JUST schooling. Malpractice insurance is always another favorite, which benefits doctors that are part of a hospital who will get an umbrella coverage for all staff and charge a fraction of the price.
The ACA makes no strides to try and stem that issue, because if it did anything you might point to as “cost savings” would be immediately moot.
Agree. But we can do better. We have more than a dozen successful models that we are ignoring.
$147 a month for a 27 year old making $25,000 after subsidies is not “affordable” health coverage by any stretch of the imagination. Neither is a household of 3 making $50,000 and paying $340 a month after subsidies. A family of four making $50,000 gets a bit more help at $280 a month out of pocket. Still not really affordable. A couple making $50,000 a year gets to foot a $395 bill after a whopping $360 yearly subsidy. Wee haw!
And after you pay your $1,764 each year in premiums as a single 27 year old making $25,000, how the hell do you pay for the $4,000-6,000 deductible? Your monthly bring-home is $1,770 and we just ate $150 of it. Rent, food, transportation, and other basic necessities will eat that alive in a lot of areas. This is the level of living paycheck to paycheck. Barely. When something comes along unexpectedly (your car’s transmission broke!) you spend six months trying to catch back up to everything you had to push back.
So unless you’re lucky and live in a rural area…oh. Wait. No. Because rural areas are getting boned on rates.
I’m sorry, but the Affordable Care Act isn’t. It doesn’t address the costs of health care in this country in any adequate way, and the creative private sector initiatives I’m not holding out much hope for, either.
I was referring to the public option for small businesses similar to what Congressional members get. I realize a single payer option wasn’t politically possible yet.
Would you care to comment on ACA’s achievement in requiring insurance companies play above board now in a free market?
Your article does not provide a source for the seeming rule-shift you quoted. To put it mildly, I think it’s full of shit.
It’s not a free market if the government will punish you for not buying their product. Or if the government charges you 30-50% more if you buy from a different supplier.
Would it be more of a free market if the government could offer you equally good insurance for 30-50% less? Then you’d be happy?
[QUOTE=Bone]
Did anyone actually believe that (1)the pool of insured people would increase, (2)that all those folks with pre-existing conditions that were too expensive to insure would now be able to be covered, (3)that those who couldn’t afford it would be given subsidies, and (4)the required amount of services provided would increase, and on top of all that, costs would decrease?
[/QUOTE]
Obama and the Dems believed it, supposedly.
Or maybe they were lying all along, and it was really a sort of “we had to destroy the village in order to save it” thinking. So that Obama was really thinking “when they see what a clusterfuck our first shot at health care reform is, they will be eager to have us take another stab at it, and then we’ll have UHC!”
Regards,
Sho-damned
I think this is a very even-handed interpretation.
Sure - it focuses on personal responsibility. “It doesn’t matter what the man said – it’s your own responsibility to read and understand the law.” I agree.
Too bad the Democrats like this approach for Obamacare and not for Voter ID.
That would be some accomplishment. I’m intrigued enough to let them try it, just so I can laugh at the failure.
So explain this to me.
I just got the new information for my son (14 year old male) on the ACA compliant policies he can get. If he stays with the one that the insurance company says is equivalent (i.e. same premium) then:
- Annual deductible increases by $3000
- Copayment increases $20
- Medication increases $20 per prescription
- Annual out of pocket increases $2600
- The only improvement (I assume under ACA requirements because all of their policies have it) is dental. For him completely unnecessary because we have good dental insurance but I guess he can now double dip if for example each plan allows one deep cleaning per year.
The plan that is truly equivalent is $20 per month which I get because if the have to cover the uninsurables, obviously premiums across the board will increase. $20/month is not that bad. The thing about his new plan is that we get dental again but everything is the same EXCEPT the annual out-of-pocket is still at the inflated rate.
A) Is dental a part of ACA requirements?
B) If so, can that answer the question of why everyone is getting cancelled/replacement because few health policies have dental?
C) Considering my son has dental through an alternate plan, can I as an individual ask HHS to grandfather in my old plan?
D) Why the out of pocket increase? Cost control for the new high-risk or just a way to screw the consumer?
Part of it is that you are subsidizing the older and sicker, but a lot of it is also things like free preventive care.
That’s one of the nonsensical things about the law, it mandates that so many things have to be free, that other things require big co-pays to make up for it. Is the government truly smart enough to decide that certain medical procedures are more vital than others?
Not so simple.
The idea behind free preventive care is that more preventive care eventually saves money, by identifying health issues before they become very serious.
There are different schools of thought about this. Personally I’m very skeptical - I think it’s true in some cases but not in others and on the whole is dubious - but that’s the idea, anyway.
“Read my lips: No New Taxes.”
“Hey, you just raised taxes!”
“Uh, yeah. I didn’t say anything about increasing existing taxes; I just promised not to invent any new ones.”
It was “No gnu taxes”. No one had theur gnu taxed.
No, no, no! He was promising “No nude Texans!”.
And, to quote The Simpsons:
“To protect Mother Earth, each copy contains a certain percentage of recycled paper.”
“And what percent is that?”
“Zero. Zero’s a percent.”
It doesn’t “focus on personal responsibility.” As I read it, the focus is on Obama’s failure to be clear about what he meant (though I expect we’ll find that the “if you like your plan, you can keep your plan” statement has been taken partly out of context.)
And to respond to your hijack, nobody opposes voter ID because of problems with reading and understanding the law. People oppose voter ID because it’s designed to disenfranchise minority voters to reduce the number of votes cast for Democrats, under the (patently false) guise of a plan to reduce electoral fraud. The law is not hard to read or understand. It simply places an unnecessary burden on voters.
But Newt still has an axe to grind.
I’m afraid he’s never going to go away. His ego forbids it.