At first, this was a misunderstanding. Now it’s a lie. The ACA was primarily focused on access, but also did a number of things to bring down costs.
For example, it penalizes hospitals who have too many readmissions, which is to say hospitals who discharge people who aren’t ready for discharge, who worsen outside the hospital, and who have to be readmitted at extra cost. Hospitals get paid for Medicare patients admitted to hospitals. If they’re admitted twice, the hospital gets paid twice. The readmission penalty is supposed to punish hospitals who discharge people, only to see them profitably readmitted the next week.
It authorized the Independent Payment Advisory Board, which was tasked to look for cost savings in Medicare if Medicare costs were rising too fast. As it turns out, since the ACA was passed, Medicare costs have been rising much more slowly than they had been, for whatever reason.
The ACA also set up various “bundling” programs for Medicare, where providers would be paid by diagnosis rather than by procedure. The idea is that if, for example, a hospital is paid a fixed amount for someone admitted for a heart attack, they will have an incentive to avoid duplicate tests and unnecessary procedures.
The Cadillac tax was also aimed at cost reduction.
My point is that if there were incentives built into the premiums, maybe people would actually curtail bad health behaviors. If enough people did that, then maybe we wouldn’t have so many people being treated for lung cancer, diabetes, or diseases that could have been prevented by taking the vaccine. So health care costs overall would go down.
In effect, the higher premiums for bad health behaviors is a tax. When you tax something you get less of it. Why are states taxing cigarettes so much? They want smoking to go down. And it does. Why tax sugary sodas, like some Bay Areas cities are? So people drink less of it.
Other insurance has similar things. I have to have smoke detectors and carbon monoxide detectors for my homeowner’s policy. It protects me and protects them from paying out.
@mom60 My D will also soon be experiencing the way our insane insurance system distorts life decisions. She works for a small non-profit which cannot afford to offer insurance to its employees. Luckily, ACA is available to her, so she has good insurance at a reasonable cost, while still being able to do a job she loves at a company she loves. If she loses that insurance, she will either have to go find a corporate job with benefits (and you cannot imagine someone who’s less suited to a corporate environment than she is), or else marry her boyfriend just for the insurance his job offers.
Isn’t this the tail wagging the dog? Call me crazy, but IMO we should be able to make insurance decisions based on our life needs, rather than life decisions based on our insurance needs.
Mr R and I married when we did so that he could get on my health insurance. Otherwise, I doubt we would have married at 24 years old. That’s just a very young age around these parts.
That’s not to say Mr R and I don’t love each other. We do. Deeply. Just neither of us saw much of a reason to make it legal rather than living the way we currently were. Marriage hasn’t changed a darn thing for us. (Though when we married, I was healthy. We probably would’ve married when I got sick since it just makes everything a lot easier with regards to health decisions, privacy laws, etc)
I and my kids have chronic conditions that are totally NOT related to anything we have or gave not done to our health. We never smoked, eat appropriate food in decent portion sizes, have low normal BMIs, exercise, rarely drink, don’t use tobacco and aren’t exposed to lung irritants, but STILL have chronic health conditions. Blaming patients isn’t very helpful, especially when none of our providers can suggest any changes to improve our health.
Why should we have to pay more because we have had the misfortune to have chronic health conditions through no fault of our own? Also, many folks with chronic health conditions are forced to retire on disability much sooner than they’d like and can’t afford to absorb higher costs so would likely have to go without until crisis forces them into ER and expensive complications. They will have had fewer years to save since they had to retire early and will be doomed to an impoverished retirement in poor health.
I certainly never said that those with conditions beyond their control should pay more. I said that those who ignore good health advice and do things that they know or should know are going to lead to bad consequences in the future should pay more. NOT as a punitive thing, but in an effort to get bad behaviors corrected, ie. stop smoking, abusing drugs, get those vaccinations, and so on.
People with 20 speeding tickets on their record are going to pay a lot more in car insurance than those with none. Even if they’ve never had an actual accident claim. It’s like that.
There’s one ACA incentive for healthy behaviors, at least in some states: smokers are charged more.
Nobody has produced any incentive that will make obese people lose significant weight and keep it off. Such an incentive doesn’t seem to exist, probably because once your body gains weight, it fights and fights and fights to keep that weight or regain it. There exist people who have lost significant amounts of weight, but they are a teeny teeny weeny percentage of all people who have been obese. For that reason, cost penalties for overweight serve not as an incentive, but as a punishment.
The ACA does of course offer some incentives for healthy behaviors. If you can afford to go to the doctor for monitoring your health conditions such as diabetes, and if you can afford the drugs you need to treat your health conditions, you are more likely to do those things. If you can’t afford to see the doctor and take needed medicine, you won’t do it.
Some people believe that Americans pay more for health care primarily because Americans are unhealthier than other people. These people are wrong. Americans are more obese than other countries, though I believe Mexico is #1 now, but we smoke less.
It is definitely true that when you tax something, you usually get less of it. But there is a limit.
Many places have high taxes on cigarettes. This has been shown to decrease smoking. However, there is a genetic condition that makes someone resistant to quitting smoking because of higher taxes. To me, this is an astonishing result, but it turns out to be true. People who don’t have the genetic variant are able to quit smoking once they have started, but people who do have the genetic varian do not quit smoking once they have started, even in the face of high cigarette taxes.
I was a year-round athlete from about the time I was about 4 until late in high school. I was often accused of being too skinny. I rarely drink, have never smoked, don’t do drugs, etc. I’m a vegetarian and have been since my early teens.
I still got sick. There’s nothing I could’ve done about it. It happens. Gallstones run in my dad’s family, but we didn’t know that until after my sister and I were born. Autoimmune diseases run in my mom’s family (apparently) but both my mom and I were the first to get sick and she didn’t get sick until long after I was born (plus she has a significantly less problematic disease than I do).
I am now overweight because I was on prednisone for several months and was essentially bed bound. I’m back into swimming and am slowly (at an excruciatingly slow pace) losing weight and becoming more mobile.
Should I pay more because of an accident of nature? (Rhetorical question. I know the answers from basically everyone in this thread.)
Now that we know some people are genetically resistant to quitting smoking because of high cigarette prices, we should consider whether some people are genetically resistant to losing weight in the face of incentives. We have to conclude that almost everyone is resistant. We know that because nobody has found any incentive that works for more than a tiny percentage of people.
Yeah, my son didn’t do anything to get schizophrenia - he was a distance runner and never did any drugs at all. My husband and three kids never did anything to inherit a bleeding disorder that requires meds that cost over $20,000 a dose if they need surgery. The med before dental procedures costs about $800 and it’s not covered at all since it’s not a “medical” cost. Ugh, it sure would be if they started bleeding after having a tooth pulled and ended up in the ER!
And there is more and more research that shows obesity has a genetic and /or environmental component.
Are you going to charge the alcoholic more? The guy with chronic high blood pressure? The guy that’s allergic to bees but goes golfing anyway. How about pregnant women?
I’m trying to imagine the administrative nightmare of determining, billing, auditing and enforcing this a la carte premium scheme. The cost of it would be enormous. Too much of our premium dollar already goes to administration-- 20%. (Compare to Medicare’s 3%.)
It’s punitive if you do it when you know it doesn’t work. It’s also punitive even if you insist on disregarding evidence that it doesn’t work, and continue to falsely insist that it does work. This sounds less like trying to help other people, and a lot more like twisting and turning to find ways to avoid paying for sick people without doing anything to make the sick people any healthier.
Pre-ACA, there was medical underwriting in the individual market for medical insurance. Those without pre-existing conditions got the lowest rates (which were not necessarily low), while those with pre-existing conditions (including such things as smoking or obesity) got higher rates or were denied coverage.
One would think so, but the problem appears to be that people do not respond well to longer term incentives. Even the prospect of spending one’s golden years in the hospital due to medical conditions that could be avoided by healthy behaviors is not enough of a deterrent against unhealthy behaviors for many people.
Of course, some people just have bad luck in the genetic lottery (or other things not related to personal behavior) and acquire pre-existing conditions that would cause them to be surcharged or uninsurable under pre-ACA medical underwriting.
Ok safe ones…maybe someone has an opinion about this.
What will happen to medical students doing elective rotations in multiple states? They must have health insurance coverage…and some med schools don’t offer it any longer through the schools.
And most specifically…what will happen if no individual plans are even available in 2018?
You want to punish Romani because why, again? She gained weight because of prednisone, and she hasn’t been able to exercise. Clearly she deserves punishment in TatinG world.
I’m also wondering how you are going to police the smoking, drinking and exercise habits of policyholders. People who drink a lot don’t even admit to themselves how much they drink. What makes you believe they’ll admit it to insurers?
People who bought individual insurance won’t have any insurance.
Cancer patients who have been continuously insured since 1973 will have no way to pay for their ongoing treatment. Even rich people will be screwed: who has the money to come up with $150,000 for cancer treatment or a quarter million to cover the premature birth of much wanted and planned for twins?
Hospitals will be in a quandary. Should they discharge that responsible law-abiding florist in the middle of her cancer treatment? Should they rip the twins out of their incubators? Hospitals simply can’t afford to eat the costs of everyone who used to have individual insurance.
Rural hospitals are already on the brink. Some will close.