Agreed. The plan is very disappointing to say the least.
Are there any MD’s willing to share compensation plans and how they incentivize unnecessary testing?
It’s not supposed to contain costs. It’s supposed to give rich people a tax break. Nothing more.
The ACA has some modest experiments at cost control. One is “bundling,” where a provider (e.g. a hospital) is paid one lump sum for an episode of care. For example, Medicare has been experimenting with paying a fixed price for a joint replacement, which will cover the tests, surgery, hospital room, etc. In July, they begin doing the same thing for heart attacks. That way, the theory goes, the hospital will have an incentive to avoid duplicate tests and unnecessary procedures.
Another cost savings initiative is Accountable Care Organizations. These are organizations of providers that band together to attempt to lower costs in treating people with chronic conditions. If they save money over the standard payment for patients with those conditions, they get to keep some of it.
Once again the ruling class is passing policy on ideological grounds and completely opposing what the people of the country actually want.
The people want single-payer:
http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx
https://www.washingtonpost.com/news/the-fix/wp/2016/05/16/most-americans-want-to-replace-obamacare-with-a-single-payer-system-including-a-lot-of-republicans/?utm_term=.d7defbb0ca25
When DD had surgery almost two,years ago…every single visit back to the doctor was included in the initial cost…and it didn’t matter how many times she went back…for the first three months. When I had surgery 10 years ago, I paid for every office visit followup except the first one.
Single payer was on the ballot in Colorado last year. It lost 80-20. It wasn’t close.
When we see a MD or PA (specialist or internist), we pay $15/visit copay, regardless of if its post-surgery, physical, urgent care or anything else in-network (including out of town world famous specialists or our hometown docs). That is under the terms of our policy which has no deductible. Because H also has Medicare B, generally he has no copay, except sometimes on Rx.
Insurance is strictly contractual. Everything is covered by contract terms. H just had surgery in August and there were bills for all his follow up visits, tho totally laid between insurance and Medicare.
ACA did mandate that certain things be included in contracts which may not have been before at a new minimum. Any new legislation is likely to change that and none of us can predict what the future will bring.
States can also make mandates and insurers can offer above the mandates and price accordingly.
Correct, and predictably the entire ruling class (Dems and Repubs) pulled out all the stops to prevent its passing:
http://www.huffingtonpost.com/entry/colorado-single-payer-vote_us_581cdf8be4b0d9ce6fbbf369
The opposition from the Left in CO was reasonable–many argue that single-payer must be nationwide, and while I’m agnostic on the issue, they make some compelling points.
I can’t take credit for this…but I’ll,say it here anyway…
I want Health insurance…not Wealth insurance.
Re: polls on health care and insurance
Of course, health care seems to be the realm of unreasonable popular expectations. For a long period of time, polls showed people opposed to ACA/ObamaCare, but in favor of every provision except the individual mandate (no one seems to be successful at explaining adverse selection).
But now that ACA/ObamaCare may be repealed, it has gained popularity. Perhaps people had various wishful thoughts about how everything will be better if ACA/ObamaCare is repealed, but then reality is hitting that no possible AHCA/RyanCare/TrumpCare will satisfy all of those who did not like ACA/ObamaCare, and many of the latter see many possible proposed changes as worse. Any proposed change that will satisfy everyone in coverage is likely to be extremely expensive, attracting opposition from fiscal conservatives and others afraid of increased taxes.
Americans want choice. The particular choice they want is the choice to buy health coverage that’s cheap and covers everything.
Not sure about the choice to “buy.” They want to have care. Cheap is just the 2nd choice after free.
I think what’s happened isn’t “unreasonable” expectations, but the massive hype launched against ACA, from the get-go. Initially, opponents referred to it as socialized medicine, equating it with socialism. The under informed bought that and heaps of other spin. It didn’t help that certain promises didn’t work out.
Yep, that stuff. And that extremely well-funded opposition to the ACA led to a watered-down version being put in place. Then, when rates went up, people were convinced that was somehow the fault of ACA, even though most reasonable healthcare analysts tell us those increases were far lower than increases in the same timeframe in the old (lack of) system.
Thanks, Fang. It’s hard to see how the individual market is a going concern longterm, when healthy people are allowed to opt out and/or penalized for jumping in. But I do trust the CBO.
Food for thought about access to care via insurance coverage and mortality from disease:
https://www.statnews.com/2017/03/13/cystic-fibrosis-canadians-americans/?s_c
One of the things in the CBO report that Republicans touted was the over $300 billion in defict reduction over 10 years. Yesterday I talked to S2, whose a policy analyst at a non-partisan think tank, who said that Obamacare would also have led to the same over $300 billion in deficit reduction. So there seems to be nothing better about the GOP plan.
(To circumvent any crticism, in order to maintain their tax exempt status, his employer has to be non-partisan)
In 2009, one of my kids had a very nice Anthem policy…$220 a month…that covered him everywhere. It was a PPO with a very rich doctor network. Oh…and he had the choice of many different plans…many. He had a orexisting condition but the underwriters said he was fine…well controlled for over five years. His RX copay were $30 a month each for name brand (no generic available)
That same kid has a very limited HMO. It has a $4500 deductible, and practically no doctors. Cost is $375 without subsidy. He is paying $275 with subsidy, RX are $160 a month each…until he reaches the $4500 deductible. No choice…one vendor.
When kid 2 was 26, she purchased an individual plan…no subsidy…from Anthem for $275 a month. That was in 2014. Same plan pretty much as the other kid but no PPO plans were available.hers was a POS. Fine. 2015 renewal was a HMO but still had a decent network here. Same price. Kid moved to another state. Got Anthem there too. $325 a month for a POS…not bad. No subsidy (no income). 2017 is $375 a month for,the same plan.
Yes, I know costs have gone up…but my second kid is a student whose school stopped offering health insurance. And it’s not a choice for her to have or not have insurance. Not a choice for kid one either.
But what is being prooosed will likely increase costs even more…and provide less choice. Anthem is already threatening to completely pull out of the individual market.
And kid one only had one vendor as it is.will he go down to NONE? Very possible.
A little math will tell you why dropping coverage for over 10 million people a year will save the government billions of dollars. Some of those people will just die without care, but others will actually end up getting even more expensive care in the emergency room, or care paid for by the states. Overall there are unlikely to be any savings from this aspect of the law.
As to why there isn’t anything in this bill designed to cut health costs, that’s partly because those kinds of things can’t be done through budget reconciliation. So, I suspect, the plan is to pass this bill, and then to strong-arm Democrats into supporting cost-cutting elements later in order to prevent an actual death spiral.
…and the Dems will almost surely play ball immediately.