With Donald Trump and a Republican Senate and House it would seem the days are numbered for ACA otherwise known as Obama care. Of all the many things Trump promised this is one he can deliver on. Not unlike when Obama delivered on his.
I believe that in a modern society that health care of all its citizens is important. It is interesting to me how much controversy this causes. Health Care in the USA has been a problem here in the US since well before Obama took office. Doctors since antiquity have sworn an oath to treat the ill to the best of one’s ability. Should we not have a system in place that promises that very same principle to its citizens here in the United States?
There might be some benefits I am missing. I do dot profess expertise in this industry. My opinions are general and based I what I read. I understand that these are complex problems and like anything an attempt at a solution has a cause and an effect.
Given that Trump did not say he was simply repealing it and he was replacing it. The question is what will this new proposal look like. He does have a mission statement online from during his candidacy. How this transforms into policy is yet to be seen,
First lets look at some of the good and bad points of ACA or Obama care. I do not think the ACA in its present form is the solution. It simply was an overlay of the current system with some tweaks. Cornerstones of ACA that I very much agree with are the following.
Elimination of pre existing conditions.
Elimination of annual and lifetime limits
Everyone is covered
Focus on preventive care
To say because you are ill you that cannot be covered or that issue will not be covered is just plain wrong. This is not car insurance where you can simply stop driving if your rates are too high due to multiple accidents. The model for car insurance should not be applied for health insurance.
Furthermore to charge a covered patient beyond a limit and the subsequently cancel the policy because it cost too much when they became ill is absurd. We do not pick our illness nor have control over treatment costs for that illness.
By everyone being covered it should reduce costs. Without access to gain preventive care by regular visits often the uninsured use the Emergency Room as their health care plan This is far more costly than regular doctor visits. Furthermore the normal result for the uninsured patient is the inability to pay for emergency care rendered. Subsequently we whom are vested in the system pay the unpaid costs. It is by order of magnitude cheaper to treat diseases early.
Two major issues that have not been addressed by ACA and need to be.
Tort reform or reining in Medical Malpractice
Lack of cost control in the industry.
Medical malpractice is a cost to the system and many of the suits are frivolous and others are grossly overpaid in litigation. These factors make for increased cost for the whole and limited benefit for the very few. It also play a huge role in a litany of tests that need to be performed to avoid litigation. In other words part of treatment focus on not getting sued rather than treating the patient. The looming cloud of litigation is so intertwined with treatment that it raises costs and does not improve care. I am not saying there should not be a vehicle for consumer protection but the current system is broken unfair and very costly.
Health Care costs are $ 8233 per person vs $ 3268 per person for the next 33 OECD countries averaged. That is means we have costs well over double of our peers or pay $2.50 for every dollar they spend for basicly the same service. These are well documented figures and statistics and cannot be denied. If the system is to become more affordable the most obvious is to get more for what we pay for now.
I was talking to a friend recently whose child was in need of a sonogram service. The procedure was going to be $ 7000 and his insurance was going to pick up $ 6000 leaving him with a $1000 dollar bill. He complained to the service and the woman on the phone told him to show up claim he did not have insurance and promise to pay cash on the spot. He did so. The procedure went from $ 7000 to $ 150. How do we accept this? Where is the other six thousand plus dollars going? This money is spread out in so many places it is difficult to point to one thing. But the industry as a whole needs to shaken up.
From $325.00 EpiPens that have no competition. A product by the way that cost about 57 bucks before being bought by a new company in 2007. The cost is about $ 50 or less for the same product from the same manufacturer in Europe right now. And to further sweeten the deal for EpiPen each and every school is required by law to have them on hand. So we the taxpayers are essentially being bilked every year from pure corporate greed.
Hospitals charging far above costs for the same procedures done in Canada, Mexico and Europe. Cost of prescriptions are way out of balance as we cross any border. Administrative costs often outpace actual treatment costs. What plan is in place to close these cost gaps?
Looking at the Trumps plan on his mission statement I see things I like and things that do not make sense to me. First I will start that Trump has mentioned he wanted to keep the no pre existing conditions. I applaud that. Here is the statement link below
Number 1 It starts by letting you opt out of the system with. I get why this is attractive but again I think the need for universal care where where everyone pays in and is covered is better overall.It is a model in other countries that have equal or even better care at less cost.
Number 2 letting companies cross State Lines. I am not clear on how that will lower rates. From what I can tell the major players are in all States now. Not sure how this “competition” will effectively lower rates. Most articles I found indicated it would not. I wonder if states can simply impose regulation making a measure like this completely ineffective.
Number 3 allowing individuals to deduct insurance cost on tax return makes allot of sense to me. This is probably the number one cost reduction of the Trump plan. If we could combine it with lower overall costs this would be huge for those who don't have employer health care. I see this as good.
Number 4 Simply having HSA is crazy when the public is not earning enough to save now. We do not need an HSA we need affordable care across the board. This will help some but only in years they are not in need. Use your insurance or have a event and this money will disappear quickly. And one must ask the question to our government why are we the only first world nation citizens that are asked by our government to save for health.
Number 5 Transparency in costs. This is really amazing that it has not been about before. This is a great idea whereby a consumer can see what costs are. But the problem is you are often dictated by your insurance of where you can go. I still love the idea but do not know how it helps in the real world where we often have no control of our treatment facilities. It could provide more competition but shouldn't the insurance companies themselves already know these costs? Why is this not done now? Anyone that has ever been given a bill wonders what it all means. We would love transparency.
Number 6 Block Grants for Medicaid. I am not sure that each State has more than it needs or not as stated. I am sure that my State California is especially poor at policing fraud and cutting costs. So I do not see how that will help as stated . This simply seems like the federal government trying to reduce their burden and I fail to see how it helps the public.
Number 7 remove barriers for prescriptions. I see nothing but good in this proposal.
Why not tort reform? Is it because most of Congress has a law degree? Is it because they rank amongst the most powerful lobby that contributes heavily to both sides of the aisle? How is it we need. I am not sure the cost of “defensive medicine” or a litany of tests that might not be needed and performed to avoid litigation are factored. Or is it because it has little to do with cost?
To be fair I have found articles that claim the cost to be 2% or less. This depends on State and specialty. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
I found a list of cost for California which is more than ten years old and it paints a much different story
As with anything it is difficult to drill down and find the real answer. But there is an added cost with dubious benefits few but costs all of us in the end.
I see no real plan on how to reduce actual cost of treatment. This laissez faire approach has led us down the path where we are now. Paying more and receiving less than other Countries. The costs are out of control. While points 5 and 7 steers in that direction I am not sure it takes us toward the desired destination of lower costs. Without a clear plan toward lower costs overall we all suffer with a burden that cannot be met by many. The question must be asked is why to we spend so much more per capita and overall visit health professionals less. This inequity must be addressed.
The insurance companies who claim Obama Care will kill them somehow have managed to beat the S&P 500 by a wide margin since ACA implementation in 2010. During which time paying shareholders dividends. CEOs also paid themselves and upper management generous bonuses. Does that sound like an industry in trouble? If these are our stewards can we not demand better stewardship. Are they part of the solution or are they part of the problem. There must be more accountability on their part as they have the keys to the treasury.
There is no better way to make healthcare more affordable than reducing costs.Trump has a legacy of doing well in business. I think he would agree overpaying for anything is bad business. I would hope part of his efforts would address this glaring need. I do not think this need to translate into sacrificing care. There are many examples of our peers doing just that. They have systems that work. Why are we not doing not the same or even better?
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