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 not 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 system 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?
3/26/2017
When I wrote the above I went off of Trumps website for the measure I thought were going to be there based on Tom Price Plan that had been before congress before which was mirrored by Trump on his campaign website. This was before he assumed the Presidency. Better Healthcare for less money that I was going to love was the promise. Repeal and Replace Obama care
The Plan did the following.
Eliminate individual mandate
Reduced government subsidies and changed the format to a tax credit
Eliminated out of pocket tax deductions
Pushed medicaid into a block grant for the states with a cap which would have resulted in loss of funds overall for those at 138 percent of poverty level
Increased HSA levels
Repealed taxes
Insurers can charge more do to age
Reduced mandated care requirements.
None of this made insurance better or cheaper. It was just a hasty plan to get rid of Obama Care with basically a worse not better system. The lack of focus was rather stunning in the end and abandoned even there own plan. Was not Price put in charge of HSA because of his body of work previously? The only thing that came out of his blueprint was the HSA and block grants for Medicaid . This is a joke as if you can't afford insurance how the hell are you going to set up a nest egg for health insurance? And kicking the can to the States and walking away seems rather rude. It was the two points of the seven part plan I liked the least originally.
If we are to reduce costs we should look first to fraud. I mean billions are bilked from the Government in pure theft each year. Billions more are bilked from insurance companies themselves. In the end we all pay for this. At least those of us within the system.
We need to look at insurance companies themselves. I see Humana wants out of ACA or Obama Care but still wants its piece of Medicare pie. If its main stream of income is being billed directly to the taxpayers I would think they should have more responsibility in the game.
Just looking at CEO salaries of Health Care should throw alarm bells up. We cannot cut cost to customers but can afford to pay CEO ten million dollars and heaven only knows how many six figure employees throughout mid management.
One would think insurance companies would have a responsibility to reduce cost for their customers but are not interested. They are a huge part of the bloat of our costs. Hospitals and doctors office have full time employees that deal primarily with the insurance companies themselves.
The system as a whole needs overhauling. While many conservatives want to rely on a free market system the free market system of Healthcare insurance companies has wholly failed in delivering health care at a reasonable cost here the US.
The fraud and abuse of Medicare is an example of how Government fails to police itself and delivers a system that is inefficient economically. Furthermore the spike in premiums caused by ACA then subsequently passed on to the taxpayer is another example of the inefficiencies of the government.
So where do we go from here I suppose is a good question. Unfortunately due to it size and the failure of the free market we must rely on government to fix it. First I would think they need to fix themselves.
Tort reform needs to happen in such a way that we are no longer paying for defensive treatment. There needs to be a vehicle that puts in place arbitration in place of litigation. Malpractice is a cancer on the system. Cutting it out would allow Doctors to administer treatment rather than ensure they not be sued.
Next would be a vehicle to root out fraud. I would think that putting a bounty that could be collected for those that find fraud both within insurance companies and medicare and medicaid should be explored. Reducing fraud in the system would help everyone.
We need to reduce the amount of time the medical profession is filling out forms. Making a simple universal system for payment seems like a no brainer. We can increase treatment time and thereby reduce costs overall.
Once we are at that point it is time to look to health companies themselves to become into a more economically efficient form. Having seventeen percent of GDP into a sector one would think there is enough money to pass around to treat all Americans well in their industry
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