MasterJaguar01
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Joined: 12/2/2006
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ORIGINAL: DesideriScuri
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ORIGINAL: MasterJaguar01
1) The only Republican alternative to the ACA that I have seen is to let the Insurance companies charge what they want, and give people a tax credit to help pay for it. (Remember Meidcare Part D?) If there is a better Republican plan, please point me to a link. Republicans have talked for years about supporting competition across state lines. They don't REALLY support that. They are too beholden to the Insurance lobby.
You're right, unless...
http://rsc.flores.house.gov/solutions/rsc-betterway.htm
http://www.cbsnews.com/htdocs/pdf/GOPHealthPlan_061709.pdf
http://freebeacon.com/issues/republican-congressmen-introduce-new-health-care-reform-proposal/
http://www.bloombergview.com/articles/2015-02-05/a-republican-alternative-to-obamacare-that-s-worth-discussing
http://www.redstate.com/2014/04/02/yes-theres-republican-health-care-plan-bobby-jindals-plan/
Some of those links are different articles about the same plan, so it's not like there are 5 different plans.
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2) I appreciate your medical school idea... But no one is keeping medical schools from existing. And a Doctor shortage is not the main problem
The AMA controls the number of medical schools by being the only accrediting body (a government sponsored monopoly). The number of Dr.'s in the US is kept low to maintain high pay.
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The Healthcare system is complicated rigged (fixed it for you). The Payers created the Fee for Service model, which, once they obtained significant volume, started to collude with the providers to create a "candy store". Hospitals and specialists could charge what they want (I have worked for 3 large ones). Payers didn't mind paying for it, as long as they could pass along the cost to their customers. The costs kept spiraling upward, until it reached a breaking point. Obviously in the individual market.
I've been railing for years that the first step to lowering costs would be to separate the payers from the providers. When one company owns both the payee and the payer, it's merely a shell game where the consumer loses.
Obamacare dictates that 80% of premiums an insurance company charges goes directly towards paying for care. If an insurer doesn't spend at least 80%, the difference is refunded the policy holders. It works to the company's benefit to jack fees up. If an insurer collects $1M, it has to spend $800K to hospitals, leaving $200k to pay for administrative expenses (which there certainly are expenses to be paid). If hospitals double their costs, they'll get $1.6M from the insurers, who will pass that on to the policyholders, along with the administrative costs. But, if $200k paid the administrative costs last year, those costs aren't going to double, even though, technically, the insurer can collect double the premiums as last year. So, that 20% share goes from $200k to $400k while administrative costs don't double. Even under Obamacare, companies can game the system to protect and increase profits.
Non-profit hospitals (hospitals that aren't affiliated with a religion would be "non-prophet" hospitals) are also required to pay out some percentage of their annual charges in charity care. Increasing prices allows for charity care to be charged out at a higher rate, requiring less (relatively) to be given away to meet the requirements.
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Something had to be done. Was ACA the right answer? In the short-term, I would say, YES.
The problem with just doing something is that it usually ends up making things worse. Obamacare is likely going to go down in history as making things worse.
The AMA controls the number of medical schools by being the only accrediting body (a government sponsored monopoly). The number of Dr.'s in the US is kept low to maintain high pay.
Interesting theory (May be true?)
I've been railing for years that the first step to lowering costs would be to separate the payers from the providers. When one company owns both the payee and the payer, it's merely a shell game where the consumer loses.
The first sentence! Yay! You are on the right track. The second sentence is actually the opposite of what is true. Hospitals that own their own insurance basically turn the FFS model on it's head. They turn into their own ACO. They collect a monthly fee for the insurance (all upfront and known to the consumer, eliminate the middle man (the insurance companies and their huge markup), and consumer is usually shielded from rate hikes. Hospital owned insurance is usually quite competitive.
Obamacare dictates that 80% of premiums an insurance company charges goes directly towards paying for care. If an insurer doesn't spend at least 80%, the difference is refunded the policy holders. It works to the company's benefit to jack fees up. If an insurer collects $1M, it has to spend $800K to hospitals, leaving $200k to pay for administrative expenses (which there certainly are expenses to be paid). If hospitals double their costs, they'll get $1.6M from the insurers, who will pass that on to the policyholders, along with the administrative costs. But, if $200k paid the administrative costs last year, those costs aren't going to double, even though, technically, the insurer can collect double the premiums as last year. So, that 20% share goes from $200k to $400k while administrative costs don't double. Even under Obamacare, companies can game the system to protect and increase profits.
True, but neither providers, nor payers were incentivized to stop raising rates before Obamacare either. Obamacare has not made this worse.
What Obamacare has done is two-fold:
1) Create exchanges, where consumers can see, side-by-side, all of the policies available, and compare, among other things, their networks. This has created a push to cut costs (reimbursements to the providers), and in some cases, where an agreement can't be reached, narrow their networks. Even $5/mo on the cost side can make a difference, especially for some young, healthy person who didn't want insurance in the first place.
2) Created mechanisms for providers to band together and
a) Neogtiate as a bloc with insurers in CIN's
OR
b) Form ACO's and bypass Payers altogether
To be honest these mechanisms could have happened without the ACA. The ACA and MU just incentivized them.
Everything is going the way of the ACO and the CIN. Even CMS. Fee for service is dying a slow death.
Downward pressure will continue on payers, who will continue to pressure providers. Providers will continue to retaliate by:
1) Starting their own insurance (in essence becoming their own ACO)
2) Join CIN's for more leverage against payers
3) Bypass payers altogether in an ACO with PCP's and Specialists.
This is EXACTLY what is needed. Is it painful at first? Yes. Both Payers and Providers are going to realize that the "candy store" is closing, and adjust their expectations a bit.
I think the ACA will be remembered as the mechanism that kick-started the free-market principles to loosen the grasp of payers and providers on the healthcare system. Republicans (truth be told) hate it, not because they think it is socialism, but rather, it pisses off their lobbyist donors (Big Insurance, and Big for profit hospitals... Dr. Frist???)
Most people don't understand the system, and only look at the basics of the Fee for service model. They don't look at the other aspects of healthcare is funded.
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