Wednesday, August 24, 2016

Healthcare Improvement Idea

I was able to retrieve Sean's ideas via my email copy.  So here we go:
"If one were drawing up a system from scratch, some form of single payer would make sense.

Since we're not doing that, we need to build on the ACA and make it better. Given cost projections have come in under budget thus far, we could afford, for instance, to address some of the problems in the individual markets whether it is subsidizing providers to increase competition in some areas (premium increases are lower in competitive areas) or increasing subsidies to citizens, which would increase the number of folks with coverage and improve the coverage they do have.

States, like Minnesota, which use a "clearinghouse" model for their exchanges, could switch to an "active purchaser" model in which the states can restrict access to the exchange to only companies that offer plans that meet their goals in addition to those that meet the minimum requirements. . For instance, MNSure plans tend to be low premium/high deductible. The problem with this is that the tax credits available under the ACA are primarily based on the premium. This means that in actuality, people pay more out of pocket here than they do in many other states which have higher premiums and lower deductibles.

We could allow younger people to buy into Medicare if they wanted, too.

We can also do some systemic things to reduce costs. Allowing Medicare to negotiate drug prices would be a major win for that program, for starters. Similarly, Medicare has been in the process of doing more competitive bidding for some supplies and tests -- that should be expanded.

Now, what would *you* do? " Sean


John said...

Sean, Reply if I messed up the fix.

John said...

A relevant comment from Sean on a previous post.

"What it really comes down to is the fact that we've decided as a society that health care isn't like grapefruit or a car. It was Ronald Reagan who signed the provision into law that an emergency room can't turn you away if you've suffered a serious injury or illness. So one way or another, we already have a "mandate" at some level that you're going to be able to get some level of care.

So the question becomes, then, how do we best organize our system to provide care to everyone?

Our current system isn't working. We spend far more and get far less than other first world countries. Conservatives would rectify this problem by doing more of what makes us different from these countries, while others would say that maybe our exceptionalism isn't working to our advantage here and we could adopt some pieces of what work other places. (For instance, European hospitals have dramatically lower rates of infections than American hospitals because they use different practices. Not only would it save us money, but it would spare us the human costs as well.) "

John said...

Your claim seems questionable... WHO Infection Fact Sheet

John said...

This is an interesting piece. Though it has me puzzled. If a government mandating that every citizen must carry health insurance is UHC... Doesn't that mean that the US now has UHC?

Forbes Universal Healthcare (UHC) vs Single Payer

John said...

From MP Obamacare / Gridlock

"UHC: If you get some free time, could you shoot me a list of your pros and cons to UHC? I'm curious to see what it makes the list and what doesn't." Todd

"Help: Hi Todd, First I need you to help me understand what you interpret as UHC. Here is an interesting piece in Forbes. (see link above)

ACA has already mandated that everyone must carry health insurance, that they will be fined if they don't, subsidizes the premiums for lower income folks (tay payer funded), made health insurance plans visible and expanded Medicaid (tax payer paid for health insurance) in many states.

What are you thinking above that?"G2A

Anonymous said...

The problem with the let a thousand flowers bloom approach is that the markets aren't unequal. We have a mindset that all states are equal, maybe because they have the same number of senators. But they are not. Some are large, others small, still others barely exist at all, and are mostly what in Britain used to be called "pocket boroughs". These marginal states aren't able to sustain competitive market places because they are just too small.


Sean said...

Once again, John is poking holes in everyone else's ideas without offering any of his own.

I'm talking specific policies. How about you join the party? If you think the ACA is so terrible, then tell me *specifically* how you could do it better!

John said...

I don't think ACA is terrible. I think it has pros/cons.

I think Single Payer is terrible.

So with ACA do we have Universal Healthcare? (ie per Forbes article)

Sean said...

No, the ACA is not universal healthcare. Our mandate is nothing like, say, Germany's where people are automatically enrolled into a public health insurance plan unless they qualify to opt-out to a private insurance plan.

But again, you've ducked the central question: what specifically would you do differently?

John said...

You won't like my answer... As I have said before.

What I want are systems that encourage people to:

- Have only the children they can afford and not until they are mature enough to raise them well with a spouse/life partner.

- Learn while they are in school/ young so they can support themselves and enjoy life as adults.

- being self reliant, hard working, collaborative and self disciplined.

These are the same goals I have for my daughters, and I assume most Parents have similar wishes for their children.

Unfortunately the War on Poverty back fired and promoted the opposite of these.

John said...

That said... I would eliminate ACA and Medicare and make people rely on getting help via their own efforts or charity.

The unintended consequences of government handing out free money and services is encouraging to much of the wrong behavior. And this is damaging families and this country.

John said...

Now Joel was giving me a hard time about the government providing low cost land to those who were willing to move there, build there, risk their lives, etc. Now that was a good government incentive program. It encouraged people to work, take risks and increase the tax rolls.

These programs that encourage people to fail school, be single parents, not work, etc by reducing the negative consequences of doing so are just bad for America and it's citizens.

Sean said...

"That said... I would eliminate ACA and Medicare and make people rely on getting help via their own efforts or charity."

How are senior citizens -- especially those with serious conditions -- going to have affordable health care under your scenario?

John said...

Oops... Sorry that was supposed to be eliminate medicaid and ACA... Medicare stays however I would increase the payroll percentage with held so the trust fund does not go empty.

At least with that program, all working citizens helped fund it.

John said...

Maybe I would keep Medicaid coverage for minors. No sense punishing them for the choices of their Parents.

John said...

Sean, Sorry for not giving this more time, it was one of those weeks at work. I will give the topic some thought this weekend and try to give a more complete answer sometime in the future.

I understand that we need to take care of those who truly need help, but I still believe that policy needs to strongly encourage people to:

- Have only the children they can afford and not until they are mature enough to raise them well with a spouse/life partner.

- Learn while they are in school/ young so they can support themselves and enjoy life as adults.

- be self reliant, hard working, collaborative and self disciplined.

Sean said...

It's easy to spout platitudes, John.

John said...

It is also easy to give people money that is taken from others who work or invest to earn it... That does not mean that it is good for the country.

Now are you willing to really think about the big picture, or are you just going to keep spouting the simple short term Liberal solutions. (ie Rob Peter and Pay Paul)

The reality is that:
- some people are industrious
- some are lazy
- some are smart
- some are ok stealing
- some are self disciplined
- some are law abiding
- some are self motivated
- some required a push
- some are independent
- some think they are owed something
- some are risk takers
- some are fearful
- some have high expectations
- some have low expectations
- etc

Now for the questions...

What do we want to encourage and what do we want to discourage as a society?

If the low risk, low motivation, low expectations, etc people are given healthcare, food, housing, etc, what incentive do they have to improve and work to make America a better country?

Or to help their children to do so?

Sean said...

It's one thing to talk about values, it's quite another to translate that into policy.

You want people to "earn" their healthcare, but already in this thread you've decided we should keep Medicare and a good chunk of Medicaid and/or SCHIP (to protect children).

So let's get down to brass tacks. What specifically would you do from a policy perspective, and are you willing to swallow the negative consequences that might happen?

John said...

What negative consequences do you envision?

Do you have no faith in Americans to care for their neighbors via charity?

Sean said...

"Do you have no faith in Americans to care for their neighbors via charity?"

These programs only exist because charity wasn't getting the job done.

John said...

That is an interesting claim, not sure if it is correct.

The question is what are people standing on American soil entitled to if they are reluctant to learn, conform, work, etc?

It is just as likely that Liberals believed these people are entitled to food, housing, medical care, etc, where as the charities believed that these folks had to change / improve to earn the help.

So do individual citizens have a responsibility to learn, conform and work to earn their keep and help our country be successful?

Or can people just live a minimalistic life paid for by the Americans who do choose to learn, conform and work?

Do we expect them to only have the children that they are able to afford and are responsible / capable enough to raise effectively?

Or is it fine for citizens to have more children than they can afford and/or raise effectively? Thus causing a burden on America and the other tax payers...

Sean said...

Blah, blah, blah. Give me some policy.

John said...

We have a problem that I am trying to think through.

Like a lion who has been raised in captivity, many of these people and families for generations have been raised to expect food, water and housing to be handed to them.

And as it would be cruel to release the lion into the wild without some training... Somehow we have to ease these folks back into being independent, self sufficient, etc...

This is taking some thought.

jerrye92002 said...

First, let us talk about "fixing" the ACA. The first thing that has to happen is to repeal all of the coverage mandates that are driving up costs for everybody. Second is to repeal the individual mandate requiring people to pay money to NOT have health insurance. Third is to eliminate the corporate mandate that is putting people out of work or on reduced hours rather than giving them health insurance, and returning that to a matter of contract between employer and employee. Without the coverage mandates, many more employers could afford to offer it. Eliminate almost everything else in the ACA, including subsidies for insurance companies that participate in the market, subsidies for individuals to buy health insurance, the IRS and every other bureaucracy in those 2200 pages. What is left? We could have a federal exchange in which every health insurance company could participate, with whatever offering(s)they chose, and consumers could choose based on their desired coverage and what they could afford. Or better yet,the government could provide an antitrust exemption so that private enterprise could set up and operate such an exchange, some of which operate already.

Beyond that it is possible to have more people covered and to bring health care costs down by about 50%, to where Americans would get better care for the same average price as the rest of the world. When that happens, more people will be able to afford healthcare. We should do that.

John said...

Sorry, I think the individual mandate is required...

Too many people choose to not pay for insurance and instead rely on the generosity of our tender society when they get sick or hurt. And the policies do need to be adequate to prevent the future costs from being incurred on our society. Just like we do with auto insurance.

By the way, before ACA healthcare costs were increasing too fast... I don't see your recommendation cutting it in half. KFF Health Costs

AON Cost Analysis

John said...

By the way, an update on my premiums. Since I am under the care of a Doctor and have yearly checkups, the wellness program approved the medical waiver and I will keep my lower premiums this year.

I am still going to work to improve my LDL, Sugars and Triglycerides before next June's checkup.

I am 50, 6' 0", and currently weigh ~210... And my Grandfather dropped dead at ~65 of a heart attack while playing in a Big Band here in the cities sometime in the 1980's. So hopefully through a better diet and keeping busy I can work my way back under 200...

$3,000 per year is a pretty good incentive to eat more salads and say no to seconds...

jerrye92002 said...

Sorry, the individual mandate is not required. You should not force people to buy something they don't want and can't afford, and people have to be responsible for themselves. Self-insurance is perfectly acceptable. Make health care cheaper rather than more expensive, and allow insurers to offer low-cost insurance plans like HSAs or catastrophic-only or high-deductible or bare-bones, and many more people will be covered than you now have. Besides, some 90% of us already had health insurance and of those who didn't, the vast majority (111% of them) had already chosen other options.

The first step in bettering our HC system is getting rid of Obamacare. That would be an improvement, right there. THEN we can talk about how easily the rest of the "system" can be fixed, and (hint) it isn't government-run UHC.

John said...

Sorry, unless we are willing to let people "die in the streets"... We will end up paying for the irresponsible folks if there is no mandate.

Maybe we can allow people to opt out if they have a large enough net worth.

The system was failing to keep healthcare affordable and available to the masses before ACA. I hope you have better ideas than just discontinue ACA.

jerrye92002 said...

Really? People were dying in the streets before ACA, and it suddenly stopped? WHERE are all the newspaper accounts of this miracle? All I know was that emergency rooms were required by law to treat anybody that showed up, insurance or no, and that the ACA was supposed to end the practice of people going there for routine care. It didn't, and the number of people doing so actually increased. Therefore, get rid of ACA and that problem gets better.

Before ACA, my company provided a very good health insurance benefit which, at one point, offered an optional plan at HALF the cost. I took it and it was great-- higher quality than the previous. One year into Obamacare we get a letter that says, basically, "our plans do not meet Obamacare standards and those that do cost too much. We'll be sending you $100/month and you can buy your own." So, get rid of the ACA and I would be better off, along with a lot of other people.

Before the ACA, a lot of young people-- the "young invincibles"- chose to forgo health insurance as an unnecessary cost, or they bought low-cost plans that suited them. Now they can't buy the low-cost plan and to do without, they have to pay "taxes" to the IRS for the privilege of doing without. So, get rid of the ACA and THOSE folks are better off.

My friend worked for a health insurance company that had been in business for over 100 years. Their plans were not approved under the ACA, and the company folded, putting thousands of people out of work and leaving tens of thousands without health insurance. So, without ACA, more people would have insurance.

And we already know that many people have been cut back to 29 hours/week to avoid the corporate mandate, or that some companies have refused to hire the 51st employee or ANY employee. So, without ACA the economy would be better.

You want a "better idea" because "the system was failing before ACA"? I point out it is failing worse AFTER ACA, and therefore killing that miscegenation is a good start. After that, we can tackle those things that CAUSED the "system" to "fail" (your word, not mine, and only for a tiny fraction of the population) before.