The CBO Score, Patients Losing Insurance Coverage and Other Myths of This Healthcare Debate

Townhall.com ^ | March 20, 2017 | Hal Scherz

[Kaslin]

There are problems with the debate over healthcare and “reforming” it. The first is that the Progressive Left has defined the terms under which we discuss healthcare. The second is that the GOP is terrible at messaging their solutions.

Examine the CBO claim that 24 million people will lose health insurance coverage under the American Health Care Act (AHCA). The only way that people lose their coverage is if the government is giving it to them. Let this sink in. That logic may be true for the greater than 50% of healthcare already being provided through Medicare, Medicaid, CHIP, VA and Indian Healthcare. It may even be the case for the entitlements given to individuals in the form of taxpayer subsidized payments to cover private healthcare premiums through the Obamacare exchanges. However, these exchanges are collapsing and insurance companies are walking away from them. They will soon not exist.

Stating that Americans will lose their healthcare coverage is “progressive speak.” Any plan that moves people into insurance programs that are controlled by patients and not the government moves the country further away from progressive nirvana, which is a single payer system. The AHCA does not result in patients losing coverage. It provides a choice. If patients choose not to participate, it is either because they are unwilling or unable. If the latter, it should be determined if it is because of cost, and if so, then making healthcare more affordable must be the goal.

The GOP needs to reclaim the narrative from the Left. They need to articulate more effectively that government needs to be taken out of healthcare and that people need to find ways to be less dependent upon it. When the government provides healthcare, they can take it away. They have done this previously and it will only get worse. Take for example prostate cancer screening. A government agency, the United States Preventative Services Task Force, downgraded it and Medicare no longer will pay for it. Another problem is that the quality and availability of the healthcare received through Medicaid or “skinny” insurance networks, as was the case in the Obamacare exchanges, is inferior to that which patients get if they, and not the government or 3rd party payers, are making the decisions.

Defending the AHCA can be difficult because it is not perfect and it’s complicated. But contrary to Obamacare, it promotes individual freedom over government control. Watching this come together is ugly and uncomfortable, but that’s how government operates. To use a medical analogy to describe the American healthcare system, the patient is dying from cancer and needs chemotherapy, which will be difficult to take but will ultimately allow him to get stronger and live a healthy life.

Once the cancer is removed in the healthcare system, efforts must be directed at making it stronger. This can be done by removing our dependence on insurance, which will actually make healthcare more affordable, as counterintuitive as that might appear.

The best way to accomplish this is via Direct Primary Care (DPC), which is a delivery model in which a patient pays a fixed amount monthly, often as little as $50, and receives almost unlimited access to THEIR regular doctor. This fee includes services that can be provided in the office, such as basic preventative and diagnostic testing and minor emergency procedures. Services that fall outside of this are available at facilities where steep cash discounts have been pre-negotiated-- like a CT scan for $150 or an MRI for $400. Even visits to specialists are a fraction of what they would cost under an insurance model. Thus, DPC is considered “concierge care for the average Joe or Jane”.

One might ask why are we not seeing more DPC? In large part because insurance companies are threatened by this model and spend vast sums lobbying lawmakers to lump DPC in the same category as insurance. Consequently, as the current law stands, patients cannot use their Health Savings Accounts to pay for this.

The Primary Care Enhancement Act (HR365) makes the clarification that DPC is not a risk bearing entity, but a delivery model, and that HSA money should be able to be used to pay for this. Seventeen states have already passed legislation to protect DPC, but federal clarification would be a game changer. This should be strongly considered as an addition to the AHCA.

Healthcare costs are unsustainable, but healthcare is not expensive, as DPC has proven. Unless we embrace disruptive innovation to drive costs down, healthcare insurance premiums will not substantially decrease regardless of what market driven innovations are created. This may be the only opportunity to begin to effectively drive down the cost curve in healthcare and it would be a tragic mistake to let this slip away.

[alloysteel]

The trouble with the CBO scoring of the impact of ANY legislation, is that it is almost always based on a static situation, and does not take into account the dynamic shift that takes place when one set of harsh regulation is lifted, and another less repressive regimen is applied.

The Laffer curve is REAL, and the effects have never been taken into account by the CBO in determining the effects of changing tax policy, only that the Federal treasury would “lose” some N or X number of billions of revenue as compared to the maintenance of current policy.

Likewise, the REMOVAL of mandates, that REQUIRING health care insurance premiums for everybody, whether though compulsory purchase of coverage or by distribution as a welfare benefit, means that a sizable number may opt to carry no formal coverage at all, making a bet that they shall either not need the coverage, or that they have the means to pay all medical costs out-of-pocket as they go.

Now, having a card that indicates you may be eligible for benefits, is not at all the same as actual delivery of medical health care services, as there may be many exclusions, or conversely, the part of the co-payment the patient must come up with is so high that the coverage does not kick in until the patient, or the patient’s family, has spent themselves into financial ruin.

You ain’t getting out of this world alive. And in the process, you will lose everything you ever had or took for granted, be it youth, beauty, health, money, possessions, loved ones, or life itself.

So enjoy the ride, that dash on your headstone between the date you were born, and the date you passed on. Danged if I am going to worry myself about “coverage”.