Posted on 03/16/2017 11:33:21 AM PDT by Kaslin
Republican proponents of the Americans Health Care Act are navigating a minefield with attacks from both the left and right. A CBO report claims 24 million people could lose coverage over 10 years, while a complete ACA repeal would only cause something like 23 million to drop out. The difference of opinion has to do with where you stand on the goal of health reform and the purpose of health coverage.
How much should a healthy person’s health insurance premiums reflect the cost of another person’s poor health status? Stated another way, how much should society invest in care for the sickest individuals? Moreover, should society invest in primary care or inpatient care?
This is a bigger question than most people realize. Currently, 20 percent of the U.S. population accounts for 80 percent of all medical spending. It gets worse: the sickest 10 percent account for two-thirds of medical spending; 5 percent accounts for half of spending while the sickest 1 percent accounts for nearly one-quarter. In other words, if you want your premiums to fall by two-thirds just kick the least healthy 10 percent off your health plan. By contrast, the healthiest 50 percent of the population has few if any medical bills during a given year. You want them in your health plan.
What should be the role of health coverage in our society? Some believe health coverage should function as insurance to manage unforeseen health risks. If you’re old and sick, you pay more; if you’re young and healthy, you pay less. Others believe the healthy and sick should all pay the same (high) premium so sick people get medical care at a bargain. Sometimes this is done through socialized national health systems, like those found in Britain and Canada. National health systems use a hefty dose of progressive taxation to fund health care. Obamacare was an attempt to achieve some of the goals of socialized medicine but through private insurance. To understand Obamacare it helps to compare and contrast health systems around the world.
Bargain Basement Health Care. Under the national health system (NHS) political model, everyone is guaranteed access to primary care, but typically less emphasis is placed on the sickest patients and access to care can depend on where you live. The British NHS makes access to primary care easy, but access to specialized care is more problematic. Patients in need of surgeries or other procedures often face long waits for care. Some of the regional British health authorities run out of lifesaving medications for cancer before the year is out. This practice of saving money by skimping on high priced medications is called the post code lottery by the British. Conditions are similar in Canada: primary care is easy to get, but there are waiting lists for many diagnostic tests and specialist consultations. The queues vary in length depending on the province in which you reside.
That is a common characteristic of national health systems: medicine becomes a political tool to maximize votes. Rational politicians want to spread public resources as broadly as possible. This suggests politicians should give the healthiest 80 percent of the population easy access to primary care, rather than expend too many resources on the sickest 5 percent — who consume half of medical expenditures. Many of the healthiest 80 percent of citizens probably vote; the sickest 5 or 10 percent may be too sick to vote.
Sky is the Limit Health Care. The polar opposite in a health care system is where the public is expected to pay for most of their primary care out of pocket — and then shell out thousands more to underwrite the extremely costly people with dread diseases. Under this model, no care should be withheld no matter how small the probability of improvement; no cost is too much for society to refuse.
Obamacare took us farther in the direction of the sky is the limit. The Affordable Care Act (ACA) banned both annual and lifetime caps on benefits, which removed any limits on what the sickest patients could demand from their fellow Americans. Specialty drugs that cost $1,500 per month and orphan drugs that run $160,000 per year are both examples of extremely costly medicine.
The ACA is failing because it allows anyone to sign up for coverage regardless of health status. Yet enrollees with poor health pay the same premiums as healthier people. This means healthy people have to pay far more than they would otherwise pay if premiums were based on their expected health risk alone. Healthy folks don’t generally like paying premiums that are the size of car payments when they only anticipate seeing a doctor once during the year. That’s why there’s an individual mandate. Without a mandate, healthy folks would drop coverage, destabilizing the insurance pool. Premiums would rise for all who remain until a fresh round of semi-healthy dropouts drove premiums even higher.
The problems facing bargain basement socialized medicine and sky is the limit Obamacare is that with either of these two extremes people aren’t allowed to make any choices about their preferences. Rather, preferences were made for people at a cost of hundreds per month. The sooner we realize that the better we will be financially.
Ultimately it is Government Takeover of Health Care
They just need to add Comprehensive to the title, that will sell it.
Comprehensive American Health Care Act
CAHCA
They keep calling it “care”; it is not care. Care is provided by hospitals, clinics, etc. This is insurance that may or not be accepted by a healthcare provider.
Votes.
Anything in the same arena will be heading in the same direction.
It all needs to be chloroformed and placed into a 4,000 degree incinerator.
Control. Plain and simple.
Control. Plain and simple.
^^^^^^^^^^^^^^^^^^^^^^^^^
Indeed, Ryancare seeks to preserve all those federal agencies and their access to your medical records to retain control of all healthcare.
Control healthcare, control the people.
https://www.nytimes.com/2017/03/16/us/politics/health-care-repeal-affordable-care-act.html
House Budget Committee Endorses Health Care Repeal Bill
In the article it notes the WH and Ryan are working to include modifications to quell disquiet.
A measure discussed is to accelerate Medicaid expansion cuts earlier than 2020. Such a change would not run afoul the Senate Parliamentarian, which in the end is the only unavoidable obstacle.
Dont confuse “health care” with “Health Insurance company premiums”. Health care is found at the ER if you need it . Health insurance premiums are just a thing you buy — like a car— or a vacation or an Iphone or $100 a month internet service. The Constitution does NOT allow any of that to be taken at gun point from one set of people and handed to other people, FOR FREE or with checks from the IRS!! That is COMMUNISM!!
Nothing in the excerpt about reducing the cost of healthcare.
The twofold purpose is to 1: keep health insurance companies flush in exchange for the contributions they make to the various pols. 2: Have a giant overwhelming entitlement with which politicians can justfiy their usefulness and thus justify the voters voting for them.
Or by a doctor and as Dr. Marc Siegel of Fox News said: “What good does health insurance do if you don’t have a doctor that will see you?”
The purpose is control!
It is to embed the federal government so deeply into the control and rape of its citizens that the citizens have no choice but to go along.
Federal government control of healthcare epitomizes the worst in Administrative State. Federal government control of healthcare sets up it's own economic structure within our government. It is ILLEGAL!
Here is the current structure under ObamaCARE
Here is the new defined structure under RinoCARE
A neighbor down the road has that ACA thing - closest doctor/clinic that would take it is in Idaho. I live in the Seattle area. The clinics in my area either are not taking new patients (hang on to the one you have) or not taking Medicare or any state/federal insurance.
To keep on allowing the collusion between the insurance industry and medical industry in price fixkng, monopolies, and trust activities that are illegal but remain unprosecuted.
Probably for a reason.
Healthy folks don’t generally like paying premiums that are the size of car payments
Even the ones that get it don’t really get it. Try the size of house payments, not car payments. Until hubby turned 65 in January our health insurance premiums were $1400 per month. That’s more than our house payment was. We recently paid the house off thank God.
Though no one appears to want to comment on the article itself, it’s actually a good summary of the two ends of the spectrum.
One thing I think the House should consider is allowing insurance companies to restore maximum lifetime caps on a health condition to their policies. That could bring down premiums considerably.
Congress could still specify a bare minimum, say a lifetime cap of $250,000 per condition, and then allow individuals to price policies that increased the cap, but the minimum offered would be $250,000. If I had the means and wanted to purchase a $500,000 cap, I’d be able to do so, and the insurance company could charge me for the privilege.
The other place I think the House bill should be changed concerns that 30%, one-time, penalty for signing up after going uninsured for a time. The initial enrollment period (grace period) should be a one-time event. If I don’t sign up during the grace period, I should bear the entire risk of going uninsured, not just the threat of a 30% penalty. I’d save the money I’d normally be spending on premiums, but bear the risk of major health expenditure, as it should be. That would also put downward pressure on premiums because if they were too high, people would tend to pass on insurance.
The problem now, is too many people are likely to pass anyway, figuring that a 30% one-year penalty isn’t that onerous, especially if they’re fairly young and unlikely to become sick. Those that finally do sign up will probably already be sick and then you’ve got the adverse selection process underway. In fact, that could happen from the very start, which would make the premiums excessive, as with Obamacare. I’ve seen little or no discussion along these lines, which sort of surprises me.
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