Repealing Obamacare

ACA is primarily insurance reform, not healthcare reform. While I understand the challenge of pre-existing conditions, it is one of the primary problems for ACA ever surviving. If someone has a known disease, it throws the whole concept of risk out of the equation. Kind of like a person buying the rental car insurance after they crash the car. Yes, it would save the consumer lots of money, but it would remove the ability of insurance to spread the risk among all people who legitimately buy the coverage. It would also result in much higher rental rates.

For this reason, if the government wishes to cover everyone, just pull pre-existing conditions out of the pool and provide them coverage separately. Then everyone else could go into separate pools and have better coverage options at lower cost.

Additionally, the system has to create incentives to do things the right way. Here is an example: I go to the pharmacy after my doctor writes for a cream for my poison ivy. The pharmacy tells me it is not on my plan, so the cost is $100. He offers that some over the counter calamine will run me $10.00. Which do you think I choose? Now if the expensive cream is covered by my plan and my co-pay is $10, which do you think I choose?

The point is that those without pre-existing conditions should all be on a high deductible plan that creates the lowest premiums. Then, allow everyone to contribute to a tax free health savings plan that builds up to cover your deductible should you have a major problem.

Additionally, you must create competition in the marketplace. Someone rightly posted earlier that the 3rd party and government payment systems are full of problems, only pay a portion of what is mysteriously charged and usually pays anywhere from 30 days to 12 months later. Yes 12 months.

Transparency in the marketplace with competition will lead to lower prices via market forces.

ACA has resulted in major cuts to Medicare, it can never keep up with population growth and longer lives and creates so many incentives to do the wrong thing it needs to be completely killed. There are other ways to skin the cat - ways that are much simpler, cost effective and beneficial to the whole country.

 

That's not an entirely fair description. Democratic hands were far from clean in the equation. They passed the law with large majorities in both houses, so to the extent that the law needed fixing, it was because they passed a crappy bill that did nothing meaningful to deal with costs. Nobody forced that on them. After that, they lied about the law to get reelected in 2012 (claimed people could keep their plans if they liked them when they knew that not to be the case) which set expectations higher than they should have been, and then weren't prepared for its implementation. Furthermore, the GOP did try to delay implementation of the law, which could have at least made the transition and website problems more manageable. They were demonized and told to screw off. I was against that maneuver, but that's beside the point. The point is that they gave Democrats a chance to avoid or at least mitigate the mess.

Once it was clear that the law had major problems, Obama did start to say he was open to changes, but I don't recall him or Democratic lawmakers offering any reforms to it or even hinting at being open to meaningful changes. And let's be honest. The differences were irreconcilable. Any GOP reform was going to mean major changes to the law (eliminating the mandate, gutting the insurance regulations, cutting back on the Medicaid expansion, etc.). Dems weren't going to go along with any of that. Dems would have called for bringing back the public option or tossing more federal money into it, and the GOP would never go along with either. We needed an election to intervene to break the logjam, and unfortunately, that gave us Trump.

 

The lack of GOP support followed a pattern of not listening to the GOP while the ACA was drafted. However, at the point that there was clearly not even a single Republican vote available, the ACA became very susceptible to lobby influence, since support of practically every Democratic vote was needed. It was not especially good legislation and I think it fair to say that the partisanship in Washington was so entrenched that no meaningful reforms were possible. Here's hoping Democrats participate actively in drafting the new healthcare act in ways that go well beyond the ievitable looking out for their big campaign contributors.

 

I doubt that the GOP would have made it less susceptible to lobby influence.

 

Engaging in Facebook political wars is almost always futile, because the overwhelming majority of the people who do it are just spouting shallow, partisan smack talk, and they love doing it. I think it makes them feel powerful and important to have other people who drink the same Kool-Aid cheering them on, and you don't get cheered on for making good points. You get cheered on for smack talking. However, if you're one of the few who actually wants to have a real discussion, you're going to get drowned out and pushed aside.

And yes, most lawyers are too busy to engage in a lot of political rhetoric online. I post a fair amount here, but I didn't do it much when I practiced and virtually never did it during the day.

 

We don't always agree, but on health policy, you're at the top of your game.

 

By the way, if anyone wonders why my signature is a persistent tribute to the greatness of NJLomghorm and Hollandtx, this thread is an example. The intellectual integrity of West Mall relies very heavily on them.

 

Aetna and Humana merger has been called off. Remember when Aetna cited poor performance of the ACA Exchanges as the reason for pulling out of all but 4 States? The presiding judge in this blocked the merger in January. It was later shown that Aetna leadership threatened the approving authorities that they'd pull out of the exchanges if the merger wasn't approved.

 

The Cigna - Anthem deal also died today. Could it be that they learned that the Trump Admin (or Sec. Tom Price) would also not support their mergers? Whatever the reason, these 2 mergers would have been very bad for healthcare consumers.

 

At the time of reporting about pulling out of the ACA, it was shown they were losing billions. They just made that up at that time?

 

Yes, they did. They were actually profitable in some markets they pulled out of per the judge. From memory, the judge was supplied email to the Justice Dept. in which they threatened to pull out of the markets if the merger wasn't approved.

 

Some details about what they did to get Obamacare rolled out are emerging

-- Aetna and Humana called off their merger which was, in large measure, necessitated by to save costs under ACA
-- Unsurprisingly, Humana also announced it will drop out of Obamacare in 2017 http://thehill.com/policy/healthcar...p-out-of-obamacare-marketplace-at-end-of-2017
-- Meanwhile the House Freedom Caucus opposes any effort to impose Obamacare Lite

Here is a decent full history, if interested https://www.nytimes.com/2017/02/14/...y-go-under-the-knife.html?partner=rss&emc=rss

 

Here is NPR's take on the next steps. http://www.npr.org/sections/health-...ign=npr&utm_term=nprnews&utm_content=20170216

I'm not particularly hopeful that unleashing the free market is a cure all. Maybe with higher deductibles and price transparency health care may start to behave like more consumer-oriented businesses. I'd be all for it. I am hopeful about state's innovating in delivery of health care to the impoverished.

I hope something creative is done to deliver health insurance to working/low income people. There should be some tier of available service/coverage that is better than fantastically expensive emergency room care, which is billed like it comes from Trump Tower. The bills may never get paid, but they crush the credit scores or poor people.

 

? Croc
Poor peop,e on Medicaid do not pay for emergency room visits. We do
People on the most subsidized obamacare plans do not pay for emergency room visits either
But you are right somehow we have to move people off of using the emergency room when clinic visits would do. After obamacare emergency room vists increased even though BO used reducing the visits to emergency room as a selling point of obamacare

 

Unleashing the free market is not the cure all, but will dramatically improve the situation by curtailing the monopolies some insurance companies have in states. More competition should improve costs and quality of plans.

A bigger need is creating a system where all citizens have incentives to use the system and related insurance properly. As well, removing many unnecessary regulations will also reduce the overall costs/

 

Being able to buy across state lines will increase competition as well.
Creating a system where all citizens have an incentive to use wisely may be impossible due to the entitlement mentality 60 years of freewheeling welfare has created.

 

Good point, but that is why there needs to be incentives and/or penalties for not using the system properly.

 

A lot of poor people don't qualify for Medicaid. They go to the emergency room and they get billed for it, whether they pay or not. You try earning $10 an hour, then paying $2,700 to have 15 stitches.

 

People can learn if you educate them and incent them. If you're playing a game where you always lose, you kind of lose interest in playing it well.

 

+1

 

By all means, tell us why.

 

And what would be wrong about withdrawing from the ACA market if the merger was not approved?

 

What monopolies exist?

 

I just don't see this getting fixed in large parts of the urban population where it's just easier to go to the ER because you know they'll figure out what to do with you there. For whatever reason, they just don't feel that way about clinics.

I'm not gonna bother posting any because we've all heard them: just google "bizzarre emergency room visit reasons" and realize why we're fighting a lost cause there unless people start getting turned away at the ER and sent to where they're supposed to be.

 

I believe there were some stats in 2016 that showed that ER visits weren't increasing but rather stayed the same. The ACA was still trying to change that. I'd agree that urban settings it's easy to go to the emergency room, especially when it may be more challenging to find an in-network doctor, schedule an appt. etc. Still, I wonder if part of that lack of improvement is the new 20 million people that now have insurance. If those people weren't going to doctors previously, what are the chance they take care of themselves now before a situation become acute?

 

ER visits have increased overall, but not by any significant amount. A big reason is the explosion of free standing, privately owned ER clinics which are a good thing in my opinion. I must say that I have no experience with them, but I do know that less serious cases should go there over the hospital ER - especially trauma centers.

Too often, the public gets lulled into extraneous issues like 26 year olds, pre-existing conditions and over utilization of ER's on an individual basis rather than looking at it in total.

They must break it down into separate utilizers, build separate risk pools off of these and push pre-existing and financially poor users in a separate Medicaid type of pool. Then everyone must be incentivized to use the system correctly by having skin in the game via HSA's. This coupled with cross state competition and transparency through published market pricing will lead to a more fair, functioning system.

 

Last year my insurance changed it's policy to pay zero if I visit an emergency room and it's not an emergency. The only exemption I believe is if it's after hours and there are no other open clinics around. I'm sure many carriers are doing the same or similar which is probably why visits are relatively flat instead of increasing.

 

Try BCBS Alabama. There are many more.

 

BCBS Alabama can prevent other carriers from competing?

 

No, but they literally own it. I am sure there are a few other small market share companies in the state, but BCBS literally refuses to pay so little or nothing for valid services simply because you have no other real choice. In some cases, they pay market in other states.

They are also dominant in Florida. Not as dominant, but dominant. They refuse to cover services provided by an equally competent clinician simply due to certification. By the way, the equally competent provider makes 50% less than the other.