Posts Tagged affordable care act
Here is the list:
- Pay doctors more
- Let the government pay subsidies to families not covered by the employee’s health insurance.
- Get rid of fee-for-service payments
- Smooth the transition from Medicaid to subsidized health insurance
- Transparent pricing
There are obviously some problems with this “consensus”. To begin with, who is part of the consensus? And who benefits from the 5 suggestions? On the face the ideas seem OK but where is overall cost reduction — the real crux of our health care problem?
So, to address each point:
- Pay doctors more — if the payment is not tied to reducing health care costs and increasing quality then it is money down the drain.
- Covering families — seems simple enough but why should business be exempt from doing what they have traditionally done? Employer insurance needs to cover the whole family — that’s simple.
- Get rid of fee-for-service. Yes that payment method is a problem but there must be an incentive for health care providers to provide a high volume of work and an incentive to do quality work. The simple solution is to pay a health care system (an accountable care organization) to provide care for a large group of people for a yearly fee. The organization must meet quality and budget constraints as opposed to our current “the sky is the limit” fee model.
- Smooth the the transition away from Medicaid. At this point Medicaid is less expensive than standard indemnity plans — why think about a change? If the person enters the workforce the employer just pays the cost — simple. Changing providers is not easy but if quality is uniformly better there would not be such concern.
- Transparent pricing. This is presented to suggest people could decide on what tests and treatments to buy if only they knew the prices — patients have never had the knowledge to make that decision and never will. The transparency of pricing should be the price for ALL the healthcare a person needs per year. Market forces may be helpful on the macro level (like for a healthcare system) but there is no free market for healthcare on the micro level — imagine a person being asked to choose between various methods of treating diabetes or the best way to remove an appendix (the decision is either random or biased by what the very person asking the question tells them).
The U.S. is experiencing something its citizens have not witnessed before: the transition away from population healthcare decisions being made behind closed doors at insurance companies to those decisions being made in the political arena. Other countries experience this all the time — just look at newspaper headlines in the UK or France over the past 20 years!
President Obama vs. Republican Congress. Another grudge match, the sweaty pugilists in the corners, puffs of smoke from the cigars in the front row, the referee holding the mike, saying it’s the 8th round, the clang of the bell, the jabs, the left hook, bam – a hard right to the teeth, finally the round ends with a flurry of punches under the belt. We now interrupt the show for an important announcement.
HEALTH CARE IS NOT A CONTEST. We are not in a reality show, this is real life. The consequences are life and death. Why is there an argument or a fight?
The sky-box view. Look down at the basic arguments of the two sides:
- Obama — health care is a right
- Republican congress — health care is not a right
- Both agree — health care costs too much
The punches and counter punches.
Punch: The southern US has poor health care
Counter: Not our problem, don’t fix it with our money
Punch: Insurance companies are unethical
Counter: They are just businesses trying to make a profit
Punch: Primary care is better and more efficient
Counter: The market determines what is better or more efficient
Punch: Everybody should have access to health care
Counter: Only those who have money should have access
Punch: If everybody has insurance the system would be more fair
Counter: Don’t tell me to buy insurance, I will do what I want.
Punch: Raise taxes to pay for the uninsured
Counter: We can’t afford higher taxes
Punch: We already pay enough to provide good health care for everybody
Counter: We don’t want regulations. Some of us get great health care already
Punch: U.S. health care only ranks 30th in the world
Counter: Poverty and old age are the fault of individuals, don’t count them
Punch: We need government oversight of health care quality
Counter: That’s what lawyers are for
Punch: Women need care for female health problems
Counter: What is good enough for men is good enough for women
Punch: The constitution gives the right to life, liberty and the pursuit of happiness. You can’t have any of those things without being healthy.
Counter: The Constitution says nothing about a right to health care.
Punch: All this fighting makes me forget about poor health care quality and high cost
Counter: Me too.