I’m joking of course since the giant health insurance companies along with Big Pharma wrote a good piece of the law. A law which was not even supported by a majority of Americans but was forced through Congress on questionable procedural grounds. A law which has now financially addicted a good portion of the American people like it was designed to. Yep, good times for the health insurance companies.
Not the small businesses of course. That’s a different matter. But they don’t have lobbyists and friends in the White House so that’s the way it goes in Obama’s America.
And all the profits the Aetna CEO is so happy about? They are a direct transfer of wealth from the middle class via taxes to his corporation’s bottom line. Congratulations big government people. Way to embrace corporatism.
But these government-given advantages enjoyed by the health plan networks are just the icing on the cake compared to the fact that these network health plans utilize strictly defined benefits that rely on a totally separate provider contract that must be in force in order to use those “benefits” (really mostly pre-paid health maintenance plan that is heavily restricted)!
And, to make matters even more economically perverse, a non-negotiable cumbersome and expensive “claims” process is required by the payer and must be filed by the provider for each encounter used by a subscriber, no matter how minor or inexpensive. It is only after the properly documented and coded “claim” has been filed with the payer that the doctor gets paid.
Read the entire article at Fair-Healthcare Zones: No Third-Party Contracts Permitted! | Robert Nelson, MD | LinkedIn.
In fact, there isn’t a single Republican replace plan that hasn’t already been called “Obamacare lite.” And that’s before any negotiation with the other side takes place. Any repeal and replace agreement that has been negotiated with Democrats in Congress and with the White House will almost certainly be viewed with suspicious mistrust by the Republican rank and file.
Fortunately, there is a way out. In going forward, the GOP needs to make clear to its own base and to the Democrats that in any negotiation they will follow five simple rules.
So, I have little doubt that in March 2015, we will be hearing lots of stories applauding Obamacare for lowering premiums even more than indicated by these early estimates. This does not show that Obamacare is saving money: It shows that Obamacare’s insurers are getting better at attracting healthy applicants.
Indeed, the preliminary research makes it very clear that new entrants are often the low bidders. Incumbents, who have one year’s worth of Obamacare claims experience, want to shrink market share. These new, low-premium competitors have finely tuned their risk-selection techniques.
The sickest patients will continue to suffer, even worse than they did in Obamacare’s first year.
However, as long as the federal government is subsidizing insurers billions of dollars in these exchanges, it should offer some of the money for beneficiaries’ direct use, via deposits in Health Savings Accounts, Health Reimbursement Arrangements or Flexible Spending Arrangements, instead of handing it over to insurers.States have improved Medicaid with innovations such as Health Opportunity Accounts HOAs, which allow Medicaid dependents to control some Medicaid money directly. Disabled Medicaid beneficiaries have benefited tremendously from “cash and counseling,” which gives them money to hire home-health aides directly, instead of passively accepting whomever the county bureaucracy sends over.Obamacare beneficiaries should have the same power as these Medicaid beneficiaries. By all means, let’s have a copper plan, but let’s give some Obamacare cash to people, not just insurers.
ObamaCare has a lot of incentives that are supposed to improve health care delivery. Plus, it has a lot of punishments that it imposes on those who deliver health care the old-fashioned way. The incentives are failing. However, the punishments might be leading to unintended outcomes that improve medical care.One example of a failing incentive is the Accountable Care Organization ACO. The term, ACO, is now used somewhat generically for any arrangement that shifts financial risk from a third-party payer to a provider. After all, who would endorse an Unaccountable Care Organization? However, in the strict legal sense, an ACO is an arrangement between the federal government and a provider, whereby the provider assumes some of the financial risk of delivering high-quality care to Medicare beneficiaries.This is supposed to result in savings for taxpayers. The results are poor: In the first year, less than one third of physician-led ACOs saved money, and only one fifth of hospital-led ACOs did. And the first year is the year in which the low-hanging fruit should have been easy to pick: The law of mean-reversion suggests that it will become increasingly difficult to find savings in future years.Why are the results so bad?
The reason we have so many problems in health care is that almost everywhere we look, people face perverse incentives — patients, doctors, employers, employees, etc. When they respond to those incentives they do things that make costs higher, quality lower, and access to care more difficult than otherwise would have been the case.
At the root of those perverse incentives is bad public policy.
Pre-ObamaCare Distortions That Affected Important Choices
Insurance or Uninsurance? Because we were spending far more on free care for the uninsured than we were spending on subsidies for individually-purchased insurance, millions of people had an incentive to be uninsured.
Public or Private? Because we spent far more on such public programs as Medicaid and CHIP than we spent on subsidies for individually-purchased insurance, millions of people had an incentive to choose public insurance rather than private insurance.
Individual or Group? Because employer-provided insurance was generously subsidized through the tax law while individually-purchased insurance received almost no tax relief, the vast majority of people with private insurance had non-portable, employer-provided coverage.
Third-Party or Self Insurance? Because employer-provided insurance was liberally subsidized through the tax law while people’s ability to get similar subsidies for Health Savings Accounts (HSAs) was greatly restricted, people had too much of the former and too little of the latter. This in turn led to third-party payer domination of the entire medical marketplace and the elimination of real market-determined prices.
Choices in the Market for Risk Avoidance. Because normal market forces had been so completely repressed, outside the individual market real health insurance simply didn’t exist.
A better solution. Wharton school health economist Mark Pauly and his colleagues have studied the individual market in great detail and discovered that despite so much negative rhetoric in the public policy arena this is a market that worked and worked reasonably well. Despite President Obama’s repeated reference to insurance plans that cancel your coverage after you get sick, this practice has been illegal for almost 20 years and in most states it was illegal long before that. And despite repeated references to people denied coverage because of a pre-existing condition, estimates are that only 1 percent of the population has this problem persistently. (Remember: only 107,000 people enrolled in the federal government’s pre-existing condition risk pool — out of a population of more than 300 million people!) At most, Pauly puts the pre-existing condition problem at 4% of the population.
So we started with a market that was working and working well for 96 to 99 percent of those who entered it and we have completely destroyed that market — ostensibly to help the few people for whom it did not work. We suspect that after the next election members of both parties will want a major return to normalcy. How can that work?
There is a principle that must never be violated. An insurance pool should never be allowed to dump its high cost patients on another pool. Suppose an individual has been paying premiums to insurer A for many years; then he gets sick and transfers to insurer B. Is it fair to let A put all those premium checks in the bank and force B to pay all the medical bills? Of course not. But even more important, if we do that we will create all of the perverse incentives discussed above — plus many more we might have added had time permitted.