Re: UPHELD!!! Obscure
Interesting responses, but for the most part driven by partial arguments, often driven by ideological perspective and personal circumstances. Sadly, public policy is not made on such parameters - unless the politics dictate it.
Just to share a few thoughts - since I have been in the health care business for some 30+ years both in payer and provider side, as well as management/consulting, and adjunct prof. - let me shed a few discussion points.
The example, regarding:
"You don't silo each customer off in isolation and then say, "okay, I will calculate you as a risk, and then you will pay enough in premium to cover whatever risk-adjusted cost over your lifetime." Well that is exactly what we do for auto insurance. Why are auto insurance premiums allowed to be risk based whereas health insurance is argued that it should be community rated?
Another example, "that is not going to work because of the super wide variation in the cost of healthcare for different people." Not true. Actuarial studies are based on certain sample sizes. Once you meet that sample size then the confidence interval becomes the issue; do you want to be 90% confident that you have correctly captured the risk of that subpopulation or 95%? At the higher level you will need a larger pool; and if you want 100% assurance then you don't take a sample, you use the entire group.
Another point of contention: the markets have failed the consumer. Wrong. There is no substitute to the efficiency and effectiveness of a truly competitive market place - the operative word being truly competitive. The markets act within the parameters set by regulators and legislators. And all participants are motivated by enhancing their "position" (monetary or otherwise) whether one is for profit or not. Political correctness will argue the non-profits care about the care they give whereas the for profits focus on their shareholders. Mostly hogwash. The non-profit systems are equally motivated to maximize their margins and further expand/grow albeit how they spend those "profits" is different from those who are for profit. And you may want to look into your 401K holdings to see if some of those for profit health care providers/payers are helping your retirement or not. The issue is not the human motivation, but rather the failure of governance by regulators and the legislators. Don't like the current winners and losers, change them through the political process so you get a better result. If you keep electing the same bozos, you will keep getting the same outcome.
The impact of ACA is going to harm businesses. This is debatable at best on various levels. Employers with less than 25 - the majority that truly create services, products and jobs - are exempt. The others by offering health care may have a healthier and more satisfied workforce hence less turnover. This has value in of itself even if it may cost the employer $3000 in tax should they opt out and have the employers go to the Exchange. Additionally, the ACA will create a huge influx of allied health workers to meet such pent-up demand with a slew of new cottage industry of navigators, assisitors, brokers etc. When you look at the big picture, it is not that simple and clear the net impact on workforce or business. As in any major public policy, there will be winners and sometimes losers. The art of bipartisan politicking in public policy is to have a Pareto Optimality - where no one is worse off than before but at least one is better off now [one can be a collective group].
Impact on individuals that currently don't have insurance. The poor will be covered by Medicaid (Medi-Cal in California). For most who are in the middle class, this will really depend on which level of approved health plan package benefit they choose (as in percent of premium, copays and deductibles). While they may now be able to afford subsidized health care, their price and income elasticity will determine which level they end up purchasing which may not necessarily encourage utilization even if access to affordable health care has been made available.
This gets technical but let me offer an example. If I have to pay $5000 per year in subsidized health insurance premiums for a family with deductibles and copays, I may have less discretionary money left to pay the actual deductibles and copays when I actually need services and use it only for catastrophic cases. But then again, the ACA is mandated to offer quite a comprehensive package of benefits based on 10 large criteria of services; it doesn't allow one to choose a less comprehensive package through the Exchange - ie, you can get it in the free market but it won't be subsidized. So why would 50 year old couples be mandated to purchase benefit packages -that also include (by mandate OB services) when they are past that stage in their life cycle - if they want the subsidy but can get it only through the Exchange offerings? Sends us back to the fairness of whether we are offering insurance packages based risk adjusted age/sex/health status and other demographics of what individuals need and will use (based on their life cycle) or what society deems we all must purchase in order to lift all others who can't afford it.
This segways nicely to the social security comment made earlier. The reference of taking social security into the stock market was not accurate. The proposal was to offer individuals, especially those at least 15 years away from retirement the option of whether they wanted their retirement investments managed by the current social security trust fund (which is not sustainable based on the continuously increased benefits offered) or for those seeking more risk/reward outcomes, to invest in other venues (stock market being one option not exclusive). Sure there was politics by the financial institutions to push for this. But in the context of this discussion, we all know that increasing number of younger aged workers are subsidizing the retirement benefits of their parents and grandparents who have paid less into the system that the benefits they are now obtaining. So the young are subsidizing the old. Well then, shouldn't the same retirees also subsidize the health insurance of the younger ones who either can't afford health care or refuse to buy them?
Tort reform and defensive medicine was mentioned. The impact of this is huge in terms of unnecessary waste, in part because we never accept that medicine is both art and science. Many are too eager to capitalize on the opportunity to sue because they don't like the law of averages that nature dictates. And we all know eager lawyers waiting to cash-in on those contingency fees with bleeding heart juries. We all end up paying for this. There is no such thing as free lunch.
I can add a few more ......... but you get the gist. The potpourri of conflicting policies is the outcome of a beautifully mangled quais pluralistic democracy of how we make public policy work. You don't like the outcome sausage, get involved and make your own kielbasa
:wink:
Now, can we tie all this to the 99 percente vs. 1 percenter debate :biggrin::tongue:
