Originally posted by Lurchy
1) for the most part, agreed, unfortunately. Some providers and economists would argue that by covering pre-existing conditions, early costs will be higher but the net will be lower medical costs down the road, less unpaid medical bills the rest of us have to make up for, higher productivity for the patient with the pre-existing condition, higher productivity for the spouse/family of the patient (less time/energy lost to caregiving), higher productivity and profits for the employers of the patient and spouse/family care giver. 60% of all bankruptcies in America are due to medical conditions, and covering pre-existing conditions will have a positive effect on reducing that number, which will ripple through the economy. Does that make up for the additional costs? Heck if I know...that's way above my pay grade.
2) The only direct cost savings in the ACA that I'm aware of medicare inflationary caps & insurers must reimburse customers if their medical reimbursement rates are under 80% of total revenues, iirc. Insurers had to return something like $1B to customers in the first year of the ACA because of this.
Medicare inflationary caps work like this: let's say that rising medicare reimbursement rates are currently capped at 1.9% annually by law (pulled that number out of arse, but prolly not too far off). The ACA caps those reimbursement rate increases at 1.8% instead, forcing insurers and providers to work together to cut costs or lose profits. That small difference may not seem like much at first, but over the next decade, with nearly every baby-boomer on some form of medicare (private or public), that small difference is going to save the taxpayers several billion dollars in direct savings. That's basically how Obama and the DFL can lol-claim the whole thing is going to save money.
Indirect cost savings:
A) preventative care
B) insurance incentivizes patients to use their primary care providers and/or clinics instead of ERs - copay = $30 vs $100 (your mileage may vary)
C) exchanges force insurers to be more competitive in pricing
Ironic cost savings:
X) Because 15 Republican states opted out of the ACA, overall ACA costs have come in under budget so far - ironically making Obama and the ACA look better.
3) Your point about negotiating from a point of strength, basically treating universal care/single payer as a tool to leverage volume discounts is exactly the reason I've been harping against the MMA since its incarnate inception. If you recall, the MMA is the law that legalized private medicare as well as made it illegal for the U.S. govt (the largest purchaser of pharmas in North America) to negotiate for discounts with the pharma industry. I'm still perplexed at the lack of opposition and the lack of demand for a recall by large portions of the public/media for that law relative to the ACA. As far as universal care/single payer goes, I'm 100% in agreement that, barring political monkey business, it saves money.
4) Pelosi and the DFL in Congress passed a version of the ACA with optional medicare for all included. That got nixed because the Repubs and some DFL in the Senate would not accept 'dat socialism'. Recall Pelosi's famous words, 'we have to wait to see what passes before we know what's in the bill'. That's what she was talking about.
I really just don't see a lower potential cost either now or in the future. Again, you are just changing the revenue stream, not slowing it or making it cheaper. If a person with a pre-existing heart condition did not have insurance in the past, he very well might have stuck the hospital with the bill and the hospital would likely be forced to squeeze those missing dollars out of the people who either do pay their bills or have insurance and depending on the location, collect funds from the government. If you give that person insurance, now the insurance company pays the bills and the additional funds are pulled from the group paying insurance which is supposed to be everyone under ACA and it is a combination of premiums paid and government money in the form of premium subsidies. I completely understand moving more people from ER care to office visits but since insurance, health care facilities are operated for a profit, any cut in billing costs will be added to another area of health care and billed accordingly.
You also might have missed my little rant about the medical costs = bankruptcy. I'm sure medical bills are often the straw that broke the camels back but if you add a monthly insurance premium to a person in financial risk and they are still required to meet their insurance deductible, I don't think you will see a measurable change in the number of bankruptcy cases. To take it a step further, if you are in that financial situation, you will likely stop paying your insurance premiums, meaning you no longer have health insurance.
To be fair, I don't have the solution either. Say you do manage to pass legislation where you do put people in large groups, able to negotiate better drug and medical care prices for that group, those savings by that group will be passed on and picked up by another group. If a hospital needs to bid a certain procedure or a drug company needs to bid their product in order to be the accepted procedure/drug/treatment for that group, they will bid the best possible price. They will also make up for that discounted price by charging other groups differently or adding prices in other areas. For profit companies are not stupid and they want to remain profitable. A grocery store might offer you a weekly special on bread but they will make up for it by increasing the price on butter, they just need to get you in the door.
Go ahead and call me a commie but if I had any faith at all in the government to be efficient in any of it's operations, I honestly think the most affordable way to control costs would be to have government run healthcare facilities. You completely remove the shell game out of medical billing/coding and hopefully eliminate administration costs. The obvious problem being that government has not shown the ability to be simple or efficient.
1) for the most part, agreed, unfortunately. Some providers and economists would argue that by covering pre-existing conditions, early costs will be higher but the net will be lower medical costs down the road, less unpaid medical bills the rest of us have to make up for, higher productivity for the patient with the pre-existing condition, higher productivity for the spouse/family of the patient (less time/energy lost to caregiving), higher productivity and profits for the employers of the patient and spouse/family care giver. 60% of all bankruptcies in America are due to medical conditions, and covering pre-existing conditions will have a positive effect on reducing that number, which will ripple through the economy. Does that make up for the additional costs? Heck if I know...that's way above my pay grade.
2) The only direct cost savings in the ACA that I'm aware of medicare inflationary caps & insurers must reimburse customers if their medical reimbursement rates are under 80% of total revenues, iirc. Insurers had to return something like $1B to customers in the first year of the ACA because of this.
Medicare inflationary caps work like this: let's say that rising medicare reimbursement rates are currently capped at 1.9% annually by law (pulled that number out of arse, but prolly not too far off). The ACA caps those reimbursement rate increases at 1.8% instead, forcing insurers and providers to work together to cut costs or lose profits. That small difference may not seem like much at first, but over the next decade, with nearly every baby-boomer on some form of medicare (private or public), that small difference is going to save the taxpayers several billion dollars in direct savings. That's basically how Obama and the DFL can lol-claim the whole thing is going to save money.
Indirect cost savings:
A) preventative care
B) insurance incentivizes patients to use their primary care providers and/or clinics instead of ERs - copay = $30 vs $100 (your mileage may vary)
C) exchanges force insurers to be more competitive in pricing
Ironic cost savings:
X) Because 15 Republican states opted out of the ACA, overall ACA costs have come in under budget so far - ironically making Obama and the ACA look better.
3) Your point about negotiating from a point of strength, basically treating universal care/single payer as a tool to leverage volume discounts is exactly the reason I've been harping against the MMA since its incarnate inception. If you recall, the MMA is the law that legalized private medicare as well as made it illegal for the U.S. govt (the largest purchaser of pharmas in North America) to negotiate for discounts with the pharma industry. I'm still perplexed at the lack of opposition and the lack of demand for a recall by large portions of the public/media for that law relative to the ACA. As far as universal care/single payer goes, I'm 100% in agreement that, barring political monkey business, it saves money.
4) Pelosi and the DFL in Congress passed a version of the ACA with optional medicare for all included. That got nixed because the Repubs and some DFL in the Senate would not accept 'dat socialism'. Recall Pelosi's famous words, 'we have to wait to see what passes before we know what's in the bill'. That's what she was talking about.
I really just don't see a lower potential cost either now or in the future. Again, you are just changing the revenue stream, not slowing it or making it cheaper. If a person with a pre-existing heart condition did not have insurance in the past, he very well might have stuck the hospital with the bill and the hospital would likely be forced to squeeze those missing dollars out of the people who either do pay their bills or have insurance and depending on the location, collect funds from the government. If you give that person insurance, now the insurance company pays the bills and the additional funds are pulled from the group paying insurance which is supposed to be everyone under ACA and it is a combination of premiums paid and government money in the form of premium subsidies. I completely understand moving more people from ER care to office visits but since insurance, health care facilities are operated for a profit, any cut in billing costs will be added to another area of health care and billed accordingly.
You also might have missed my little rant about the medical costs = bankruptcy. I'm sure medical bills are often the straw that broke the camels back but if you add a monthly insurance premium to a person in financial risk and they are still required to meet their insurance deductible, I don't think you will see a measurable change in the number of bankruptcy cases. To take it a step further, if you are in that financial situation, you will likely stop paying your insurance premiums, meaning you no longer have health insurance.
To be fair, I don't have the solution either. Say you do manage to pass legislation where you do put people in large groups, able to negotiate better drug and medical care prices for that group, those savings by that group will be passed on and picked up by another group. If a hospital needs to bid a certain procedure or a drug company needs to bid their product in order to be the accepted procedure/drug/treatment for that group, they will bid the best possible price. They will also make up for that discounted price by charging other groups differently or adding prices in other areas. For profit companies are not stupid and they want to remain profitable. A grocery store might offer you a weekly special on bread but they will make up for it by increasing the price on butter, they just need to get you in the door.
Go ahead and call me a commie but if I had any faith at all in the government to be efficient in any of it's operations, I honestly think the most affordable way to control costs would be to have government run healthcare facilities. You completely remove the shell game out of medical billing/coding and hopefully eliminate administration costs. The obvious problem being that government has not shown the ability to be simple or efficient.
Edited by Cowpoker on May 16, 2015 04:34:16
