Since Donald Trump’s election I’ve seen a lot of thrashing back and forth and handwringing about the Affordable Care Act. “Repeal and replace” seems to be a foregone conclusion.
My question is whether the problem is the ACA or the very idea of insurance as applied to healthcare? The cost of healthcare insurance is proportional to the cost of healthcare. There’s no way to control the cost of healthcare insurance without controlling the cost of healthcare and the cost of healthcare is presently rising at a multiple of all other costs.
Even if healthcare costs could be brought under control, to make insurance applicable to healthcare you’d need to limit what was covered to insurable risks. That’s politically impossible.
Anything subsidized by gummint, whether college tuition or health care is bound to become more and more expensive. That in addition to the 20% or more of premiums lost to insurance profit and administration right off the top. Just be glad we’re not saddled with Obamafood and Obamasex.
I would say that ACA took the political problem (of health insurance as something other than covering incurable risks) and put it on stilts.
We’ve been buying on the marketplace for three years now, no subsidy but self employed so it was supposed to be the easiest way to access the individual marketplace. Ha.
Aside from the bureaucratic nightmare that resulted when my son’s foreign birth apparently flagged our account (I was forced to prove his citizenship though it has never been clear to me why it should have been a problem for us to purchase health insurance for him with our own funds, even if he had not been a citizen) we have also seen the price inflation for lesser product each year.
On the other hand, costs for medical services and prescriptions (those that haven’t yet gone generic) are so high that virtually no one could afford them. This year I had an elective sinus procedure- outpatient surgery, took one hour. Some high tech stuff involved, which I’m sure adds cost…but I was still gobsmacked by the final price tag of $34,000. Someone in that chain (or a lot of someones up and down the chain) is making out pretty well there. Without insurance coverage, would anyone do this procedure? Would the providers have to find a way to reduce costs?
While I’m amused a lab test bills at $450 is marked paid in full when insurance pays $17.34, by and large, health care is a seller’s market and that’s not likely change. Also, in the FWIW, in the military, VA and IHS system, costs are rising even though physicians etc are on salary, competitive bids are taken on meds, malpractice is a non issue, formularies exist, etc. If there is a cost effective way out, it has not shown itself.
One of the great errors is convincing people that just because someone else is paying the bill healthcare costs less or is more affordable.
A nation which can subsidize an “Empire of Bases” (Chalmers Johnson) but cannot subsidize national health care is a nation which must reform or collapse.
Yes, and Trump has addressed this when he said 15 years of pointless war in the mideast cost enough to rebuild what Obama calls “our crumbling roads and bridges” twice over.
I’m excited about America having an American president.
I can’t think of a way to make first world health care available to most people w/o the use of insurance. Think we are stuck with it.
Steve
I think I mean something different by insurance than you do. If premiums aren’t proportional to risk, it’s not insurance. All insurance is cost-sharing but not all cost-sharing is insurance.
My intuition is that you mean a system for awarding subsidies. If that’s the case, I agree with you. To maintain a system in which everybody can get healthcare we’ll need to subsidize some people and that means we’ll need a system for doing it.
I am coming around to Frakt’s POV. I think they will probably repeal, but won’t replace if and until they think it is politically safe to do so.
http://theincidentaleconomist.com/wordpress/senator-lamar-alexander-and-endless-can-kicking-repeal/
Steve