In the comments to an earlier post it was noted by a frequent commenter that the Republican healthcare plan “largely shifts costs onto the consumer”. So does the PPACA, as this article at Bloomberg from Christopher Flavelle points out:
…cost sharing on the exchanges is still typically far higher than for the employer-based coverage that about half of Americans still have. Maybe that’s a necessary price to pay for extending government-subsidized health care. But it also means that when people complain about the high cost of care, they’re not wrong.
That seems to be the consensus view from both sides of the aisle on reducing healthcare costs in the United States. I’m skeptical. I’m unaware of any study that has ever demonstrated that people economize solely on unnecessary healthcare as higher costs fall on them. Quite to the contrary I think they skimp on both unnecessary and necessary healthcare, resulting in higher costs down the road.
The ACA, through the exchanges, relies upon market forces to cut costs. That means higher deductibles and co-pays, if one chooses silver and bronze plans. With Platinum and gold plans, deductibles are not that high. So, when people complained about the high deductibles in the ACA plans, they were really just getting a market based solution to costs. The current GOP “plan” looks to shift those costs even more.
However, the ACA is not limited to cost shifting to the consumer. It also sets limits on what insurers can charge (in the form of how much they can raise premiums and by setting the MLR). The ACA has also directly cut Medicare spending and is requiring that quality measurements must be met in order to receive payments.
In short, the ACA addresses costs through multiple mechanisms, only one of which is shifting costs onto patients, and patients have some choice in how much risk they want to assume. They also know that when they buy through an exchange they are comparing similar products. The GOP “plan” takes this away so that patients are once again buying from brokers (which costs 10-15% more) and not knowing what they are buying.
Steve