I haven’t been paying much attention to the Republicans’ proposed alternative to the Affordable Care Act for any number of reasons, the most important of which is that I don’t believe that it will survive contact with the enemy. For those who are paying attention to it, are there any genuinely thoughtful analyses of it? I mean by that analyses that couldn’t have been sitting in a drawer for the last seven years and that recognize that the Affordable Care Act will need to be reformed in order to survive and that reform must be in the direction of the politically possible.
IMO whether you support or oppose the Affordable Care Act there are a couple of things you should keep in mind. First, inaction means that the ACA will cease to be operational of its own weight. It must change or die. Second, the range of viable options is actually pretty limited.
I like Megan McArdle’s take.
It’s a plan that pleases hardly anyone and is incoherent as to its purpose beyond fulfilling the “repeal and replace” promised by the GoP. I doubt it goes anywhere in its current form.
That’s one of the other reasons I’m not paying much attention to it. It’s transparently just satisfying campaign pledges without much regard to actual merit.
I suppose it’s not surprising, but you’d think the GoP would have planned a bit better. They’ve had many years to work on an alternative and it seems pretty clear they didn’t and then threw this together when they had to come up with something.
Question, does Obamacare specify what happens if there are no insurance companies in an exchange for a certain locale (i.e. Collapse). Or it never imagined a death spiral and so Trump and courts will make the rules in that case?
I have only skimmed over it. (I try to read in detail every plan.) It has not been scored by the CBO. My sense is that this is just so that they can say they put out something quickly, as Andy suggested. Will be worth reading in more detail when they revise it, after the CBO score. Laszewski’s is a good take I think w/o being too wonky.
http://thehealthcareblog.com/blog/2017/03/07/the-house-republicans-terrible-horrible-no-good-very-bad-obamacare-replacement-plan/
Steve
Nothing is going to pass until 2018. There is a war going on for control of the Democratic Party. It is not going to be settled until the next election, maybe.
In the meantime the ACA will collapse. Only then is repeal possible.
CuriousOnlooker:
The answer to both of those questions is “No”. If there are no carriers for a given state, the ACA effectively becomes inoperative there.
There could be a political question as to what to do next but, as I say, at this point doing nothing could well be the effective equivalent of repeal.
I believe that the original idea was for the “public option” to take over, i.e. that the federal government would act as carrier under those circumstances, but that was struck out of the law. That would have made the ACA single payer by degrees.
I don’t know why you are asking such a thing, Curious. As Steve had admonished us numerous times, all is financially fine with ObamaCare.
He’s got studies to prove it.
No, the solution is quite simple:
1. Force all healthcare providers (docs, hospitals, clinics, pharma) to publish their prices on line, just as Harbor Freight does.
2. Institute HSAs so that Amerikans can free themselves from insurance altogether.
3. Allow patients to spend HSA, insurance or credit funds on treatment or drugs overseas without restrictions.
This will create a free market with worldwide network of healthcare providers. No need for any other measures.
This is what Amazon would do if we left healthcare to them.
Fighting with the insurance company right now. They denied my wife’s claim because she gave then last years ins. card, when informed, NINE months later , we provided the correct acct. number, only to be told we hadn’t submitted the claim in a timely fashion, DENIED.
Blue Cross , Blue Shield, Anthem.
AVOID THEM
In that case (of collapse), Republicans have a weird incentive to do absolutely nothing — don’t spend any capital on repealing or reforming ACA except to say “i told you so”.
Democrats also have an incentive to do nothing — grandstand that they prevented “repeal”, and then sigh relief when the ACA exchanges anchor disappears.
And then the ACA’s legacy is Medicaid expansion.
IF ACA is fated to collapse on its current trajectory.
I realize that the free-market allows for voluntary value-for-value transactions, but this assumes that both parties are knowledgeable on the goods or services being traded. When one or both parties do not have enough knowledge about the goods or services, they must devise an alternate process to determine how much value (goods/services or money) to transact.
I will propose that the free-market solution will not be what any “free-market anything and everything” person envisions. I have no way of judging which doctor, hospital, imaging company, blood lab works, or almost associated with healthcare. I do not even know which tongue depressors are the best, and therefore, I do not have the foggiest idea of how to make the best choice.
I do know that the best of anything is usually the most expensive. When choosing the best healthcare, I am going to get the most expensive that I can afford. If I were a medical goods or service provider, I would price accordingly.
When choosing a healthcare good or service, the metrics of deciding which hotel I should do not apply. The best hospital may have the most patients die in surgery, but they may be operating on the most severe or on the patients about to die anyway.
For everyday healthcare, I would look for the cheapest, and I would cut out coupons to get discounts. The market based approach is going to be as miserable a failure as Obamacare.
The drug companies advertise on television, and I suspect that the best drug is the one with the most puppies, bubbles, and smiling people. For some of them, I do not have the foggiest idea of what it cures, but I want to be cured anyway.
What I would really like is a healthcare card not insurance or trying to get the best care for the cheapest. I do not want to have papers to fill out. I do not want co-pays. I want to be able to call for an appointment using my fancy new healthcare card and to get a date and time. It would be nice if there were a pharmacy I could get refills online or over the phone.
Oh wait, I do. It is my VA card. Many of my medications are generics. My neurologist is an intern, and I am on my third in about as many years. He/she/he were under one of the senior physicians. I think I get average or above average care, but for the price, I know I am not getting the best physicians in the world. Nonetheless, almost everybody is hard working and trying to provide the best care possible. Plus, they respect the veterans.
For the rest of you all, sharpen those scissors and free-up Sunday because you are going to be cutting out the healthcare discount coupons in the Sunday paper. Maybe they will bring back S&H Green Stamps. (For the youngsters, look it up.) After you fill out three books, you could get a free clock radio. (Again, look it up.)
And now, as of March first, the insured are no longer able to reach a human on the phone, but must use the automated system with Blue Cross Blue Shield, Anthem, to resolve issues, much more conveniently, in the insurers favor.
“When choosing the best healthcare, I am going to get the most expensive that I can afford.”
Hate to disappoint you, but in healthcare there is not that much correlation between most expensive and best care. The 10 most expensive hospitals in the country, the ones that charge the most, are nearly all for profit hospitals. One of them is very close to where I live. I would not let any family or friends go near the place. The occasionally, by accident as far as I can tell, sign up a really good doc. When that happens the doc leaves as soon as they can, which does help me with my recruiting.
Steve
@steve
I have no idea of how to make the comparison, and therefore, I have no idea of which hospital is better. With the free-market or some abomination labeled as such, the only thing I can use is the free-market, and according to the free-market advocates, the free-market will pay the highest price for the best goods and services.
The free-market approach assumes that everybody is equally knowledgeable to make a rational decision, and that these rational decisions will be of equal value to each participant. In addition, every participant must be able to project the consequences of today’s choices into the future consequences.
Your knowledge is enough to allow you to make those decisions, but again, I do not have enough knowledge to know whether I should believe you or not. Furthermore, my lack of knowledge prevents me from identifying people with enough subject matter expertise who could certify your credentials.
This is a problem for everything associated with the free-market. One solution is having somebody or some organization that can be trusted because the person or organization can be trusted. The FDA, FAA, health board, etc. are intended to use the trust in government as a substitute, but the free-marketeers claim that the free-market will police itself.
In an absolute or almost absolute free-market economy, it is in the best interests of the participants to become less open and more opaque, and again, few people make the rational decisions that free-marketeers assume they will make. The idea of substantially increasing the price of a good in comparison to a competitor’s equivalent goods is outside the free-market paradigm.
When there is a commercial with a guy/gal in a white lab coat with a stethoscope around his/her neck tells me smoking, snake-oil, or any other quake remedy is the best, I have no way knowing one way or the other. If it is the leading brand by sales, the free-market rational choice is the one with the most demand, or the one some people will pay the most.