http://www.foxbusiness.com/markets/...zon-for-2017-but-there-is-some-good-news.html Yes it is Fox Business, but what say you WF. And yes I put it in the Green room as I don't want the back and forth, I want real answers, not devils advocate and cat scratches.
Just my opinion, of course, but I am thankful for it. Without it, I would have likely had a heart attack by this point, but because I qualified for the medicaid expansion laid out under the PPACA, and because my state governor wasn't a twat waffle in this instance (Thank you, Gov. Kasich for pushing through the expansion when your GOP colleagues demanded you reject it), my doctor was able to catch the rapidly increasing warning signs before it could occur.
Well, living in TN, I feel I can comment on this with some information that's not mentioned in the article. For starters, the penalty its screaming about in the headline is what's faced by folks who have no insurance, and thus, doesn't apply to the majority of Americans. So that's a bit of fear-mongering, though it is a concerned for the uninsured. Next, you have the requests for the insurance rate hikes. They are, as the article mentions later on, just that, requests. Ideally, what should happen is that the insurance company asks for a larger hike than it needs, knowing that its request will be turned down, and then it puts forth one that seems more "reasonable." (Standard practice in all negotiations, so not a slam on the folks in this instance.) Where it gets tricky, and I don't have any answers to this, are in the states which have gone with expanded Medicare coverage. TN did not despite the Republican governor wanting to do so. The Republican controlled statehouse voted against expanding Medicare coverage in TN. This means that the insurance companies have a much freer hand in the state to do as they please. Not surprising, seeing as how insurance is one of the largest industries in the state. (Not country music or tourism, those are lower down in the list, below religious publishing.) So, TN is a less regulated insurance market than many other states, which means that we're probably going to get hit with higher insurance costs, the same way the US pays for higher drug costs than other countries, since we don't regulate the prices of drugs, while other countries do. How it all shakes out, is going to vary on a state-by-state basis, and we won't have even the faintest idea of the final results until after the election. (Yay!) I am reasonably certain, however, that no matter who wins in November, we're going to see big changes to all of this shortly after the new President is sworn in.
Okay, quite a bit in that article, I think I can break it in to four essential themes: More/better coverage Concern about rate increases Penalty escalation Pool attrition I don't think there is much to say about the first item. It reflects actual current and historic data, and it's hard to see how more people covered with better quality products could be seen as anything but good. Regarding the other three, they are a bit more speculative, though certainly something to monitor. We have some experience with rate setting in massachusetts going back several years, even preceding Romney Care. Generally speaking, the story is the same every year -- extremely large increases requested by the providers, much lower increases when the rate negotiation is complete. I suspect that is how it will go under ACA, too, but only time will tell. Penalty escalation, as I understand it, actually is somewhat predictable in terms of understanding how it is to be calculated. What is less known, is how this will impact behavior. as the penalty increases, will more people conclude that it's worthwhile to buy coverage? That's the idea behind escalation -- make not having insurance a less appealing option. Viewed through that lens, it's possible that the penalty needs to escalate more aggressively, which brings us to the last theme. The concern is that unsustainably high premium rates of increase, combined with a relatively less punitive penalty (compare the rate to the premium, the ratio might move to favor the penalty) will cause healthy subscribers to drop or reduce coverage. If this happens, coverage becomes more and more focused on more expensive, low health subscribers. This in turn leads to higher rates, and we get a vicious cycle. This is why I think the penalty needs to increase more quickly for ACA to work. The only way to keep the rates from growing too quickly involves spreading the risk across healthy patients. If such low cost subscribers continue to buy coverage, the per subscriber cost of treatment will go down, and the rates can thereby remain reasonable. So a higher penalty might help to establish a virtuous cycle, one that results in greater enrollment, lower rates, and more for the success portion of the story. Of course, all of this more rosy scenario requires that consumers behave in a way that makes economic sense. I don't think we can count on this. Any solution requires that almost everybody has insurance. A system that depends on leverage won't necessarily do the trick, which is why I favor single payer. It actually covers everybody, thereby establishing the needed risk pool to control rates. But we can't have the simple and obvious solutions in this country, for reasons easily demonstrated by most threads in the Red Room.
The individual mandate is what really pisses me off about it, combined with the fine for it increasing exponentially. It's ridiculous, and frankly the law completely misses the point of what the problem was to begin with. Instead it looked at the problem of people being unable to afford health care they need and for some daft reason assumed that this was about the lack of insurance rather than just the absurd costs themselves. And every year it adds to this problem.
Regarding rate increases: Healthcare spending is far lower than expected both before and immediately after the ACA was passed. Every year someone writes some paranoid doggerel claiming the end is nigh and the Obamacare rate increases will eat us all, yet overall medical costs are running 10% below projections at the time of the ACA passing, with the gap only widening over time. By the end of the decade total national medical costs will be over half-a-trillion dollars less per year than either the Pre-ACA baseline or the projections at the time the ACA was passed. That's the equivalent of about a 7% pay raise for each American household. I'll take that kind of rate hike any day, thank you very much.
Health care costs have increased since the ACA was enacted, but not at the rate that was previously forecast. This is a good thing. What standards? The cost that has increased most noticeably to those that already had insurance is the preponderance of high deductible insurance plans through their employers. This is shifting the lion's share of health care costs directly to consumers and is lowering their standards about when they seek care. This may be encouraged by the ACA, but I think it was happening anyway. Millions more can afford insurance that previously couldn't. And millions can get insurance now that previously couldn't due to preexisting conditions. Tens of thousands and their families are being saved from bankruptcy due to medical conditions that previously would have maxed-out insurance plans (yearly and lifetime maximums). High deductible healthcare insurance is shifting the buying decision from doctors to consumers and exerting a downward pressure on health care costs, but I'm not sure this is a good thing. What has disappeared is cheap insurance that really didn't protect you from major healthcare costs bankrupting individuals and their families. I would prefer a single payer system that would simplify processing claims and exert maximum pressure on costs without burdening consumers with the decision of treating illness like they would buying a car. This could still be private insurance, but regulated by the government. This is the system in France and I don't know how many other 1st world countries. Having lived in France for half a decade in the 90s, having children there (ok I participated), I can attest to its simplicity and comprehensive coverage while providing world-class care at affordable costs. Yeah the medical facilities looked tired but the staff and equipment were top notch and no one was worried about health coverage.
France does not have a single payer system. IIRC France has 3 different reimbursement funds depending on your age and exact illness, and the reimbursements are only 70%, with exception. The patient still pays for everything up front, which is not what happens in a single-payer system. France also has private insurance, which is the exact opposite of single-payer. I'm not knocking France's healthcare, I'm just describing their system. France and America have different demographic dynamics, economies, and global obligations, and cannot operate identically. What works in America won't necessarily work in France, and vise versa. IMO what would work best for America is a taxpayer-funded Health Savings Account given to you along with your birth certificate and Social Security Number when you're born.
It has gone through some changes, but the structure is basically the same as it was in the 90s. You're correct it pays 70% with exceptions today. Private insurance is available to cover the balance. The 3 companies are, I think, regional. Liberally copied from wiki: The entire population must pay compulsory health insurance. The insurers are non-profit agencies that annually participate in negotiations with the state regarding the overall funding of health care in France. There are three main funds, the largest of which covers 84% of the population and the other two a further 12%. A premium is deducted from all employees' pay automatically. The 2001 Social Security Funding Act, set the rates for health insurance covering the statutory health care plan at 5.25% on earned income, capital and winnings from gambling and at 3.95% on benefits (pensions and allowances).[5] The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "close to best overall health care" in the world.[1] In 2011, France spent 11.6% of GDP on health care, or US$4,086 per capita,[2] a figure much higher than the average spent by countries in Europe but less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.[3] Most general physicians are in private practice but draw their income from the public insurance funds. These funds, unlike their German counterparts, have never gained self-management responsibility. Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded).[1] The French government generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until 2000, coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place universal health coverage and extended the coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and dental care (35.9%) (Figures from the year 2000). There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals. The national pension plan is also quite nice.
