United States Health Care Reform: Progress to Date and Next Steps
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I have seen many patients lose their doctors because the doctors were not contracted with Covered California. The reason the doctors do not contract with Covered California is because at face value the plan appears to be just like the usual say PPO plan. But in fact it pays about 33% less than medicare (in other words, no different than Medi-Cal.
These are only some of the financial problems created by Obamacare. The problem with the government effectively taking over Health IT by way of forcing Electronic Health Records to abide by bureaucrats definitions for "meaningful use" is a completely different disaster that has resulted in marked decreases in productivity and worse care for patients.
Giant Hospital systems are taking over individual and group practices and turning them into corporate mills with little to no autonomy for physicians and terrible care for patients. All the while greedily taking in government and private dollars.
This is crony capitalism at its very worst.
Monthly premiums for my wife and I are ~$700/month (both healthy, early 30s, Blue Cross Blue Shield). When our daughter arrives shortly, that will increase to $1000/month. That's a high deductible plan where we're out of pocket for everything for the first $6000/year.
I work remotely, so we're looking at moving to Central America (Panama or Belize, wherever its cheaper to dock a 40' catamaran); if you live outside the US more than 330 days/year, you're not obligated to carry insurance. I can obtain expat insurance, that covers my entire family in every country in the world except the US, for $3000/year. $9000/year after-tax savings is nothing to sneeze at.
The ACA was a sham; it measures the insured rate, not the ability of citizens to receive the care they need. On that metric, its failing terribly. But health insurance companies are doing well at least.
EDIT: I have no problem with universal healthcare. I believe greatly in it. I despise that the federal government didn't eliminate health insurance companies entirely and move to single payer through Medicare.
http://www.commonwealthfund.org/publications/issue-briefs/20...
Its important to note that the backstop payments those insurers were to receive from the federal government are being tied up by Congress, to stick a wrench in the ACA.
http://www.thefiscaltimes.com/2015/12/17/Congress-Weakens-Ob...
The elephant in the room is: How do we spend less on healthcare for everyone when so many people have vested interests in the status quo? Change must come from the outside, and must be applied with force.
As the US population ages, more and more people will be on Medicare [1]. This increases its power, and removes almost entirely the likelihood it would be scaled back.
We will eventually have no choice but to move to single payer, as the cracks in the current model (dictated by the ACA) are already forming.
[1] https://www.census.gov/prod/2014pubs/p25-1140.pdf (warning: pdf)
Can you elaborate on this? Not because I think you're wrong, but because I haven't been able to find any data one way or the other about health outcomes and the ACA.
It mandates everyone buys insurance meeting minimum standards.
> Does it matter if you buy insurance if your deductible is $6000 and you never seek medical help until its too late (because you can't afford the copay(s))?
By definition, with "too late" as part of the premise, no; but more meaningfully, it definitely makes a difference if you buy a high-deductible plan and only use it to cover catastrophic costs.
(Of course, to meet the minimum standards under the ACA, plans must cover certain, mostly preventive, services at no cost to the covered individual, regardless of what co-pay and/or deductible they have for other services, so that also makes a difference.)
Medicare isn't single payer. Its actually very similar to the ACA exchange system, only with a public option alongside private options (all of which must offer at least as much coverage as the public option, and which are partially publicly subsidized for people choosing them instead of the public option.)
(And, in the case of prescription drugs, with a big hole in the public option, for which, if you want coverage, you either have to reject the public option or purchase a publicly-subsized private plan to cover that hole on top of the public plan.)
Medicare was a single payer system, back before most of the people posting on HN were alive.
See, I can anecdote too.
Like the report said, there's still progress to be made.
The rate of increase in per-capita costs has decreased under the ACA. So, while it perhaps hasn't yet solved the problem, its certainly hard to argue that its been thing worse than the system in place before it was adopted.
The most recent recession ended the same year the ACA was passed, the annual average cost growth rates, for private insurance and both major public programs, after the ACA are lower than the 5 year period containing that recession and the passage of the ACA, and even moreso lower than the 5 year period before that (during which there was no "huge recession".) [0]
[0] Figure 4 in TFA.
The uninsured rate has decreased from 16% to 9%, so there are now a significant more number of people insured that were not before.
And in response to the parent, are there problems with the ACA? Of course, but let's iterate on it, instead of dismissing it completely because you happen to be one of the few who doesn't benefit from it.
You could do that before ACA.
> instead of being chained to a 8-5 corporate job
What does this lifestyle choice have to do with ACA? ACA doesn't somehow give you free time or extra money. Unless you are getting your insurance for free (which was possible before ACA, mind you). ACA often does not offer the cheapest plans either...
It never was. You could always get an individual plan.
The GP said he was a cancer survivor. I've talked with several people with serious past or pre-existing conditions, including past occurrences of cancer, who could not find anyone willing to sell them an individual health insurance plan at any price prior to the ACA -- the only way they could get insurance was to be in a job where a group plan was offered.
> What does this lifestyle choice have to do with ACA?
It creates health insurance exchanges on which people can by individual insurance without being denied for pre-existing conditions, meaning they don't need to be in a job offering a group plan in order to get insurance.
> ACA often does not offer the cheapest plans either...
ACA has made it possible for people to buy individual plans who were not able to buy them, at any price, before (the rules that do that, such as the rule against pre-existing condition exclusions, are the reason for the cost increases for individual insurance for people who were insurable prior to the ACA.)
One could (and can) do this without the exchanges.
Yes, before ACA some pre-existing conditions would deny access to some policies from some insurers. This was to prevent a career smoker at age 75 from signing up for a new very large policy, and immediately get the benefits they haven't paid for.
We didn't need all of the baggage that came with ACA to accomplish this.
> meaning they don't need to be in a job offering a group plan in order to get insurance
> ACA has made it possible for people to buy individual plans who were not able to buy them
Before ACA, you did not need to belong to a group plan to get insurance. And to that endeavor, private individual insurance policies are about the same price now as they were then...
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Meanwhile... ACA didn't touch pharmaceutical companies - the true reason healthcare is so expensive ($700 salt water IV's anyone?).
Not for `zrail: pre-ACA, insurers charged high-risk buyers like him/her much higher-than-average premiums based on their medical history. Now that's not allowed.
Not only did we not get the healthcare that we voted for, we got mandated insurance based healthcare at even higher prices, with even more bureaucracy, and huge tech boondoggles as the icing on the cake. Sold to the public as not a tax, but then justified at the Supreme Court as a tax. 5% of the population comes out ahead and everybody else behind.
The 111th congress will go down in history as the most cowardly and counter effective we will ever see. That Obama is whitewashing and patting himself on the back like this is bordering on insanity.
> Not only did we not get the healthcare that we voted for
Three of the Democratic candidates in that election campaigned on something very similar to what the ACA delivered, including both of the top two -- Clinton and Obama.
None of them campaigned on single payer, so its not surprising that what was delivered looked like what was successfully campaigned on. Inasmuch as anything can be said to be the "healthcare we voted for", the ACA is more like that than single-payer would have been.
Aside from that, do you have any suggestions for how to improve it? It sounds like you have a useful perspective.
however, I was always under the impression that Electronic Health Records would result in a meaningful improvement care and record keeping. Can you elaborate on what problems will come from this?
I don't think it competes with, just for two obvious, off-the-top-of-my-head examples, either the Indian Removal Act or the Alien and Sedition Acts.
> I have seen many patients lose their doctors because the doctors were not contracted with Covered California.
Covered California is the California state health insurance exchange, it does not contract with doctors at all. The individual health insurance plans offered by private companies on the exchange contract with doctors.
> The reason the doctors do not contract with Covered California is because at face value the plan appears to be just like the usual say PPO plan.
Covered California is not a plan, PPO or otherwise. It is the exchange on which plans are offered. A number of different plans, PPO and otherwise, are offered on the exchange.
> The problem with the government effectively taking over Health IT by way of forcing Electronic Health Records to abide by bureaucrats definitions for "meaningful use" is a completely different disaster that has resulted in marked decreases in productivity and worse care for patients.
"Meaningful use" of EHRs is voluntary; the government involvement is providing incentives for meaningful use within the Medicare and Medicaid programs, not penalties outside those programs.
(EDIT: clarification of the meaningful use comments)
Those legislation mainly affected people who weren't US citizens, though. Obamacare does, which makes it way worse for US citizens.
Prohibition or the Japanese internments(if executive orders count) are maybe a better example.
Then what about Samuel Worcester?
Certainly the Sedition Act's repression of free speech was not restricted to, nor primarily targeting, non-citizens; it principally targeted domestic dissent. (The first prosecution under that act -- or any of the Alien and Sedition Acts -- was of an opposition-party Congressman for writings critical of the administration.)
Not that "worst for American citizens" was the original claim, anyway.
11 thousand pages of new regulations can not be called reform. It is unbelievable how this new giant piece of regulation is even termed as "reform".
The reform in US healthcare could have been destroying the monopoly of AMA over supply of doctors, getting rid of complex procedures for prescription medicine, downsizing FDA and giving more flexibility to doctors to determine quality of service for day to day medical care.
I do not agree with "crony capitalism" part however. The Obama Labyrinth of Healthcare Mess is soviet style big government in action. It does not do good to pharma-companies, insurance companies, doctors or patients. All big insurance companies had to exit in few years from the government insurance exchanges.
Why not? Now, if you were complaining about someone, hypothetically, calling it "simplification", I can at least comprehend the objection, but what does the number of pages of regulation have anything to do with whether or not it can be called reform?
Reform generally means government gives up control in favor of market so people can get what they want, forcing people to buy insurance is not reform it is tyranny.
There is a good reason why US constitution is just 4 pages and not 400 thousand.
Representatives don't read and study most regulations, since regulations are issued by appointed regulatory bodies to implement legislation, not elected legislative bodies.
> Reform generally means government gives up control in favor of market so people can get what they want
No, that's what "privatization" means. Privatization can be a reform, but it is not what reform means generally.
Can't think why the Occupy movement caught on in the US.
Yeah, in my field (astronomy) that would have also merited co-authorship. But, I think standards vary wildly. In astronomy, many co-authors' contributions consist solely of commenting on nearly-finished manuscripts. Some friends in ecology think that's way too generous and would instead just acknowledge people for their comments.
Then again, they're politicians and not academics so not as big a deal.
Having studied readmission rates, I was amazed, only to be disappointed as I looked at the Y-axis.
>These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending
Has the rate of change in insurance premiums or healthcare spending actually slowed? I don't see it in any of the data presented.
"Barack Obama ... don't know the cat. Oh, he has a law degree? Hm, okay, I guess his opinion might matter then."
It would be like seeing "Guido van Rossum, Dropbox Employee".
See http://jama.jamanetwork.com/article.aspx?articleid=2533068, http://jama.jamanetwork.com/article.aspx?articleid=2533066, etc.
"Barack Obama, President of the United States of America" == "Guido van Rossum, Python's BDFL"
"Barack Obama, JD" == "Guido van Rossum, Software Engineer"
Which, I'm cool with.