Healthcare going forward

[Stardreamer]

The "ACA" is not the same thing as the Marketplace. The ACA is a healthcare reform bill whose purpose was to reform healthcare delivery. Insurance plans are just the most visible part that the public sees.

The Marketplace has two components - Medicaid and Private Insurance.

The Private Insurance part of the marketplace offers individual plans to people who don't have a group plan through their employer and who don't qualify for Medicaid. That's about 12,216,000 people ending Jan-2016 - up from 8 million in 2013.

There's another 7 million people who gained coverage via Medicaid.

Something that is insuring 19 million people isn't "failing".

The issue in the individual market is the affordability of plans, the cost of subsidies and the number of insurance companies that are participating outside urban markets. Each of issues those can be fixed. If the individual market doesn't get fixed, then expect the "public option" (aka "Medicare for all") to be back on the table for discussion.

The one factor that is really at the root of the problem- and it nothing to do with the ACA- is the cost of healthcare. That includes the exorbitant prices for medications, the inherent problems of fee-for-service healthcare and the ridiculous price structure that charges more to people who don't have insurance. That's going to be much harder to fix.

I would agree completely with your analysis. The problem we have now is the current administration does not want to fix any of this because they want the system to fail. Their approach going forward is for the healthcare system to suffer massive failures that they can blame on the ACA and force Democrats to come running to them to accept their fix. So we can assume the present administration will do nothing to address the problems. This is the reason why I think that to actually work towards fixing the problems we first have to figure out how to keep it from getting worse at the hands of an actively hostile administration.

 

[rareboy]

The one thing to bear in mind though is that mid-terms are a-comin' round the bend.

Congress members aren't likely going to get away with talk about letting ACA fail from voters who are now protected by it.

Based on the town halls over the last few months, reps are going to be under some pressure to make it seem like they are committed to fixing the system.

 

[Stardreamer]

The one thing to bear in mind though is that mid-terms are a-comin' round the bend.

Congress members aren't likely going to get away with talk about letting ACA fail from voters who are now protected by it.

Based on the town halls over the last few months, reps are going to be under some pressure to make it seem like they are committed to fixing the system.

That is another thing to add to the list, the Republicans taking a pounding in the mid-terms will clearly send a message.

 

[Benvolio]

The "ACA" is not the same thing as the Marketplace. The ACA is a healthcare reform bill whose purpose was to reform healthcare delivery. Insurance plans are just the most visible part that the public sees.

The Marketplace has two components - Medicaid and Private Insurance.

The Private Insurance part of the marketplace offers individual plans to people who don't have a group plan through their employer and who don't qualify for Medicaid. That's about 12,216,000 people ending Jan-2016 - up from 8 million in 2013.

There's another 7 million people who gained coverage via Medicaid.

Something that is insuring 19 million people isn't "failing".

The issue in the individual market is the affordability of plans, the cost of subsidies and the number of insurance companies that are participating outside urban markets. Each of issues those can be fixed. If the individual market doesn't get fixed, then expect the "public option" (aka "Medicare for all") to be back on the table for discussion.

The one factor that is really at the root of the problem- and it nothing to do with the ACA- is the cost of healthcare. That includes the exorbitant prices for medications, the inherent problems of fee-for-service healthcare and the ridiculous price structure that charges more to people who don't have insurance. That's going to be much harder to fix.

Medicare for all ignores that Medicare isn't free. A monthly fee is subtracted from the social security payment. Most then pay for a supplemental police to pay the 20% not paid by Medicare. Most uninsured cannot be forced to pay those premiums.

 

[KaraBulut]

I would agree completely with your analysis. The problem we have now is the current administration does not want to fix any of this because they want the system to fail.

Notice a particular sentence in my previous post:

If the individual market doesn't get fixed, then expect the "public option" (aka "Medicare for all") to be back on the table for discussion.

It's not just the extreme right that wants to see the individual market fail; it's also the extreme left.

That is another thing to add to the list, the Republicans taking a pounding in the mid-terms will clearly send a message.

And it puts both houses at the federal level back in Democratic hands with a President who claims that he "likes to do deals".

Medicare for all ignores that Medicare isn't free. A monthly fee is subtracted from the social security payment. Most then pay for a supplemental police to pay the 20% not paid by Medicare. Most uninsured cannot be forced to pay those premiums.

Your first statement is accurate. The rest is not.

The Medicare system is an entitlement funded through payroll deductions. The employer pays 1.45% of taxable gross. The employee pays 1.45% on taxable gross up to $200,000 in earnings (an additional 0.9% kicks in for the employee for earnings over $200,000).

In addition, there is a small copayment that Medicare beneficiaries pay.

For traditional Medicare, the overhead costs are lower than any commercial insurance. Medicare pays a fixed rate which allows the provider a modest profit.

The proposal that is being discussed is to have the funds that are being paid to commercial insurance companies as monthly premiums be instead sent to the federal treasury. So, those under 65 years old who opt into "the public option" would be paying a monthly premium similar to what Marketplace individual plans charge today.

The combined program would also have significant leverage to negotiate for pharmaceutical prices.

 

[TX-Beau]

...Your first statement is accurate. The rest is not....

Well, I think his first sentence is incoherent, and I also think that Health Insurance for some ignores the fact that Insurance Company profits are killing people who need help.

Ben does not care about this since the right has defined "uninsured" with all the code words for brown.

 

[KaraBulut]

Well, I think his first sentence is incoherent, and I also think that Health Insurance for some ignores the fact that Insurance Company profits are killing people who need help.

There's a couple of interesting things that don't get discussed much. The margin for insurance companies is usually in the range of 3.3% to 5%. That's very conservative compared to other sectors of US publicly-owned companies. The ACA also mandates that they can only spend 20% of premiums toward administrative (i.e. non-claim) costs. Most of their CEOs are not on the list of highest paid executives in the US.

On the other hand, insurance companies make a lot of money off of their investment portfolios.

Compare the insurance company profits to other sectors- particularly the wholesale and retail pharmaceutical industry:
https://blogs-images.forbes.com/theapothecary/files/2014/06/8.6aDATA.jpg

 

[Stardreamer]

Nancy Pelosi has sent a letter around the Democratic Caucus asking for ideas for reforming and improving healthcare. This is in response to growing noises from Republicans that the a Republican only Repeal and Replace bill through reconciliation is simply not possible and the real path forward is a bipartisan bill that can pass with 60 votes in the senate. The basic critera Democrats are asking for:
- Lower premiums/costs
- Coverage for everyone
- Higher quality
- No defunding Planned Parenthood provisions

 

[TX-Beau]

Nancy Pelosi has sent a letter around the Democratic Caucus asking for ideas for reforming and improving healthcare. This is in response to growing noises from Republicans that the a Republican only Repeal and Replace bill through reconciliation is simply not possible and the real path forward is a bipartisan bill that can pass with 60 votes in the senate. The basic critera Democrats are asking for:
- Lower premiums/costs
- Coverage for everyone
- Higher quality
- No defunding Planned Parenthood provisions

Anything looking like that will never get to the House floor, because Ryan won't let it.

 

[Kulindahr]

There's a couple of interesting things that don't get discussed much. The margin for insurance companies is usually in the range of 3.3% to 5%. That's very conservative compared to other sectors of US publicly-owned companies. The ACA also mandates that they can only spend 20% of premiums toward administrative (i.e. non-claim) costs. Most of their CEOs are not on the list of highest paid executives in the US.

On the other hand, insurance companies make a lot of money off of their investment portfolios.

Compare the insurance company profits to other sectors- particularly the wholesale and retail pharmaceutical industry:
https://blogs-images.forbes.com/theapothecary/files/2014/06/8.6aDATA.jpg

20% for administrative seems ridiculously high. I can't find current figures, but last I knew my private insurance administrative costs were in single digits, not double. Of course it's not-for-profit, so they probably don't spend as much paying bureaucrats to find reasons not to pay, but I can't see how a for-profit company is spending more than twice as much on administration as a not-for-profit.

 

[Kulindahr]

Nancy Pelosi has sent a letter around the Democratic Caucus asking for ideas for reforming and improving healthcare. This is in response to growing noises from Republicans that the a Republican only Repeal and Replace bill through reconciliation is simply not possible and the real path forward is a bipartisan bill that can pass with 60 votes in the senate. The basic critera Democrats are asking for:
- Lower premiums/costs
- Coverage for everyone
- Higher quality
- No defunding Planned Parenthood provisions

They ought to include provisions for increasing the supply of doctors, or nothing that gets done will serve to cut medical costs.

 

[Stardreamer]

They ought to include provisions for increasing the supply of doctors, or nothing that gets done will serve to cut medical costs.

That would have to be part of the details under the lower costs part, this is just the high-level criteria.

 

[Benvolio]

Nancy Pelosi has sent a letter around the Democratic Caucus asking for ideas for reforming and improving healthcare. This is in response to growing noises from Republicans that the a Republican only Repeal and Replace bill through reconciliation is simply not possible and the real path forward is a bipartisan bill that can pass with 60 votes in the senate. The basic critera Democrats are asking for:
- Lower premiums/costs
- Coverage for everyone
- Higher quality
- No defunding Planned Parenthood provisions

Some people cannot and many will not, unless forced, pay premiums, so coverage for everyone necessarily means socialism, so called single payer. Republicans cannot agree with that. Lower premiums can only be achieved by government, taxpayer subsidies.

 

[TX-Beau]

Some people cannot and many will not, unless forced, pay premiums, so coverage for everyone necessarily means socialism, so called single payer. Republicans cannot agree with that. Lower premiums can only be achieved by government, taxpayer subsidies.

What bullshit, everyone in the developed world has single payer, EVERYONE!

 

[Stardreamer]

Some people cannot and many will not, unless forced, pay premiums, so coverage for everyone necessarily means socialism, so called single payer. Republicans cannot agree with that. Lower premiums can only be achieved by government, taxpayer subsidies.

Oh boo hoo hoo hoo somebody in need might actually get help it is so unfair.

I hate to inform you but a little socialism is part and parcel of modern societies, particularly those that claim to be Christian ones. It is why it is called a society.

Why should the rest of us suffer with the higher premiums and health costs that results from the uninsured just so you can feel good that nobody is getting a handout?

 

[Kabluey]

Some people cannot and many will not, unless forced, pay premiums, so coverage for everyone necessarily means socialism, so called single payer. Republicans cannot agree with that. Lower premiums can only be achieved by government, taxpayer subsidies.

You and your death wish for others.
Quite an appalling human being.

 

[KaraBulut]

20% for administrative seems ridiculously high. I can't find current figures, but last I knew my private insurance administrative costs were in single digits, not double. Of course it's not-for-profit, so they probably don't spend as much paying bureaucrats to find reasons not to pay, but I can't see how a for-profit company is spending more than twice as much on administration as a not-for-profit.

The rule is here.

The industry average from what I recall is about 13% to 14%. One of the insurance companies' complaints has been that their administrative costs for ACA plans have been closer to 22%.

CMS reports Medicare's administrative costs at 2%.

They ought to include provisions for increasing the supply of doctors, or nothing that gets done will serve to cut medical costs.

There's no connection between supply of physicians and costs- it's not a supply and demand issue. The cost issue in physician offices is largely fixed and it's the administrative (non-revenue producing) staff that are the largest cost burden.

For example, having 1 doctor in a neighborhood versus 20 doctors won't change the price of the physician service. The price is fixed.

In healthcare, the patient is isolated from costs unless they are paying cash. It's the insurance companies and Medicare (specifically CMS- the Centers for Medicare and Medicaid Services) that set the price for services. This is part of why Ryan's arguments about "the free market" aren't applicable to healthcare.

The reimbursement rates for paraprofessionals- nurse practitioners and physicians assistants- is lower, so increasing the supply of these practitioners would lower the overall patient's cost but in most states, these practitioners must work under the supervision of a physician, so the cost for the practice is still the same (and physicians tend to use these practitioners as an enabler to see fewer patients). Using ARNPs and PAs doesn't necessarily bring more revenue into the practice unless the physician continues to take on a full patient load (or use the time to perform procedures that only a physician can do).

 

[Kulindahr]

Oh boo hoo hoo hoo somebody in need might actually get help it is so unfair.

I hate to inform you but a little socialism is part and parcel of modern societies, particularly those that claim to be Christian ones. It is why it is called a society.

Why should the rest of us suffer with the higher premiums and health costs that results from the uninsured just so you can feel good that nobody is getting a handout?

I've been reading a history of Venice and noticed something interesting: during the heyday of the commercial republics of Europe, it was a badge of honor that republics could take care of their citizens while autocracies could not. Letting citizens rot in squalor was considered to be a mark of despotism, because despotism valued only the wealthy and powerful instead of everyone.

How did we manage to lose that sense that every citizen is a valued member of the Republic and thus worthy of being taken care of? Actually, the answer is simple: the United States threw away its Judeo-Christian heritage and embraced greed as god. Especially in the GOP -- but the Democrats are hardly immune -- the attributes once despised in despotism have been elevated to a badge of honor, and the virtues of a republic have been thrown out. The serious irony there is that it is the very party which bears the name of "Republican" which has thrown away old republican virtues, so that the wealthy no longer see any obligation to use the power they have been allowed by the republic to guide that republic into caring for all.


Just as an example, Venice had a law that when food became scarce, the wealthy were required to feed anyone who came to them. That was considered part of the essence of being a republic, that all who were citizens of the republic shared in the basic wealth of the republic. And it was seen that way because those medieval republicans understood something that today's Republicans have denied: that none of them would have had any wealth were it not for the republic in which they all stood and shared.

By that standard, the G.O.P. is not republican -- it is, in fact, anarchist.

 

[Kulindahr]

The rule is here.

The industry average from what I recall is about 13% to 14%. One of the insurance companies' complaints has been that their administrative costs for ACA plans have been closer to 22%.

CMS reports Medicare's administrative costs at 2%.

The last figures I heard for my insurance outfit were 6% and then a few years later 8% -- at which point people were insisting that something had to be done.

There's no connection between supply of physicians and costs- it's not a supply and demand issue. The cost issue in physician offices is largely fixed and it's the administrative (non-revenue producing) staff that are the largest cost burden.

For example, having 1 doctor in a neighborhood versus 20 doctors won't change the price of the physician service. The price is fixed.

In healthcare, the patient is isolated from costs unless they are paying cash. It's the insurance companies and Medicare (specifically CMS- the Centers for Medicare and Medicaid Services) that set the price for services. This is part of why Ryan's arguments about "the free market" aren't applicable to healthcare.

The reimbursement rates for paraprofessionals- nurse practitioners and physicians assistants- is lower, so increasing the supply of these practitioners would lower the overall patient's cost but in most states, these practitioners must work under the supervision of a physician, so the cost for the practice is still the same (and physicians tend to use these practitioners as an enabler to see fewer patients). Using ARNPs and PAs doesn't necessarily bring more revenue into the practice unless the physician continues to take on a full patient load (or use the time to perform procedures that only a physician can do).

The people at the local clinic as well as those at the hospital where my mom just spent a few days both told me that costs are indeed higher because of fewer doctors. One reason given was that with fewer doctors it takes more administration per doctor to handle the logistics, another that with so many patients per doctor the doctors themselves have to spend more time doing paperwork just to keep track of who they're treating.

Mathematically, it's probably a limit function, where to a certain point there's no cost difference, and then to another certain point the cost difference isn't noticeable, but eventually things shift to where the cost shoots up and becomes obvious. My guess is we're in the "not noticeable" zone, and closer to the sharp change than anyone would think.

Of course mathematics alone can't address the whole issue, since a function based on just physicians isn't going to be able to take into account the variable of other specialties emerging to handle things a physician isn't necessarily required for. OTOH, physicians can only be stretched so thin before becoming so unfamiliar with their patients that quality suffers.

 

[rareboy]

Some people cannot and many will not, unless forced, pay premiums, so coverage for everyone necessarily means socialism, so called single payer. Republicans cannot agree with that. Lower premiums can only be achieved by government, taxpayer subsidies.

Much better to continue to give the multi-national corporations taxpayer subsidies.

It is still abundantly clear that you have no clue how single payer coverage works. It isn't based on taxpayer subsidies, it is based on tax allocation that can include revenue from sales tax through to corporate income tax, as well as through personal income tax. At the end of the day, in countries with federal sales or other provincial or state sales taxes...every time someone purchases anything, they are effectively paying the premium for their health insurance. It is administratively much less costly than having multiple layers of administration handling health care billings and payments. It leads to much lower case costs, which mean that more people effectively have access to care.

And it works on the same principle as any other insurance, except that everyone is actually paying into the pool.

It is all about choices. People like you seem to have no issue with the idea that an overbloated military industrial complex will be 100% subsidized by taxes....but feel that the medical care industry is a communist plot.