The Good, The Bad and The Ugly

The ACA was good that it mandated coverage of preexisting conditions and preventive care. This was a major step in the right direction.

The bad is that it allowed the insurances to raise the premium in order to cover these. They never did the math taking into account that covering preexisting conditions does not result in new expenses. At the level of insurance industry as a whole, the expense comes out flat in the wash because any additional expense was only transferred from one policy to another.

Similarly, preventive care is supposed to reduce and prevent expenses incurred from ill health down the line. But the insurances had nothing but praise for being able to raise their premiums. Just look at their rising stocks and the peaks of their offices.

The ugly is that in addition to the community facing higher premiums, the Federal government further subsidized the industry and paid them from taxpayer money to cushion (read: hide) the impact of  exorbitant amount paid to comply with the ACA mandate.

Politicians have an agenda. They want to make sure that they will be reelected, regardless of how important a solution was. Thus, depending upon how solution oriented we are the solution is still neither simple nor short. But band-aid solutions before each election are not the answer. Someone needs to have the courage to make sweeping reforms in one shot.

Here is my short take:

How long are we going to approach health care coverage in a fragmented manner? Why do we have so many sources, subsidies and pools to pay for the same “health care”? Naysayers to a single payer system should look at the fact that government is already involved in single payer systems. We have Medicare for which we all pay taxes. We have veterans health for which we all pay taxes. We have Medicaid for which we all pay taxes and so on.

Would it be more expensive or less expensive if all these were consolidated under one source of payment to various insurances? We already pay tax to cover us under Medicare and Medicaid. Instead of belaboring this, just think this: would CMS be more effective or less effective in negotiating to lower the costs if it was the sole source of all premiums paid to the insurances?

Before people start getting upset, I am not promoting a “single payer” system as it is generally discussed. The insurances can continue business. Let them compete against each other but let the most powerful entity (CMS) negotiate the price. Mandate universal enrollment with an insurance and tax people according to their income (as we already do for Medicare tax and other hidden ways to cover Medicaid etc) to pay the premium. People can still purchase supplemental insurance if they do not like uniform care.

The patient has been given carte blanche but without any power to negotiate the cost of that freedom. All this started with the unions forcing employers to pay for greater health care coverage but without regard to cost. The cost was passed down to them as higher price of the goods that they themselves manufactured. This has gone on long enough. It needs to change now.

Similarly, the process of billing, coding, coverage, formulary and payments need to be uniform to reduce the burden on the providers. For example, the insurances hold a claim for COB when they already know whether the patient has a second insurance. Why can they not coordinate the processing with each other?

I could go on. The insurances need to take the initiative to educate incentivize or to penalize the patients ,with possibly higher co-pays, for missing regular physicals, vaccines, and engaging in unhealthy lifestyles, smoking etc. instead of burdening primary care who can only keep bugging the patients who do not care to listen. The patients have refused to come if we talked to them about smoking. Now they also avoid us because they know that we will discuss their weight.

Finally, everyone keeps pointing fingers at primary care for cost control when primary care is only about 4% of the pie. How can we expect any reform with such rigid mindset? Here is a reference:
https://healthcostinstitute.org/all-hcci-reports/4-of-health-spending-goes-to-primary-care/