NPR's Julie Rovner has done an excellent job covering the Affordable Care Act to the point where I would wager she knows more about the ACA than many members of Congress. The amount of coverage dedicated to explaining the ACA has been helpful to those affected by the law, but it goes to show how complex the law is.
And does it need to be this complex? Listening to Morning Edition this morning, I heard David Greene asking listener questions to Ms. Rovner about the ACA. The interview can be heard here:
http://www.npr.org/blogs/health/2013/11/11/243987330/self-employed-and-with-lots-of-questions-about-health-care
Questions came from small business owners who are often caught between a subsidy and a higher priced plan. I couldn't help but think as I was listening to the answers: Does it need to be this hard?
How messed up is our health care system that instead of focusing on improving the cost of care or the quality of the services we are putting all of our effort into the financial intermediaries between us and the providers of the services?
If the cost of health care services (not insurance) was lower to begin with there would be less of a need for insurance companies to play such a significant role in the process. So how can we get the cost of care down?
The President and proponents of the ACA have paid some attention to the cost of care but have instead focused most of their efforts on getting people into insurance plans - public or private, which has increased the role of insurance companies without putting enough pressure on the cost of services. I suppose the President wants to worry about that later.
What are the possible ways of reducing the cost of care?
1. Federal laws dictating prices for each procedure at the provider level
2. Federal laws dictating reimbursements at the reimbursement level
3. Reduction in demand from the consumer level
4. Voluntary proactive demand for price reduction from consumers
5. Voluntary proactive demand for price reduction from insurers
It would be too difficult at this time to get back to a time when health insurance was only used for catastrophic purposes. We could get there eventually. What I would propose first would be much simpler. We should stop subsidizing health care providers with tax dollars and no health care plan should receive favorable tax treatment. Getting rid of favorable tax treatment would eliminate the incentive for employees to request plans from their employers. Insurance plans would then have to compete on a private marketplace in the same way car insurance plans do.
Over time the competitive insurance marketplace would help to keep the cost of services down. At that point we could explore making plans more catastrophic with high deductible health savings accounts paying for less expensive services.
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The goal of the ACA appears to be getting people into insurance plans by accepting most of the current system as non-negotiable. To get people into plans the government is pointing a gun at insurers saying they must offer a minimum plan that doesn't max out and one where they cannot turn down applicants for pre-existing conditions. There is a gun to the head of the states to expand medicaid to cover the poor. There is a gun to the head of consumers to buy insurance or else pay a tax. There is a gun to the head of the taxpayer saying they must subsidize plans for those making too much for medicaid.
The administration has decided that health care is too necessary, health insurance is too expensive, and not enough of the population have access to it. Hmmm this is starting to sound like the necessity of public education, something which was at one time totally privatized. When having an educated population became a national priority public schools were created. Hmmmm...............
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