It misses a big problem with the ACA. If you earn less than the 133% minimum and are a citizen you cannot buy insurance on the exchange and thereby qualify for a premium subsidy and reduced deductible. You have to either use Medicaid or buy commercial insurance. However resident aliens who earn less than the 133% minimum can buy insurance on the exchange and qualify for a premium subsidy and reduced deductible.
Ideally, you want the well off to be underinsured and the poor overinsured. The former creates a cash market for medicine which gives insurers (or Medicare) market data. The latter keeps poor people from clogging up the emergency rooms or doing without needed care.
The old system of employer provided medicine had a backward incentive in this regard. Tax-freeness is more valuable for those with high salaries. A professional corporation with a bunch of engineers or lawyers saves on taxes by buying super insurance. A McFoodproduct chain has no such incentive.
ObamaCare fixes some of these problems and creates some new ones. It is needlessly complex. I have proposed some progressive-compatible fixes here: http://www.financeandfreedom.org/smallBusiness/obamaCare.php
The proposal is simpler than either ObamaCare or what preceded it, and it targets more government largesse to the poor than the old system. Unlike Medicare for all, it preserves a many-to-many market for medicine.
I strongly object to the panel that implies Heritagecare was the same as ACA and what Massachusetts enacted. They had the mandate in common but otherwise these plans were very different. Heritagecare was mean, almost evil and deserves absolutely no credit. I wish the cartoonist had actually put some effort into researching that part. Here’s a blogpost pointing out major difference:
http://www.lawyersgunsmoneyblog.com/2013/12/the-aca-v-the-heritage-plan-a-comparison-in-chart-form
I also object to calling the Massachusetts healthcare law “Romneycare”. Romney vetoed the law and it only passed because it had a veto proof majority in the state legislature. Romney’s actual plan was more like Heritagecare, which as we can see from the link above was a very different beast.
Please don’t give Romney and Heritage undeserved credit for major Democratic achievements The moderate Republicans in the Massachusetts legislature do deserve accolade but not Romney, ever.
Oy, if only more people lived close to Canada, knew and talked to Canadians, this persistent lie wouldn’t be so easy for regressives to repeat.
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After having no insurance for most of my life, I signed up for Obamacare. I am lucky to be in Kentucky. My choices for a silver plan were one national company and our (drum roll) non-profit state insurance co-op. After subsidies, my bill would have been $392 a month with the well-known company, or $88 with the non-profit. You can guess what I selected. What that tells me is that the vast majority of our premiums is profit for the insurance companies.
I think the idea of expanding Medicare to all is the best idea we have. It doesn’t cover everything, as a stack of medical bills for my husband’s recent hospitalization attests, but at least we won’t lose the house.
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How about some sort of a National Health Service paid for from a National Insurance contribution? Its a crazy idea, but it might just work.
Of course, the UK Gov is desperately trying to swap us over to the terrible, cruel and horrible US system; but then, what do you expect from a bunch of Eaton Psychopaths.
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So the Romney/Heritage plan was intended to eliminate employer-provided healthcare and medicaid, and roll everyone into one big federal healthcare system?
Interesting, but I’m not seeing how this fits the broader right wing narrative. Seems to me it makes it even more obvious that Obamacare is an ugly compromise to placate the entrenched private insurance industry, and that Heritagecare would have been more left-wing than Obamacare…
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I’m actually a bit disappointed that the cartoon doesn’t point out that there’s a fundamental problem with trying to use insurance to pay for healthcare: it doesn’t work.
Insurance is a mechanism for hedging against contingent uncertain loss. Healthcare has all kinds of economic properties that make it fundamentally unsuitable for insurance:
- It’s not uncertain – everyone will need some.
- It’s not contingent – need for treatment is often forseeable and caused by deliberate action, so there are moral hazard issues. (Furthermore, a lot of the need for treatment is caused by products sold by massively profitable corporations.)
- It has massive information asymmetry – the doctors know a lot more about medical science than the person expected to buy the insurance, or the person at the insurance company approving the treatment for that matter.
- There’s huge uncertainty – read Ben Goldacre’s stuff for an idea of how little we actually know about effectiveness of many interventions.
- Appraisal is problematic – what do you do about people who genetically will need constant medical care for their entire lives? If you have a car or a house like that, you just declare it a lemon and trash it, but that’s generally seen as an unacceptable option with human beings.
- There’s an agency dilemma – the person who has the most power to decide treatment is neither the person paying for it nor the person buying the insurance.
- There’s a “too big to fail” problem, in that generally a nation will be unwilling to watch people die if a major insurance company goes bust. (Watching people die because they’re poor and uninsured is, for some reason, viewed completely differently.)
And that’s before you even get into the laundry list of problems that insurance adds to the situation, like the fact that it’s more profitable to deny treatment, that it increases costs, and so on.
So yeah, even if you’re not an economist, you don’t need to listen to many economics podcasts before you pick up the general principles and start to realize that insurance just can’t solve the problem of providing healthcare.
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And then there’s my case, where my premiums really did go up for identical coverage (actually, slightly worse coverage – the deductible went from $5K to $6.5K). The premiums, though? More than double. According to the insurer, this is because the company’s credit rating can no longer be taken into account, and ours was pretty damned good.
Oh, and the kicker – I’m Canadian living in the US, so I know exactly how good it can be.
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Did you bother reading the whole post or how did you so fundamentally misunderstand it?
I mean, where on earth did you read that Heritagecare would provide universal healthcare? On the contrary it would have reduced health care coverage by reducing incentives for employers to provide healthcare to employees and then provide nothing to compensate ordinary people with. It’s actually worse than nothing, for it would have gutted Medicaid leaving the poor and disabled well and truly shafted. Medicare (available mainly to over-65) would be converted to a voucher system, which would then have been squeezed for resources over time. Then on top of all this they would have slashed regulations, making it easier for insurance companies to screw customers. The mandate would then force most people to pay for insurance anyway, without being reasonably sure it will pay out when they fall sick.
The whole purpose of the Heritagecare plan was to reduce government spending by simply kicking people off the system while at the same time saving businesses money. From the viewpoint of ordinary people there’s very little benign because the burden shifts onto them instead.
From the Heritage foundation:
Developed in detail in a new monograph, A National Health System for America, the Heritage plan aims at achieving four related objectives: All citizens should be guaranteed universal access to affordable health care. […]
You can argue that it wouldn’t have worked, but it seems pretty clear that their intention was to eliminate employer-provided insurance, introduce an individual mandate just like Obamacare, and continue government help for “those who cannot afford protection” via a “reformed” replacement for Medicaid.
I really enjoyed this info until the end where the author made it clear that they’ve never worked in the healthcare industry. If everyone just took Medicare and Medicaid, the system would go bankrupt in a day. My spouse has a specialty treatment (that’s effective!) but requires a one hour individual session. Medicare reimburses $15. That doesn’t even cover overhead, let alone salary. If not for others within the practice that balance with treatments that can charge more, these patients wouldn’t get the care they need. This is why many health practitioners are refusing to take Medicare, going completely pay-out-of-pocket, or just quitting the business.
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Sorry, I should have been clearer about what I meant by universal health access. Specifically I’m objecting to your claim that Heritagecare would “roll everyone into one big federal healthcare system” and that it would be more left wing than ACA. How so, when Heritagecare is preserving and extending private insurance while reducing direct government aid? You can see two cherished conservative principles at work; smaller government and individual responsibility. So less government spending and less regulations, setting minimal insurance standards lower than in ACA and leaving individuals more vulnerable to abuse. Just because Heritage would expand private coverage doesn’t mean it would do so in a way that would lead to better health outcomes than ACA (or be more left wing).
If the Medicare reimbursement rate is $15 then they clearly do not consider it an hour long procedure. Medicare doesn’t pick their reimbursement rates out of a hat, they’re based on a negotiation between providers and insurance companies.
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Re-read the Dr’s last sentence. Citation badly needed.
Well, they call their thing a system, and it’s at federal level. You apparently disagree because it involves private insurance still. Which is fine, but it’s a semantic argument and not one I’m particularly interested in. The key feature is that they intended far more people to be in a single marketplace, rather than the Obamacare solution of group plans continuing as is and a second market for individual plans being set up.
It’s more left wing in some senses, because it removes healthcare from corporate employer control. It’s also similar to Obamacare in the key areas of having an individual mandate, and being based on the flawed idea that insurance is a workable way to handle regular healthcare.
The primary difference is the elimination of employer-provided insurance, whereas Obamacare was more timid and didn’t want to rock the boat by doing anything that radical. So Obamacare still looks like a watered-down Heritagecare to me. But hey, it’s a value judgement.
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I agree that they don’t pick their reimbursement rates out of a hat, but when Medicare reimburses at less than half the rate of insurance companies (which still don’t reimburse enough) it makes me question the financial soundness of the system as a whole. I’m sure some MBA decided that this particular treatment falls under a class of treatments that can be co-treated, i.e. multiple people receiving treatment at the same time. Unfortunately, due to the privacy concerns of this particular treatment, that’s not true. So, the reimbursement rate is terrible.
Really, it just draws attention to the fact that they system as a whole is broken, as the author nicely pointed out, and that reimbursements don’t often align properly with the effectiveness or style of treatment provided.
Medicare reimbursing at half of the rate of some other companies might well be a symptom of our bloated and inefficient healthcare system. Like a hospital that charges $50 for two aspirin normally, but insurance companies pay only $10 while Medicare pays only $5.
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This is what I don’t get; companies hate having their employees dependent on them for healthcare, because it’s bloody expensive for them. It’s why they’re always trying to screw us over on it (or at least that’s what they say - presumably having a captive workforce balances that out a bit)
So why aren’t they pushing for a national health service where they could just contribute a fixed amount per employee, and employees would also contribute?
Those parasitic insurance companies are something like 20-30% of the cost, too, so get rid of them and there’s a big saving for everyone.
I don’t get this obsession over having a choice of supplier - one is plenty if they’re good.
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The citizens of the red states are the ones that need the ACA the most. They love it and so do small business owners in those states. This, of course, does not sit well with red state politicians - but at this point, there’s not a god damn thing they can do about it. To repeal it now would piss off the very people that vote for them.
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