2014

Any hope of actually making health care and hence health insurance affordable is not within the Affordable Care Act and its focus on expanding insurance coverage. First, we must understand and accept that the problem is not health insurance companies, rather the problem is the health care delivery system, the costs of which are reflected in the premiums we pay.

So forget all the rhetoric about insurance companies and focus on changing the system.  Health insurance premiums are a long way from affordable in total or even to individuals with tax credits and will remain so until the system changes.

To some extent the ACA attempts desirable change with regard to Medicare through Accountable Care Organizations ACOs) and other programs designed to better coordinate care and focus providers on quality such as avoiding hospital readmission. However, to make all this work for the general population also requires a focus by patients and health care providers willing to actively participate in the changes necessary.

To date, that has never happened. Our greatest failure was the national push in the 1980s for health maintenance organizations.  That failure was driven by both patients and providers rejecting managed care and limited provider networks … like what we already see happening with elements of Obamacare.

What the authors in the article below are saying is that some form of rationing is necessary, but we should make its application fair to all Americans.

I also call your attention to these words, “if employers continue to reduce benefits and increase employee cost-sharing.” How true, once again employers are shooting themselves in the foot by undermining the financial security of their workers. They have been doing so for years with regard to pensions and now with health insurance coverage. Do employers even consider the long-term consequences of their actions? The result in many cases has been more and more federal legislation, labor unrest and eventually more costs in a different form.  In any case, back to the truth about health care.

Are you ready to accept the real changes that are necessary?

From the New England Journal of Medicine via Becker’s Hospital Review

To curb healthcare costs in the long-term, the authors said healthcare and policy leaders will be faced with two broad options: healthcare rationing or discarding the fee-for-service payment system altogether. Rationing already occurs in the U.S., as the more affluent typically receive better care because they can afford it, and further rationing could occur if employers continue to reduce benefits and increase employee cost-sharing. To avoid the unsustainability and ethical issues of rationing, a full commitment to ACOs, global budgets, care coordination and value-based services may be the most important part of any solution, the authors said. via Is Healthcare Spending Finally Under Control?.