I've said it before, we need a single payer system.
Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.)
This behavior should not be surprising. Until the American people get pissed off enough, we'll continue to have these shenanigans.
Obama said that too, once. I think most Democrats in office have said that at one point, even if they don't want to say it in public anymore. The ACA was not passed because it was better than single payer, it was just the closest thing that could possibly get through Congress.
Single payer would be ideal for most Americans, but those in power (both government and industry) seem to prefer the high deductible health plans with health savings accounts.
Unfortunately I don't see high deductible plans working for anyone unless healthcare providers and pharmacies are required to list all prices up-front. As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks).
Honest question. What chance do you think, or how would you propose we start this discussion with people who genuinely believe the market as it is now, with 'choice' is the best option for consumers?
I live in flyover country, and people legit believe that letting the market make choices is best, and single payer is a quick step to full on communism. I'm looking for positive arguments to counter that nonsense.
So obviously single payer is a system that is what most would strive for. But could it work in the US?
I am from Denmark originally where we have it and it's not without issues because suddenly you turn a profit center into a cost center which means you need to budget and you need to restrict who can get what, how much you can afford etc.
What about illegal immigration, do people who are here illegally get access too?
These are all questions that are very hard to answer IMO because the US after all is such an open society.
Let's not ignore the providers themselves. Excluding the middlemen, my wife had a bill for a lithrotripsy procedure (she was there for approximately 4 hours) of nearly $10,000, and most of that went to the hospital. That was before insurance negotiated their rate.
>>> Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.)
How is this consistent with the pre-ACA availability of high deductible, low premium PPO plans in low-regulation states?
As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go.
Millions of self-employed people and people working jobs that provided no group insurance benefits were able to take advantage of these products. I was able to insure my family of three for $330 a month at that time, and the coverage was quite good.
I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. For a country as big and diverse as the U.S., it sounds expensive and unworkable.
I would propose as an alternative a hybrid of low-regulation plans such as we had prior to ACA, plus support for those who can't even afford one of these low price plans. Free or low fee clinics for the needy, less regulatory load on hospitals and small practices, e.g. remove or delay the electronic medical record requirement, attack the causes of high malpractice insurance, stop incentivizing physicians to "turf" challenging patients off to specialists and overprescription of tests to cover their liability.
There has to be a way that works, short of a national Medicare for all that I fear would lead to great mediocrity.
On paper, none of the Star Wars movies ever made a cent of profit. On paper, Google and Facebook had not profits in America.
ACA insurance profit are loss are similar. With enough creative accounting the business could be made unprofitable to squeeze concessions from the Obama administration.
Look at all the major insurers stock price since Obamacare began. That will tell you all you need to know about this story. If you think they are making all that money because the non-ACA health insurance business suddenly got real good, I have a bridge to sell you.
The trade off that made the ACA possible was clear to everyone at the beginning: The mandate will bring the insurance companies more customers and that will help pay for the sicker customers they will have to cover. If it doesn't work out the federal government will be backstopping their losses.
Optimism around insurance stocks reflected in their stock prices was all about larger volumes making up for smaller margins and lower risk, there is no tricky misdirection going on here. That is "all you need to know about this story".
Am I misreading this, or are they forgoing profit purely out of spite? Or I guess the idea is they could make more profit in the long run if they generate enough bad publicity for the ACA. These quotes almost seem too on the nose to be real:
> “I just can’t make sense out of the Florida dec[ision],” the executive, Christopher Ciano, wrote to Jonathan Mayhew, the head of Aetna’s national exchange business. “Based on the latest run rate data . . . we are making money from the on-exchange business. Was Florida’s performance ever debated?” Mayhew told him to discuss the matter by phone, not email, “to avoid leaving a paper trail,” [the judge] found.
Aetna hoped to forego smaller profits from these exchanges to access larger profits with the acquisition of Humana. By withdrawing from those markets where Humana was competing with Aetna, Aetna could then claim that the merger would not reduce competition between insurance providers. Also, article claims that participation in ACA exchanges was privately used as a bargaining chip to pressure the DOJ into allowing the merger.
From article:
"Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger." — U.S. District Judge John D. Bates
Not quite. Based on the article, they threatened to withdraw if the DoJ did not support their proposed merger with Humana. The DoJ did not support it, so they followed through on their earlier threat. So it's not spite, but part of a negotiating tactic.
> Am I misreading this, or are they forgoing profit purely out of spite?
Not spite: it's sacrificing short-term profit to help create a political context in which they expect more favorable general policy -- the entire idea was that if the Democratic administration wouldn't give them favorable anti-trustanalysis treatment, they'd do what they could to make the ACA look like a failure, knowing it would be a major election issue. Presumably, they expected a Republic administration to be friendlier, either for ideological reasons, or gratitude, or because Aetna successfully flexing it's political muscles would have proven that they must be deferred to (or a mix of all three.)
There are 2 simple things we can do to fix health care. First, make it like public school. If you want to pay for private school, go ahead, but health care should be socialist like school and sewage. 2nd, make it illegal for the AMA to limit the number of doctors admitted to med school. Its a cartel that reduces supply.
Unfortunately, a lot of doctors believe that to become a doctor, you need to practice on real patients. I believe there is artificial reduction in the number of doctors minted each year, but I also realize there are practical limits on that number as well(ie cadavers). Fortunately, we are working on the problem with use of technology.
Not an expert but I'm pretty sure the AMA gates the number of residency seats and then the schools take the hint and gate admissions numbers independently.
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Note that both things can be true: that Aetna lost money in the individual marketplace (which would square with the experiences of other insurers in guaranteed-issue markets) and that their tolerance for loss was sharply influenced by support for their proposed merger.
"Bates found that this rationalization was largely untrue. In fact, he noted, Aetna pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations."
It could be the case, but it seems that, in at least some of the markets, it was not. They were pulling out to try to invalidate the DOJs finding that the merger would produce insufficient competition.
Even if this was true, which the article states it is not, isn't that the point of insurance? To spread the risk and cost across a geographic or demographic populace while making a reasonable, but steady profit?
It could have been but it doesn't sound like that's the case. The evidence indicates that they just wanted an anti-competitive merger enough to leave profitable, competitive markets.
That being said, I fail to understand one thing about those who propose a single payer system (and I mean this with all sincerity): If we cannot afford to pay for doctors, hospitals, and medications, how can we afford to pay for doctors, hospitals, medications, plus a bureaucracy to manage all of it?
To me, "negotiating" better deals doesn't work. As a single payer system, that's just a rephrasing of "price controls".
It seems game theory could be put to good use here, as life is effectively a single round game where many (most?) participants will spend everything they can for the game to not end (i.e. extend their lives and postpone their death). This one attribute seems destined to really challenge insurance of any kind (including single payer) given the large aging demographics in the US (aka "Baby Boomers").
> If we cannot afford to pay for doctors, hospitals, and medications, how can we afford to pay for doctors, hospitals, medications, plus a bureaucracy to manage all of it?
The same we are doing it now. Do you think the insurance companies are not bureaucracies? A regulated monopoly is the most efficient form of bureaucracy, because of efficiencies of scale.
Also, insurance companies still generate profits, profits that can directly go towards health care, instead of being used as an investment cushion or for god knows what.
Also, having every single person under 1 health care umbrella is a systematic reduction in risk, which further lowers costs.
I was pretty sure the news orgs I was following pointed this out at the time the merger was approaching its conclusion.
I'm glad a judge with access to more information that the average news consumer was able to make a judgement and reduce the uncertainty around the claims (both Aetna's and the news coverage).
I'm for universal healthcare but the ACA is collapsing in many states. I happened to ride back to Santa Fe with the CEO of Blue Cross of Omaha who told me that BC/BS of NM lost $100m on the ACA in 2015. That's a lot of money for anyone to lose. He believed there were a few relatively simple fixes that would go a long way to bring some sanity to the system. And let's face it, tax penalties are not the way to achieve health coverage for all Americans. Boo on Obama for not even bothering to try for Universal Healthcare...
> Boo on Obama for not even bothering to try for Universal Healthcare...
President Obama didn't create the ACA. Congress did. It was modeled after a system that works very well in Massachusetts and was developed by Republican, free-market think tanks.
And every Congress since has tried to sabotage it rather than fix it. Last I heard, the current Congress still doesn't have a great solution to solve the core issues. And that is after 40+ votes to dismantle it.
I think you mischaracterize the Democrats of 2009. There was a significant desire to push for "a single payer option" (a partial "universal healthcare"), but there was also severe resistance, even within the party. And Republicans largely didn't want to deal with any option the Democrats came up with.
I'm glad something was done, even if it was an imperfect law. It forced the issue to eventually be dealt with. I would have preferred that Republican Congress critters would have chosen to try and fix the law rather than sabotage it (they were largely waiting for Republican president that could get credit for fixing the flaws).
> Boo on Obama for not even bothering to try for Universal Healthcare...
You must have missed the entirety of 2009 that extensively debated the topic with Obama very much gunning for universal coverage and the GOP very much trying that no one got covered. The public option would solve much of the current issues, but was shot down by the Tea Party. Same for expanded Medicaid to cover the poor, Republican governors refused to expand.
The ACA is far from perfect, but not because Obama wanted it to cover less.
"Boo on Obama for not even bothering to try for Universal Healthcare..."
How old were you when the ACA was passed? I ask not to be snarky, but to see if you remember the huge fight that erupted over the whole thing. Go back and read some of the coverage of the time, and ask yourself if you really think that he would have had the political capital to push the public option through.
[+] [-] GiorgioG|9 years ago|reply
Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.)
This behavior should not be surprising. Until the American people get pissed off enough, we'll continue to have these shenanigans.
[+] [-] burkaman|9 years ago|reply
[+] [-] jobu|9 years ago|reply
Unfortunately I don't see high deductible plans working for anyone unless healthcare providers and pharmacies are required to list all prices up-front. As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks).
[+] [-] Loughla|9 years ago|reply
I live in flyover country, and people legit believe that letting the market make choices is best, and single payer is a quick step to full on communism. I'm looking for positive arguments to counter that nonsense.
[+] [-] ThomPete|9 years ago|reply
I am from Denmark originally where we have it and it's not without issues because suddenly you turn a profit center into a cost center which means you need to budget and you need to restrict who can get what, how much you can afford etc.
What about illegal immigration, do people who are here illegally get access too?
These are all questions that are very hard to answer IMO because the US after all is such an open society.
[+] [-] oldprogrammer2|9 years ago|reply
[+] [-] gozur88|9 years ago|reply
[+] [-] wyager|9 years ago|reply
This is a problem with overreaching intellectual property law, not with having a choice in health providers.
[+] [-] blisterpeanuts|9 years ago|reply
How is this consistent with the pre-ACA availability of high deductible, low premium PPO plans in low-regulation states?
As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go.
Millions of self-employed people and people working jobs that provided no group insurance benefits were able to take advantage of these products. I was able to insure my family of three for $330 a month at that time, and the coverage was quite good.
I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. For a country as big and diverse as the U.S., it sounds expensive and unworkable.
I would propose as an alternative a hybrid of low-regulation plans such as we had prior to ACA, plus support for those who can't even afford one of these low price plans. Free or low fee clinics for the needy, less regulatory load on hospitals and small practices, e.g. remove or delay the electronic medical record requirement, attack the causes of high malpractice insurance, stop incentivizing physicians to "turf" challenging patients off to specialists and overprescription of tests to cover their liability.
There has to be a way that works, short of a national Medicare for all that I fear would lead to great mediocrity.
[+] [-] attaboyjon|9 years ago|reply
ACA insurance profit are loss are similar. With enough creative accounting the business could be made unprofitable to squeeze concessions from the Obama administration.
Look at all the major insurers stock price since Obamacare began. That will tell you all you need to know about this story. If you think they are making all that money because the non-ACA health insurance business suddenly got real good, I have a bridge to sell you.
[+] [-] JamisonM|9 years ago|reply
Optimism around insurance stocks reflected in their stock prices was all about larger volumes making up for smaller margins and lower risk, there is no tricky misdirection going on here. That is "all you need to know about this story".
[+] [-] brutus1213|9 years ago|reply
[+] [-] unknown|9 years ago|reply
[deleted]
[+] [-] burkaman|9 years ago|reply
> “I just can’t make sense out of the Florida dec[ision],” the executive, Christopher Ciano, wrote to Jonathan Mayhew, the head of Aetna’s national exchange business. “Based on the latest run rate data . . . we are making money from the on-exchange business. Was Florida’s performance ever debated?” Mayhew told him to discuss the matter by phone, not email, “to avoid leaving a paper trail,” [the judge] found.
[+] [-] elipsey|9 years ago|reply
From article: "Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger." — U.S. District Judge John D. Bates
[+] [-] marcell|9 years ago|reply
[+] [-] dragonwriter|9 years ago|reply
Not spite: it's sacrificing short-term profit to help create a political context in which they expect more favorable general policy -- the entire idea was that if the Democratic administration wouldn't give them favorable anti-trustanalysis treatment, they'd do what they could to make the ACA look like a failure, knowing it would be a major election issue. Presumably, they expected a Republic administration to be friendlier, either for ideological reasons, or gratitude, or because Aetna successfully flexing it's political muscles would have proven that they must be deferred to (or a mix of all three.)
[+] [-] gleb|9 years ago|reply
Source - ACA author: http://www.wsj.com/articles/i-was-wrong-about-obamacare-1469... (How I Was Wrong About ObamaCare: The law’s drafters wanted consolidation)
Which why, all of a sudden, all the hospitals are buying each other, and insurance companies are buying each other.
It seems Aetna felt that the government didn't live up to its side of the bargain.
[+] [-] runamok|9 years ago|reply
[+] [-] a3n|9 years ago|reply
[+] [-] Lagged2Death|9 years ago|reply
I love how all the responses here are all "No no no, it's not spite, it's perfectly valid extortion. Well what else could they do?"
[+] [-] kapauldo|9 years ago|reply
[+] [-] micahbright|9 years ago|reply
[+] [-] avn2109|9 years ago|reply
[+] [-] AdmiralAsshat|9 years ago|reply
[+] [-] noobermin|9 years ago|reply
[+] [-] mhurron|9 years ago|reply
[+] [-] tptacek|9 years ago|reply
[+] [-] tghw|9 years ago|reply
It could be the case, but it seems that, in at least some of the markets, it was not. They were pulling out to try to invalidate the DOJs finding that the merger would produce insufficient competition.
[+] [-] azdesertbuddha|9 years ago|reply
[+] [-] badlucklottery|9 years ago|reply
[+] [-] Macsenour|9 years ago|reply
[+] [-] MR4D|9 years ago|reply
That being said, I fail to understand one thing about those who propose a single payer system (and I mean this with all sincerity): If we cannot afford to pay for doctors, hospitals, and medications, how can we afford to pay for doctors, hospitals, medications, plus a bureaucracy to manage all of it?
To me, "negotiating" better deals doesn't work. As a single payer system, that's just a rephrasing of "price controls".
It seems game theory could be put to good use here, as life is effectively a single round game where many (most?) participants will spend everything they can for the game to not end (i.e. extend their lives and postpone their death). This one attribute seems destined to really challenge insurance of any kind (including single payer) given the large aging demographics in the US (aka "Baby Boomers").
[+] [-] antisthenes|9 years ago|reply
The same we are doing it now. Do you think the insurance companies are not bureaucracies? A regulated monopoly is the most efficient form of bureaucracy, because of efficiencies of scale.
Also, insurance companies still generate profits, profits that can directly go towards health care, instead of being used as an investment cushion or for god knows what.
Also, having every single person under 1 health care umbrella is a systematic reduction in risk, which further lowers costs.
[+] [-] thephyber|9 years ago|reply
I'm glad a judge with access to more information that the average news consumer was able to make a judgement and reduce the uncertainty around the claims (both Aetna's and the news coverage).
[+] [-] mcheshier|9 years ago|reply
[+] [-] burkaman|9 years ago|reply
[+] [-] ddp|9 years ago|reply
[+] [-] thephyber|9 years ago|reply
President Obama didn't create the ACA. Congress did. It was modeled after a system that works very well in Massachusetts and was developed by Republican, free-market think tanks.
And every Congress since has tried to sabotage it rather than fix it. Last I heard, the current Congress still doesn't have a great solution to solve the core issues. And that is after 40+ votes to dismantle it.
I think you mischaracterize the Democrats of 2009. There was a significant desire to push for "a single payer option" (a partial "universal healthcare"), but there was also severe resistance, even within the party. And Republicans largely didn't want to deal with any option the Democrats came up with.
I'm glad something was done, even if it was an imperfect law. It forced the issue to eventually be dealt with. I would have preferred that Republican Congress critters would have chosen to try and fix the law rather than sabotage it (they were largely waiting for Republican president that could get credit for fixing the flaws).
[+] [-] jonknee|9 years ago|reply
You must have missed the entirety of 2009 that extensively debated the topic with Obama very much gunning for universal coverage and the GOP very much trying that no one got covered. The public option would solve much of the current issues, but was shot down by the Tea Party. Same for expanded Medicaid to cover the poor, Republican governors refused to expand.
The ACA is far from perfect, but not because Obama wanted it to cover less.
[+] [-] bojl|9 years ago|reply
He tried to include the public option but it only had 59 votes to the 60 required to pass it
[+] [-] st3v3r|9 years ago|reply
How old were you when the ACA was passed? I ask not to be snarky, but to see if you remember the huge fight that erupted over the whole thing. Go back and read some of the coverage of the time, and ask yourself if you really think that he would have had the political capital to push the public option through.
[+] [-] Steko|9 years ago|reply
And they would have broken even on Risk Corridors if it wasn't for Marco Rubio.