"There is only one thing that was good and should remain regarding the PPACA; including Health Insurance Companies under the Sherman Act and other legislation regarding monopolies and price fixing. And, requiring them to disclose benefits/coverge, annual deductibe(including what will go to/apply to deductibles), total out of pocket, and, most importantly, all providers(physicians, surgeons, clinics, hospitals, medical equipment companies and so on) that have signed agreements to participate in the said insurance plan. To date, that is still nearly impossible, unless you are knowledgeable on the subject, to ascertain. The PPACA as written did nothing to lower the cost of "providing" medical care. It only has lowered medical costs as the Federal Government claims because "Exchange" policies lowered reimbursements and narrowed the available providers, including only those willing to accept substandard reimbursements for treatment. And, many of the "Exchange" policies fail to cover various high cost procedures. Plus Medicare has not increased reimbursements for treatment for almost a decade. While they claim fees have not been lowered, so what, the fees have not kept up with the cost of providing care to Medicare patients. The lower cost of health care that Obama claims is a lie. It is nothing but savings to the Federal Government due to reimbursing less, covering less and over zealous claims against physicians to recover money they claim to have overpaid. The PPACA does not do one thing to lower the cost of "providing" medical care. If fact, it has raised the cost of providing medical care due to costly regulations. It will not be much longer before private practice physicians will be forced to stop accepting Medicare and Medicaid as the reimbursements begin to equal the cost of providing care. Why expose yourself to litigation when you aren't even making a profit to treat these patients? Republicans should 1. keep the insurance reforms, minus the regulation forcing them to insure those with "costly" pre-existing conditions. And, those conditions should be listed in completely and should not include minor conditions such as allergies, high blood pressure and the like(as determined by a panel of practicing physicians from each and every specialty). And, Republicans should propose that those with costly pre-existing conditions/the uninsurable; be offered coverage under what I would title, "medicare Part E". Offering them insurance at a cost based on the overall cost of insuring the group, or putting coverage of this group out for bid. And, States should offer group plans for individuals and family's who don't have an employer group plan option available. There is no question that grouping people together, in large groups will lower the cost of premiums and is more attractive to Health Insurance Companies as it reduces their exposure and actuarially affords them a chance for profit, rather than loss. " The only group benefiting from the PPACA is the Health Insurance Companies. It has done nothing to lower the cost of providing health care. Which is much different from Obama's claim that it has lowered the Governments expenditures on health care. The expansive costly regulations provided for in the PPACA and stagnant fee reimbursements has increased the cost of providing health care.
So your solution is basically to allow insurance companies to pick and choose whom they will insure, if the individuals are not part of a large group? Belive that is exactly what the old system did. Your only change is to group all those with preexisting conditions into a single group hoping that somehow that is going to reduce the cost of insuring those with preexisting conditions. Grouping all the sick together is not going to magically reduce the cost of insuring that group. The basis of insurance is spreading the costs so that those that don't use the insurance are subsidized by those who do. That applies to health insurance, auto and homeowners insurance. The large the group the less the cost to those that don't use the insurance of covering those who do.
Those with pre-existing conditions are not all "sick". Some have costly illnesses some have disease/illness that are not costly but "may require surgery" at a future time or the cost may increase if the disease advances in the future, therefore, grouping them together under say a new part of Medicare, say Part E, can lower their overall cost of treatment. It would be managed exactly as Medicare is now managed but the insured's would pay a premium based on the cost of insuring those in the group, call it Part E. It would be administered just as Medicare Part A, B is now. but the premium set on cost of insuring them, determined by the Federal Government, not private insurance companies. And supplemental insurance for those in this group priced as Medicare Advantage companies now price their insurance. And, those currently covered by medicare have pre-existing conditions and yet their premiums are the same. Same can be true of the new Part E, but their premiums will be an average of the overall "real" cost of the Government insuring them. So, it will be the Government insuring them and paying for it from the premiums they collect. Premiums based on the average cost of insurance. It will be much cheaper for tax payers, because all uninsurable individuals will have access to lower cost insurance with causing private insurance premiums to rise. Because, it will not be private insurance companies losing money to insure them and forcing healthier individuals to pick up the cost.
If you really believe that the Government can insure people with preexisting conditions at a lower total cost than private insurance then it logically follows that the Government should be able to insure everyone at a lower cost than private insurance. That is exactly the arguement for a single payer system.
No because, it will not be private insurance companies losing money to insure them and forcing healthier individuals to pick up the cost. It will be those not eligible for Private Health Insurance due to pre-existing conditions paying premiums to the Federal government based on the Federal governments cost to insure them. And, even if the Government has to subsidize a portion of the cost, it will be far less expensive to the taxpayers. I base this on my 35+ years in Medical Administration which including Insurance, Medicare and Medicaid billing. Single payer isn't a total stupid idea, but, it would depend on the terms as to whether I would support it. For one thing, it could drastically reduce the incentive to develop new drugs and treatments, including surgical procedures. And it will only make our medical system better if it doesn't pay providers salaries so low that it discourages them to stay in practice or discourage students from enrolling in Medical Programs. And, if it doesn't length the wait times for receiving care. And, if it doesn't regulate who can receive X treatment for X illness or surgical need. Given how PPACA was written and the resulting law, I am skeptical that our Government can pass a "single payer law" that doesn't further destroy our medical care system. Just my opinion. Plus Health Insurance companies are Private Companies and legally shouldn't be forced to provide coverage to individuals they know already need costly care/surgery, perhaps for the duration of their lives. Nor should the Federal Government be allowed to "set the fees" that a Private Practice Physician can charge without determining if the fee will cover their cost of providing that care/surgery and afford them a profit based on their level of education, experience and cost of doing business in the City their practice is located in.
If the goal is to reduce total healthcare costs I really don't understand how this makes any difference. And your assumption that the government will be more effective in providing healthcare to people with preexisting conditions seems like a real stretch given the normal Conservative claim that private enterprise I always more cost effective than the government. And following your thought that private insurance should be able to pick and choose who they will insure leads to the extrapolation that private insurance companies should be able to drop people when they become sick since at that point they have a preexisting condition.
Seems like a strange response from someone that believes the Federal government should be running the entire Health Care system. And, Private Insurance companies are private businesses so why do you think they don't have the righto offer products that can provide them the profit they wish to make? Perhaps the Federal Government should limit profit for all small and corporate businesses then. i.e. you can only charge an amount for you services or goods that earns you X percent net profit during your tax year.. Legal, accounting, electrician, plumber, lawn service, grocery, gas, retail stores, every business. Wouldn't that be as fair as limiting the profit an insurance company can make on their products or that a physician can earn in payment for his services.? When you don't allow a provider of health care to charge a fee for service he deems to be fair, one that covers his overhead, reimburses him for his education, experience and anything else he wishes to base it on, as should be his right as the owner of the business, the Government is basically forcing him to refuse treatment to patients/individuals or forcing him to accept a sub-standard payment or service, one that has been proven over and over to often not even cover the cost of providing the treatment. This has forced physicians and hospitals to invest any profit they make in other businesses, some medically related, some not. As a matter of fact, many physicians I know, earn more from ancillary investments than they earn by caring for their patients. I often wonder why they continue their practice of medicine. So I ask them. The #1 answer is because they love caring for people, saving lives. So in order to keep their practices, they invest their earnings in other companies and investments that pay them enough to keep their practices open. You thoughts? And you can not reduce the cost of health care unless you reduce the cost to provide that care, not increase the operating costs through expensive/costly regulations and fees and taxes; while reducing payment for services. Or, taking away the opportunity to bill for the portion that Medicare refuses to pay for. Medicare basically is "fixing fees", something physicians legally are not allowed to do. Yes, a physician can charge any amount they want but it means nothing. Medicare has a set reimbursement rate, pays 80% of that rate and the patient can billed the remaining 20%. So I call that "fixing the amount a physician can charged". The reason physicians submit bills that they "know" are over the reimbursement rate is simply to show what they believe is a "fair charge" and what they would charge a private insurer.
No, the reason physicians and hospitals submit bill that are four to five times the Medicare reimbursement limits is because when the patient doesn't pay the inflated bill the entire amount can be deducted from income for tax purposes. And my other point is that thinking the government will do a more cost effective job on providing health insurance for people with pre existing conditions while also claiming that the government would be less cost effective in providing insurance for the total population is logically contradictory. And what makes physicians services unique from most other services is that there is no cost transparency and essentially no competition. Want to have some fun try to get a firm quote from a hospital before your next surgery.
I'm not here to fulfill somebody's wishes or fill-up somebody's bottom line. If they can't provide the services I want at the price I want to pay, I'll get them somewhere else. If that doesn't include the private insurance companies, so be it. If, within that framework, they can make a buck, more power to 'em.
I don't understand this logic. Sure maybe some people who are deemed uninsurable aren't that sick or are only a little sick, but the vast majority of those who are deemed are sick. Grouping a bunch of sick people together isn't going to reduce costs. Cost savings in medical insurance is realized when you have a large amount of healthy people in a group who can pay for the sick people's claims. Since this group would be vastly comprised of sick people the insurance premiums would be very high. This would most likely cause the group to death spiral. That's what happened to the individual market in New York state would they made all health insurance policies guarantee issue, and didn't require an individual mandate. In this situation, I'm guessing everyone in "Medicare part E" would be very sick. If someone is deemed uninsurable by a private health insurance company and they want to roll the dice and see if they can go uninsured they probably won't sign up for "Medicare part E" because the premiums would be super high. The only way the premiums would be reasonable would be if the government paid for part of the premiums, like 48% like they do in Medicare. It yeah I see that resulting in a death spiral group. Again, this is going to be a death spiral group. I don't agree with your idea in principal. This creates a system of haves and have nots. Healthy people get cheap insurance, and sick people will probably go bankrupt en masse from this plan. I believe societies function best when people don't have to worry (or maybe worry but don't panic) about getting sick. The affordable care act is far from a perfect system but it is better than the old one. Insurance companies are now in the business of taking risk, not avoiding it. That's the way it should be.
