Avik Roy, of the conservative Manhattan Institute, has just released a new health care reform plan, with the general goal of using the best parts of the ACA to move forward, rather than sticking with the “repeal and replace” mantra:
“…the Plan uses a reformed version of the ACA’s health insurance exchanges as the basis for far-reaching entitlement reform. The Plan would repeal many of the ACA’s cost-increasing insurance mandates, including the individual mandate. But it would preserve the ACA’s guarantee that every American can purchase coverage regardless of preexisting conditions. And it would utilize the concept of using federal premium support subsidies, on a means-tested basis, to defray the cost of private health coverage.”
And responses to the plan here:
“Roy hopes his proposal, by embracing many of the goals of the left and right, could be the basis of a grand health care compromise. But it could also have the opposite effect. Because it adopts many elements of Obamacare, it would likely be untouchable for most Republicans.”
Uh-oh. There is evidence that the new pay-for-performance experiment being tried by the ACA is not resulting in the anticipated cost savings.
“The aim of the penalty and reward system was to encourage all hospitals to improve the care they deliver. That might not have happened.”
And, a similar pay-for-performance program in England seems to have failed in its objectives.
“…the reduction in mortality among patients with these conditions was greater in the control hospitals (those not participating in the program) than in the hospitals that were participating in the program”
A review of direct-to-consumer health screening companies (you know, those people doing coronary calcium scores in shopping malls and spooking people into thinking that they are at immediate risk for MI) and the resulting conflicts of interest with health care providers:
“Although medical professionals attempt to detect subclinical disease early and improve morbidity and mortality for their patient populations, hospitals also benefit financially when new patients enroll to see their physicians and have follow-up tests and treatments ordered, leading to increased financial reimbursement.”
Can clinics based out of Wal-Mart stores help to hold down health care costs?
“In-store primary clinics—versions of which you can already find at CVS, Target, and Walgreens—are one way to meet that need. These clinics rely more heavily on nurse practitioners and other non-physicians to deliver care. This is why they can ramp up quickly and address the growing need for services. This is also why the clinics can provide care for less money. “