Recently, 3 Republican senators put forward the latest plan under the “alternative to Obamacare” banner. As any health care plan is ridiculously complex, it is good to have clear summary of the main points. I think I have found one, here:
“My sense is that voters will end up liking parts of both Republican and Democratic ideas. They might ask a reasonable question: Why can’t we take the best from both sides?“
Latest piece by Elizabeth Rosenthal in the NYT. Subject: the out-of-pocket costs that are increasingly becoming a part of insurance plans, especially those under the ACA. The theory behind these costs – charging more to the patient at the point of care – is that this “skin in the game” will force patients to become more savvy consumers, searching out lower prices and getting on that care that they NEED, and maybe not go into clinic every time they get the sniffles. Whether this is a good strategy to hold down costs long-term is under study; what is clear, is that these extra charges hurt!
“It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills…But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.”
And here is a good quantification (with nice visuals) of those same out-of-pocket costs for patients on ACA exchange plans. They don’t talk about monthly premiums here, and one of the goals to having patients pay so much out of pocket is that at least the monthly cost will be less…but, at least looking at OOP costs alone, the difference is clear:
“So it’s not surprising that out-of-pocket payments, also called cost-sharing charges, are higher for lower-cost plans. It is surprising just how high those payments are, even for middle-tier exchange plans, and also how high they are compared with the average plans that workers get through their companies.”
Why does Medicare reimburse more for hospital tests than office tests? And is it a good thing that this is driving docs out of private practice and into the large health systems, if it means higher prices to patients?
“But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.”
A Vox.com primer on All-payer Rate Setting, a government regulation idea that would set prices for specific medical procedures, rather than leaving them up to insurers and health systems to negotiate. The potential to hold down medical costs through efficiency gains is great, but is it too close to a Single Payer (“government health care”) for America to swallow?
“A system with so many prices can be inefficient: each time a patient comes in for an appointment, a billing clerk has to look up what rate his or her insurance company ought to be charged. All those billing clerks’ salaries become part of the country’s $2.7 trillion health care system.”
Pharma spending on advertising to physicians has been in the news recently, after John Oliver did a segment about this on his show. You can find a link to that in this Vox.com article here:
hat tip to Josh Briscoe