Only single payer medicare for all can fix our broken for profit system. The concept has been proven in every industrialized country for over 30 yrs as we were misled by the free market advocates. This is not hard and it will cost far less than our current system. I would rather pay 5% more on income and have guranteed coverage than pay out what I now pay in out of pocket expenses. It's not a difficult concept as long as everyone is in the system. There is no way to build on the ACA as long as it protects for profit healthcare and does not control costs.
1
A single payer plan such as Medicare for the masses would be incredibly expensive. One cannot get unions to pay for their already expensive health care that is growing rapidly due to aging. Would the public like a few hundred deducted per week from their paycheck to pay for a single payer program? I think not.
Obamacare was the result of many negotiated compromises between the Obama Administration and Congressional Democrats. It was constricted by the need to avoid huge budget deficits. It was also constricted by the decision to keep and expand Medicaid for the lowest income people. Then the Supreme Court decided that each state should be free to reject Medicaid expansion -- as many Republican-dominated states have done. So what we ended up with is a flawed, though improved, health care financing system. We could fix the system, but Republicans have all committed instead to its destruction with no proposals as to its replacement.
In some ways, Obamacare perpetuates and exacerbates the quality of care for lower income people and makes it much difficult for them to figure out how and when to seek health insurance. We've created a tiered system that favors the relatively wealthy and those over 65 qualifying for Medicare, which pays providers higher rates than Medicaid and Obamacare. How can we possibly justify such a system? We have nothing better that could be enacted.
In some ways, Obamacare perpetuates and exacerbates the quality of care for lower income people and makes it much difficult for them to figure out how and when to seek health insurance. We've created a tiered system that favors the relatively wealthy and those over 65 qualifying for Medicare, which pays providers higher rates than Medicaid and Obamacare. How can we possibly justify such a system? We have nothing better that could be enacted.
2
Good ideas, Dr. Khullar. Let's defend Obamacare and make it better. We can make it better.
I do not agree with christv1 that Medicare for all is the answer. Medicare started in the 1960's when people over age 65 had no alternative. Private insurers would not sell coverage to people 65 and over. So Medicare was the answer then to people 65 and over. It is not the answer now for people under 65 where the market is full of competing insurers. The answer is not to dismantle all of that. The answer is to manage it better under the ACA/Obamacare.
I do not agree with christv1 that Medicare for all is the answer. Medicare started in the 1960's when people over age 65 had no alternative. Private insurers would not sell coverage to people 65 and over. So Medicare was the answer then to people 65 and over. It is not the answer now for people under 65 where the market is full of competing insurers. The answer is not to dismantle all of that. The answer is to manage it better under the ACA/Obamacare.
1
Medicare for all is the answer.
1
I sure can't think of any viable political candidates who favor Medicare for all. Can you?
1
Bernie Sanders.
"Guaranteeing coverage through the end of the calendar year would reduce churning by nearly 80 percent."
Get Medicaid Jan 1, get a job in March to Nov, then go unemployed again.
Renew Medicaid Jan 1, get a job in March to Nov, then go unemployed again.
repeat to keep a zero premium.
"Another approach is to smooth the transition between Medicaid and the marketplace plans by aligning plans, benefits and networks of providers. "
FORCE providers to take crappy pay Medicaid - and have therm exit the health care system
Get Medicaid Jan 1, get a job in March to Nov, then go unemployed again.
Renew Medicaid Jan 1, get a job in March to Nov, then go unemployed again.
repeat to keep a zero premium.
"Another approach is to smooth the transition between Medicaid and the marketplace plans by aligning plans, benefits and networks of providers. "
FORCE providers to take crappy pay Medicaid - and have therm exit the health care system
1
Another big and expensive (to taxpayers) problem is intentional churning by those who are eligible for ACA. They refuse to sign up while they are healthy, choosing to pay the relatively cheap government penalty. When they or a child get sick they sign up knowing that existing conditions are covered. They use all the expensive services, and when they're done they drop out again.
By the way- As noted in a previous NYT article the administration, in an effort to get millions more persons enrolled, granted enrollment exemptions to over 30 different classifications of potential ACA enrollees, meaning they can enroll at any time during the year, not just during the annual enrollment period. As could be expected a good number of these people have figured out how to abuse this right to their benefit.
By the way- As noted in a previous NYT article the administration, in an effort to get millions more persons enrolled, granted enrollment exemptions to over 30 different classifications of potential ACA enrollees, meaning they can enroll at any time during the year, not just during the annual enrollment period. As could be expected a good number of these people have figured out how to abuse this right to their benefit.
Yes, ACA is sick. it was a bad convoluted system from the beginning. No sane person could have supported it. ACA has placed more people on insurance now than before ACA. For that it gets credit - but it could have accomplished that in 1/10 the number of pages and much simpler. For those yearning for single-payer - that is a huge hurdle. ACA survived because ~50% of the population receive health insurance through the employer as a tax free benefit. So ACA had minimal affect on these folks. In addition ACA moved thousands of people onto medicaid that had nothing before - a big win for them. Most* of those who purchase insurance on the open market were the big losers - they found their existing insurance plans they liked invalidated by ACA and replaced with new more expensive options that also required more out of pocket. This group is too small to affect any change. Moving to single payer disrupts that approximately 50% receiving tax free health insurance through their employer. Union jobs get the best health insurance as it is - are they really willing to give that up for single payer system? I would be surprised. ACA messed things up for a group of people that was not a majority - try messing with the health plans of the majority and it will be a different battle. (*eliminating denial of insurance for pre-existing conditions did help some who were on the open market -but that would have been a much simpler ACA bill to write that law).
1
ACA subsidies aren't determined by monthly income. They are determined by annual income. You estimate your MAGI (basically your AGI) when you sign up for ACA insurance and your monthly subsidy is determined by the annual amount. So the construction worker in this article shouldn't need to cycle on and off ACA insurance because of changes in monthly income. He either qualifies for subsidies during the year, or he doesn't. And if he lives in a Medicaid expansion state (which it sounds like he does), his annual income is either over 138% of poverty (ACA subsidies) or under 138% of poverty (Medicaid). So another aspect of this story is that the construction worker needs some better advice on how to purchase ACA health insurance.
3
Most federal programs that hinge on income qualification limits are measured quarterly and the beneficiary must keep the agency apprised of their income.
Tons of people qualify one quarter for WIC but not the next. I haven't heard that the ACA funding is for a year at a time.
Tons of people qualify one quarter for WIC but not the next. I haven't heard that the ACA funding is for a year at a time.
Another challenge is that because the subsidies on the exchange are based on taxable income, patients who fall under the threshold, even for a few months of the year, can face substantial tax penalties at the end of the year if they stay on their purchased plan, which is a serious hardship for these patients who are living on the edge anyways.
2
This is very true. You sign up once. Then during the course of the year (even if you sign up during the non-enrollment period) it doesn't make any difference if your income goes up or down. The final amount you pay or get back takes place once you fill out your taxes the following January. As a 3rd year subscriber to the ACA, I don't find it difficult to use at all. Last year my income took a hit downward but it increased my tax refund at the end of the year.
For years I was fortunate to have employer healthcare coverage minimal cost to me. However, that job was eliminated and I found myself without coverage. Everyone needs to remember that we can lose our great employer coverage at any time. Yes single payer would be great but that will never get through unfortunately.
For years I was fortunate to have employer healthcare coverage minimal cost to me. However, that job was eliminated and I found myself without coverage. Everyone needs to remember that we can lose our great employer coverage at any time. Yes single payer would be great but that will never get through unfortunately.
A related wrinkle was introduced this year. For the first 2 years of the ACA, anyone over 138% of the federal poverty level needed to opt for a silver plan to get a subsidy, and that provided excellent and 'real' insurance, as opposed to Medicaid, which is essentially only good for clinics and ER's, as most doctors won't take it due to the awful rates it pays. However, this year, a thing called the Essential Plan was introduced for those making 138% - 200% of the FPL. It is not called Medicaid, but that is exactly what it is.
For those of us in this zone, it has been a nightmare. For two years I had 'real' insurance, but this year I was forced into an Essential Plan. I broke my foot badly in February. I could not find a single foot specialist who would perform the necessary operation because Emblem offered to pay (including consultation, surgeon, nurses, anesthesiologist, facility usage, and follow-ups) a grand total of $200: the Medicaid rate. You could almost understand it if the insurance companies were in turn being paid nothing, but the combined payment they receive (from me+gov) is over $600/month.
I honestly don't know what the solution is. However what is clear is that the insurance companies continue to game the system. Until our federal government is united in making the ACA successful, such that there are immediate toothy consequences for the insurance companies, the average patient will continue to get a horrifically raw deal.
For those of us in this zone, it has been a nightmare. For two years I had 'real' insurance, but this year I was forced into an Essential Plan. I broke my foot badly in February. I could not find a single foot specialist who would perform the necessary operation because Emblem offered to pay (including consultation, surgeon, nurses, anesthesiologist, facility usage, and follow-ups) a grand total of $200: the Medicaid rate. You could almost understand it if the insurance companies were in turn being paid nothing, but the combined payment they receive (from me+gov) is over $600/month.
I honestly don't know what the solution is. However what is clear is that the insurance companies continue to game the system. Until our federal government is united in making the ACA successful, such that there are immediate toothy consequences for the insurance companies, the average patient will continue to get a horrifically raw deal.
9
Someone who bought something from me ( and who owns a business) explained to me how Obamacare was a ridiculous fortune for him. He paid $8,000 (out-of-pocket) for an operation on a detached retina instead of thousands more for Obamacare. Obviously, it is unfair and does not work.
3
My insect treatment guy is paying $17,000 annually for medical insurance and the family deductible id over $5,000.
The idea was never to save anyone any money, but to allow the central government to control nearly every economic aspect of our lives to facilitate such future ideas as re-allocating where everyone gets to live.
How far we get to travel has to be on their list for future governmental supervision. The border guards with their rifles pointed inward will be there to ''help us.''
The idea was never to save anyone any money, but to allow the central government to control nearly every economic aspect of our lives to facilitate such future ideas as re-allocating where everyone gets to live.
How far we get to travel has to be on their list for future governmental supervision. The border guards with their rifles pointed inward will be there to ''help us.''
3
There are many small business owners whose incomes fluctuate dramatically from month to month and year to year.
And of course, there are the incessant rate increases by the insurance companies, so this year's insurance policy will be anything but "affordable" next year.
It's ironic that the political party that claims to love entrepreneurship would work so hard to deny health insurance to entrepreneurs.
Wake up, Washington! The ACA was an important FIRST STEP--but there is still a long way to go. (And when all is said and done, single payer will look like a bargain, I suspect.)
And of course, there are the incessant rate increases by the insurance companies, so this year's insurance policy will be anything but "affordable" next year.
It's ironic that the political party that claims to love entrepreneurship would work so hard to deny health insurance to entrepreneurs.
Wake up, Washington! The ACA was an important FIRST STEP--but there is still a long way to go. (And when all is said and done, single payer will look like a bargain, I suspect.)
9
My wife and I are on the medicare/private insurance cut off line and because our sole source of income comes from the ebb and flow of production of our small farm. We regularly bounce above and below that line, at least a couple of times and sometimes three or four times, PER YEAR.
Many commentators have suggested that solving this "churn" problem is just a minor tweak and single payer is the only way. Maybe that is true if you are not actually dealing with the problem. But as a real-life poor person working his tail off to stay above 138% of the poverty line and out of the second class citizen status that is Medicare, I can tell you that fixing the problem of churn would be a significant improvement to a government program that has already had a significant positive impact on my life.
Many commentators have suggested that solving this "churn" problem is just a minor tweak and single payer is the only way. Maybe that is true if you are not actually dealing with the problem. But as a real-life poor person working his tail off to stay above 138% of the poverty line and out of the second class citizen status that is Medicare, I can tell you that fixing the problem of churn would be a significant improvement to a government program that has already had a significant positive impact on my life.
3
"Obamacare" is what it has always been about - money (greed), and politics. Single payer is, clearly, and always has been, the answer. Quality of care will actually improve, as will pride in the profession of medicine (contrary to the marketing, protestations, scare tactics, and sophomoric reasons given by the "bought-and-paid-for" protesters and so-called "experts"). Follow the money.
5
For-profit health care as a delivery system is costly to administer because of the profits made by "management companies" and administrators hired to process claims, enrollment forms and other tools of a bureaucratic system designed to be profitable to as many non-healthcare providers as possible.
The irrational American love of so-called "free markets" which treat life or death healthcare, drugs and necessary medical equipment as profit centers like automobiles sensitive to competition on price wastes significant resources. Sick people and their families are rarely in any position to "shop around" for the best deal. Many chronic conditions such as diabetes, hypertension and asthma require continuous monitoring and not emergency interventions in busy ER facilities.
Any move away from healthcare being considered a "benefit" of employment or a "welfare" program to healthcare as a right is likely decades away. The churning highlighted in this Upshot article is just one of many system inefficiencies which costs money and risks the lives of the most vulnerable Americans.
The irrational American love of so-called "free markets" which treat life or death healthcare, drugs and necessary medical equipment as profit centers like automobiles sensitive to competition on price wastes significant resources. Sick people and their families are rarely in any position to "shop around" for the best deal. Many chronic conditions such as diabetes, hypertension and asthma require continuous monitoring and not emergency interventions in busy ER facilities.
Any move away from healthcare being considered a "benefit" of employment or a "welfare" program to healthcare as a right is likely decades away. The churning highlighted in this Upshot article is just one of many system inefficiencies which costs money and risks the lives of the most vulnerable Americans.
11
Obamacare is completely dysfunctional. It's main problem is that it left the insurance companies and BigPharma in charge.
The only answer to this madness is what seems to work well in all other industrialized countries, what takes the burden of providing health care off the backs of private businesses and provides them a level playing field: Single Payer.
The only answer to this madness is what seems to work well in all other industrialized countries, what takes the burden of providing health care off the backs of private businesses and provides them a level playing field: Single Payer.
14
Excellent comment, Claude. This is deserving of a NY Times "Highlight".
5
The problem is we have too much government intervention in healthcare. There needs to be open pricing, doctor ratings, hospital ratings, etc. Single payer is where the government has been leading you with their sabotage of the healthcare sector. Every doctor needs insurance, a lawyer and two people to handle the government codes and paperwork. Do you think these add to your costs? Medicare and medicaid do not reimburse the doctors enough, that's why your aspirin costs $50. Then there are the people who get care and walk out on the payment which the government has made simple. Now they want it all and they have people lining up for V.A. style care.
2
Once upon a time "churning" had something to do with butter. Of course, that was before the invention of for-profit health insurance. Political puppets obediently parrot the claim that we can't afford a single payer system, and the biggest losers are the American taxpayers. What we can't afford is the bloated administration of health insurance that frustrates doctors and sacrifices sick people in order to maximize profits. It's impossible for mere humans to evaluate a medical insurance plan prior to actually needing it. Even more absurd is the idea of intelligent cross-shopping as Ms. Clinton condescendingly suggested to a very polite woman at the end of her rope during a televised town hall Q/A exchange.
Here's an idea. Let's ask our public servants in Congress to forego their excellent federal health insurance so they can fend for themselves in the free market just like the rest of us. Ask them to experience first-hand our maze of impenetrable insurance options without the help of staffers or professional advisors. Impose random budgetary constraints so they can play the same game we do. Of course, it might take a few years for a serious disease to kick in so they can actually evaluate their healthcare choices. But hey - I guess that's how incremental change works. Congressional gridlock would be no match for healthcare hell if Congress had to grapple with it for themselves firsthand.
Here's an idea. Let's ask our public servants in Congress to forego their excellent federal health insurance so they can fend for themselves in the free market just like the rest of us. Ask them to experience first-hand our maze of impenetrable insurance options without the help of staffers or professional advisors. Impose random budgetary constraints so they can play the same game we do. Of course, it might take a few years for a serious disease to kick in so they can actually evaluate their healthcare choices. But hey - I guess that's how incremental change works. Congressional gridlock would be no match for healthcare hell if Congress had to grapple with it for themselves firsthand.
15
You propose an excellent idea, and I would add that it will not take a serious illness to open the eyes of those affected. A broken leg, a kid who needs stitches, the need for a call-back mammogram, a benign polyp changing a "routine" colonoscopy into a "diagnostic"---any of the things that Americans spend countless hours on the phone trying to deal with would do it. One visit to an ER for stitches in a cut finger can result in as many as five separate bills--one for the hospital room, the doctor or PA who did the actual stitching, the Xray, the lab if there was something in that deep cut that was sent to pathology. The "routine" colonoscopy becomes "diagnostic" when anything, even something that the surgeon can plainly see and is willing to state is non-malignant, is found. The patient finds out that it went from "covered" to "surgery" with the whole different schedule of charges and copays while they were out like a light. Not even an opportunity to say, "Whoa, wait, is that really necessary, because it is going to cost me at least $2000 in copays?" Ironic, really, considering how the procedure is performed, but I digress.
One or two of these incidents is all it would take for the members of Congress to get a clue.
One or two of these incidents is all it would take for the members of Congress to get a clue.
10
Everything you say about the colonoscopy I learned the hard way last year. I have a high deductible plan through my employer and found myself on the hook for more than $1000 for something I though was going to cost $0. Isnt the point of a colonoscopy to determine if there is a problem?
2
It's not just churning between Medicaid and ACA that's a problem. If one's income is above the Medicaid limit and fluctuates significantly throughout the year, then one becomes eligible for different plans, with different premiums and cost sharing. The premium payments are reconciled when income taxes are filed, but there's no mechanism to reconcile the differences in the cost sharing, which can be significant.
During open enrollment for 2015, we were told by Covered CA that we could use our estimated yearly income and not bother with the hassle of reporting monthly changes. So we ended up in high deductible plan with twice the out-of-pocket expense limit as the zero deductible plan we ultimately qualified for. Covered CA's response was that we were actually required by law to report any changes in income within 30 days.
We filed a grievance and at our hearing Covered CA denied telling us that we could use a yearly estimate. The administrative law judge told us that indeed, we had to report changes within 30 days or be subject to perjury laws.
I called Covered CA today to report an income change, as it is still impossible to complete them online, and was told, once again, that it would be easier to use our yearly income estimate and not bother with the monthly changes. When I pointed out that that is illegal, she was flummoxed and had to consult with a supervisor.
Medicare for all!
During open enrollment for 2015, we were told by Covered CA that we could use our estimated yearly income and not bother with the hassle of reporting monthly changes. So we ended up in high deductible plan with twice the out-of-pocket expense limit as the zero deductible plan we ultimately qualified for. Covered CA's response was that we were actually required by law to report any changes in income within 30 days.
We filed a grievance and at our hearing Covered CA denied telling us that we could use a yearly estimate. The administrative law judge told us that indeed, we had to report changes within 30 days or be subject to perjury laws.
I called Covered CA today to report an income change, as it is still impossible to complete them online, and was told, once again, that it would be easier to use our yearly income estimate and not bother with the monthly changes. When I pointed out that that is illegal, she was flummoxed and had to consult with a supervisor.
Medicare for all!
14
The only reason seniors have such great coverage with Medicare is that it's subsidized by the higher premiums everyone else pays. We need TRUE insurance reform, which we'll never get as long as the GOP controls either the House and the Senate, much less both as they do now. All the "angry" voters chanting FOR Trump are the same voters who send their own district's corporate puppets back to DC term after term.
1
You do not want to be on Medicaid unless you absolutely have to be. When my husband and I went on Medicare, we had to find a plan for my daughter. She was in school and making very little so the market place wanted to put her on Medicaid. We could not find a doctor or a dentist that would take it in our area. There might be a clinic that would take care of the medical end, but there are no dental clinics. We wound up finding an individual plan that we paid for. This needs to be fixed, seriously
7
If you have kids in college, one of you or both should have continued to work and have insurance until she finished. You deserve what you got.
It's also pretty crazy that basically no insurance plans, aside from expensive BCBS premium plans, provide Multi-state insurance. I remember when Obamacare had just launched and I asked the representative on the phone: "So, if I have insurance in NY and I go to visit my family in PA and happen to have an accident, I'm not covered?" Her answer: "yes, that's correct". A year later during my next enrollment period when looking for different plans, I asked the same questions and was told they "weren't allowed to answer those questions". Now, I've just moved from NYC to LA for more career opportunities..I've been having the worst time trying to switch state plans. It's just crazy man. Still insured in NY, but not here now. I go to Obamacare, it takes me to Covered CA. I go to Covered CA and dial the numbers, the automated system takes me in circles to literally, nothing. I go to "Live Chat" help and fill out my info and never get contacted. Been on the website twice filling out applications and eventually the page reaches "An error occurred when we tried to process your request. We're working to resolve this issue" Is this for real?
12
Government has proven beyond ALL doubt that it has NO business meddling with medical care or any for of insurance. states can run local hospitals whether they are built using federal monies or not. This extends to the VA.
Had the shipload of cash wasted setting up Obamacare been invested in actual medical facilities, the lives if millions of people would be better today - and the middle class would not be damaged everyday by Democratic love of more and more government.
Had the shipload of cash wasted setting up Obamacare been invested in actual medical facilities, the lives if millions of people would be better today - and the middle class would not be damaged everyday by Democratic love of more and more government.
4
If we are going to leave millions on Medicaid for long periods -- as seems to be the case under ACA, especially with children -- then we need to incentivize providers to see them. Here the state tried to get doctors to sign on to fully-capitated HMOs for Medicaid. Exactly zero physicians locally took the bait.
If the paltry Medicaid payments at least had parity with Medicare, more doctors might consider accepting patients, and fewer would drop the coverage or refuse to take on any new patients. I honestly cannot blame those who refuse right now; they have to earn a living, after all.
If the paltry Medicaid payments at least had parity with Medicare, more doctors might consider accepting patients, and fewer would drop the coverage or refuse to take on any new patients. I honestly cannot blame those who refuse right now; they have to earn a living, after all.
12
The other consideration that should be taken into account is choice. If someone chooses a profession that does not provide the necessary income to support the healthcare they need is it really the responsibility of government to step in and fill the gap? In this situation does the young construction worker not have the choice to find additional work that would allow him to maintain his private coverage with the available tax credits? Or should we as a society agree to allow people to make choices that then require government to intervene? To be clear I am fully supportive of Medicaid as a safety net and being compassionate and supportive of those that encounter hard times and need temporary assistance to get back on their feet. Obviously Universal Health Care solves this particular problem, but this issue is not unique to health care. Are we advocating for a society where health care, housing, food and other critical needs are provided by the government regardless of the choices individuals make . . . in a free society?
1
1. Yes, a lot of us are advocating for a society where health care, basic housing, food and other critical needs are provided by the government - it's called a robust social safety net. A number of countries no wealthier than the US have them rather successfully; they do tend to spend less on their militaries, have more progressive income taxes on individuals, lower corporate tax rates(!) but fewer loopholes. The idea that we should have people working in jobs that are necessary to our economy, e.g. construction, without their being able to afford basic necessities including health care for their families is what bothers many of us.
2. The construction worker probably could get a gig with a steady income year around. BUT the total he earned during the year would likely be less. Well-timed fill-in jobs are not so easy to come by. (Would you hire him and rehire him if he left your business every construction season?)
2. The construction worker probably could get a gig with a steady income year around. BUT the total he earned during the year would likely be less. Well-timed fill-in jobs are not so easy to come by. (Would you hire him and rehire him if he left your business every construction season?)
9
"Are we advocating for a society where health care, housing, food and other critical needs are provided by the government regardless of the choices individuals make..." what I would like is a government that supports the needs of the people to have the jobs that support housing, food and critical needs and help make sure the insurance and financial industry does not force an unbalanced relationship with their customers. I don't want the government to provide all these things to me - I want the government to make it a goal for me to be independent. Which is not to say everyone has the ability - there will always be a part of society that needs extra temporary or permanent support.
4
The overhead for managing hundreds of healthcare policies in the American system is LUDICROUS.
No other country has to contend with this sort of nonsense. It is both a waste of time (for everyone - including the providers) and money.
No other country has to contend with this sort of nonsense. It is both a waste of time (for everyone - including the providers) and money.
19
Medicare for All is the answer.
25
ACA is a bad act. My Medicare Advantage plan left my county so I had to switch to a Medigap Policy for more money. You have to sign up by December but the insurance companies don't have to tell you what you will end up paying until April. Of course, they raise the rates. In my investigation I found that Regence is just called an insurance company but in reality they told me that their premiums must equal what they pay out, so in truth they are just a middleman with no risk. They are allowed by the government to call themselves non profits but when I looked into it I found that their CEO was making in the range of $1.5 million a year. ACA provides way too many perks to the "insurance" companies. Since they carry no risk, they have no incentive to better their services.
9
You realize that Medicare is not part of the ACA insurance, right? I have insurance through the ACA, and except for the $1600 out-of-pocket max (which I can barely afford,) the coverage is excellent. I don't know what to expect with Medicare when I turn 65.
1
Instead of further embracing the notion of insurance companies making even more money from illness (as you suggest). lets move towards Medicare for all, like most of the rest of the industrialized world.
22
This is sick. Are we demented?
7
This kind of thing is just another good reason ObamaCare needs to be abandoned and replaced by a single-payer system. There are still millions of people on the margin who cannot get adequate care or insurance they can afford. For them "affordable" health care is very sick joke - a false promise. Why do they keep telling us we can't afford universally-available health care when every one else can?
20
First of all, few insurance companies allow alternative medicine. There are people who cannot (medically) use much of anything else. Medicaid, ditto.
Second, before this will work, Medicaid itself needs fixed. Only the poorest people become fully aware of how little Medicaid covers in terms of dental care, etc.
Third, as long as medical care is considered business and not a humane need, this will persist. There will be no adequate health care system as long as money rules the rules.
Fourth, this was a flustercluck to start with. It should NEVER have been pushed through without those voting on it being able to fully understand it. It's an uncontrollable behemoth with teeth.
Millions die of lack of medical care each year. Will you be one of them?
Second, before this will work, Medicaid itself needs fixed. Only the poorest people become fully aware of how little Medicaid covers in terms of dental care, etc.
Third, as long as medical care is considered business and not a humane need, this will persist. There will be no adequate health care system as long as money rules the rules.
Fourth, this was a flustercluck to start with. It should NEVER have been pushed through without those voting on it being able to fully understand it. It's an uncontrollable behemoth with teeth.
Millions die of lack of medical care each year. Will you be one of them?
6
Eligibility for ACA subsidy is based on annual income not monthly. A great deal of the churning is due to bad enrollment advice and poorly informed individuals enrolling themselves. It will get worse now that most major plan providers are no longer paying trained independent insurance agents to enroll .
1
Not all of us can predict our annual income. I'm a free-lancer and my income fluctuates a great deal. Even in December I may not know whether a large check will arrive before the end of the month or not show up until January. I signed up for coverage under the ACA in 2014 and found that my estimated income was literally less than $100 below the Medicaid line. For the rest of the year I was afraid to see a doctor as I worried that my income would exceed the limit and I'd end up having to pay out of pocket. I finally went in December as my prescription for heart meds had run out six weeks prior and I was having chest pains. The stress of literally not knowing which checks would arrive and whether they would throw me over the limit didn't help my situation.
I applaud Obama and the Democratic congressional members for making health care a priority. I just wish that the Republicans could have participated in a positive way so as to make the ACA better, instead of blocking and forcing it to be railroaded through.
I applaud Obama and the Democratic congressional members for making health care a priority. I just wish that the Republicans could have participated in a positive way so as to make the ACA better, instead of blocking and forcing it to be railroaded through.
19
The republicans forced the democrats to railroad it through? The POTUS chief of staff declaring "Forget them - we have have the votes?" (maybe it was more forceful language go look it up). The democrats could have written a better bill. They got exactly what they wanted.
1
Dare I suggest a sensible solution called Medicare for all (aka known as a single-payer system, similar to Canada's system). Oh, I forgot--this is the United States, home of powerful insurance companies and pharmaceutical companies.
49
Being shunted back and forth between the Marketplace and Medicaid is bad enough, but try being in a place like Texas where they take away all your subsidy if you don't make enough money and replace it with no health care assistance at all. Oh I'm sorry, did you make $10K last year instead of the minimum? Here, pay hundreds of dollars more per month for insurance.
20
While a single payor system would be preferable, that is not currently politically feasible so it is necessary to fix this issue. ALLOW Medicaid-eligible populations to buy private plans on the marketplaces and guarantee those eligible for Medicaid and want to stay on Medicaid can CHOOSE to stay in that program for a year. The key here is give the patient the CHOICE rather than making this a government dictated decision. I can make the best decision for me.
6
As if all this isn't bad enough, try doing it in New York, where the usual incompetent, bureaucratic nightmare multiplies the problems tenfold. Any efforts to reform and simplify anything in this country - the health-care industry, the tax code, the legal system - are quickly and perennially squashed by the corporate powers whose only interest is not in helping society, but in keeping themselves rich and in control.
24
The costs of this ping-ponging are likely far greater than the administrative costs that this author has described. As the young construction worker bounces from plan to plan, so does his family. Each time, the family gets a new set of doctors, and they all have to start over with checkups and relating their medical histories, and there are costs to that. More importantly, people are more complicated than their medical histories. Those of us fortunate enough to have been able to have our children stay with a single pediatrician know just how important it can be for an accurate diagnosis for the doctor to know the child, and for the child to trust the doctor. In addition to the human costs of bad diagnoses, errors generally lead to additional insurance costs for medical treatment.
We like to think that we're saving money by having strict and simple rules for eligibility for public programs. Instead, we're just being penny-wise and pound-foolish.
We like to think that we're saving money by having strict and simple rules for eligibility for public programs. Instead, we're just being penny-wise and pound-foolish.
19
Universal Medicare would be less wasteful and more user-friendly.
Forcing ourselves to run through marathon-length bureaucratic mazes every 6-12 months is an incredibly idiotic way to make health care available
to most -- but not even all -- Americans.
Forcing ourselves to run through marathon-length bureaucratic mazes every 6-12 months is an incredibly idiotic way to make health care available
to most -- but not even all -- Americans.
43
What can be done? Don't restrict those under 65 from enrolling in Medicare. Obamacare is a last ditch attempt to save our dysfunctional private insurance driven healthcare system. It will ultimately fail, leaving in its wake the sick who cannot get affordable healthcare.
You could not design a more dysfunctional healthcare system if you tried than the one we have. It is the result of profit and greed over care and compassion.
You could not design a more dysfunctional healthcare system if you tried than the one we have. It is the result of profit and greed over care and compassion.
43
At what price? Currently, Medicare costs around $10,000/recipient, which is more than a plan on the exchange would cost. Medicare's population is elderly, so the cost of covering an 80-something is high, but before you open Medicare for all, you need a price and you need to sign up Ob-gyns, pediatricians, and birthing centers.
1
You also need more doctors to accept medicare patients. Many do not.
There is a solution to the problems of churning: a single national voucher system that covers everyone, which provides everyone a choice among competing health plans for a continual year enrollment. No Medicaid, no Medicare, no ACA, no employer-sponsored coverage: a single system where everyone gets a risk-adjusted voucher and can enroll in any plan for 12 months - and every plan has to accept everyone.
This is the model used in the Netherlands and in Israel, and would represent a compromise between a single payer system as advocated by Senator Sanders and the current mess of employer-sponsored plans, traditional Medicare, Medicare Advantage plans, ACA plans, traditional Medicaid, Medicaid managed care plans, and the uninsured. Will this happen? Probably not for another 20 years.
This is the model used in the Netherlands and in Israel, and would represent a compromise between a single payer system as advocated by Senator Sanders and the current mess of employer-sponsored plans, traditional Medicare, Medicare Advantage plans, ACA plans, traditional Medicaid, Medicaid managed care plans, and the uninsured. Will this happen? Probably not for another 20 years.
28
Tweaking the alignment of Medicaid and the private ACA exchange plans still leaves in place a fragmented system of incongruous provider networks, and unstable cost sharing depending on plan actuarial values and sliding-scale subsidy qualifications. These efforts result in wasteful administrative excesses, inefficiencies and inequities in care.
A well designed single payer system - an improved Medicare for all - would provide stable health care coverage for life - totally eliminating churning. The savings from the administrative efficiencies would be enough to eliminate current financial barriers faced by the uninsured and the underinsured, while reducing inequities and ensuring access for all.
Tweaking a highly dysfunctional system just won't get us there.
A well designed single payer system - an improved Medicare for all - would provide stable health care coverage for life - totally eliminating churning. The savings from the administrative efficiencies would be enough to eliminate current financial barriers faced by the uninsured and the underinsured, while reducing inequities and ensuring access for all.
Tweaking a highly dysfunctional system just won't get us there.
62
Readers may want to see how their own states fare with Medicaid eligibility churn. Researchers at George Washington University developed estimates of churn within each state - you can find churn maps and other information here: http://www.communityplans.net/portals/0/coverageyoucancounton/index.html
Also, note that the 2016 and 2017 White House budget proposals included an option for states to implement 12-month continuous eligibility for adults in Medicaid. As the author mentions, states already have the option for children, although only 24 have used it for Medicaid and 26 for CHIP, indicating that a policy that is voluntary for states is not a complete solution.
Also, note that the 2016 and 2017 White House budget proposals included an option for states to implement 12-month continuous eligibility for adults in Medicaid. As the author mentions, states already have the option for children, although only 24 have used it for Medicaid and 26 for CHIP, indicating that a policy that is voluntary for states is not a complete solution.
5
Thats what I said just not quite as well
1
I support Medicare expansion for all, but I would also like to see the development of a side-by-side NONPROFIT health insurance industry with continued subsidies for all income levels for participation. This is what Germany and Japan both have, and they do the best jobs in keeping healthcare costs low and quality medical care high.
Billing Medicare is a nightmare for providers and costly to small practices, which are the lifeblood of rural communities, even with the accelerated payments from CMS for rural providers. Also, having come from the VA system, the loss of patient choice for insurers is a concern for me. I don't want to see a system where people have to travel 300-500 miles just for orthopedic surgery or basic oncology services because of Medicare mandates it- which is what currently happens in our local VA system here in Wyoming.
Billing Medicare is a nightmare for providers and costly to small practices, which are the lifeblood of rural communities, even with the accelerated payments from CMS for rural providers. Also, having come from the VA system, the loss of patient choice for insurers is a concern for me. I don't want to see a system where people have to travel 300-500 miles just for orthopedic surgery or basic oncology services because of Medicare mandates it- which is what currently happens in our local VA system here in Wyoming.
There are at least two Medicaid DPC pilot projects in the early stages of development that are estimating a 20% savings. In one state alone, that equates to a $3.4 billion savings.