THCB

Healthcare Reform Even the Tea Party Could Support

flying cadeuciiThe Affordable Care Act (ACA) is the law of the land, and nothing the Tea Party does is likely to lead to its repeal.  But the ACA can be amended to make it less objectionable, and it wouldn’t be that hard.  We just need to modify it to allow Tea Partiers (and others) to form their own healthcare groups.

All insurance, including healthcare insurance, works by forming risk pools.  The members of the pool contribute to a pool of money which is then used to pay the claims by the members.  Most participants pay in more than they use.  In healthcare most people pay more money into the pool than the cost of the care they receive.  A few people receive far more care than they pay for.

For risk pools to work, boundaries have to be drawn around what is paid for by the risk pool.  As an example car insurance policies place a limit on how much they will pay for any one accident.  It’s nice to think that as a rich country we don’t have to draw boundaries around healthcare, that we should be able to pay for any possible medical treatment, but we can’t.  We already spend almost twice as much on healthcare as other nations and if costs keep increasing eventually it will bankrupt our country.

Many people blame private insurance companies for our expensive healthcare system, but insurers actually have very little to do with rising costs.  Instead advancing medical technology is the primary cause.  Our for-profit medical technology industry has made amazing advances in treatment and care that have allowed us to save people that used to die.  But its primary goal is still profit.  Every year the industry comes up with new procedures or refinements.  Most provide only incremental improvements in care but they all come with a higher price tag.  Every year the industry spends billions of dollars – yes, billions – successfully encouraging doctors to recommend the new procedures.  And it’s about to get much, much worse.  There is a flood of new treatments and targeted drugs getting ready to hit the market.  Some will undoubtedly be true advances, but all are likely to cost tens and even hundreds of thousands of dollars per treatment.

So like it or not, health insurance needs boundaries just like auto or homeowners’ insurance.  Who draws those boundaries, of course, is one of the most contentious questions in the U.S.  Part of our country doesn’t trust insurance companies to draw acceptable boundaries.  Part of our country, including the Tea Party, doesn’t think the government should be entrusted with this authority.

The Affordable Care Act greatly expands the federal government’s role in drawing these boundaries.  At the same time the ACA makes it much harder for insurance companies to control costs.  One of the tools insurance companies used to make sure private insurance remained affordable were annual and lifetime limits on payment for care, similar to the financial limits of auto or home insurance.  The ACA forced insurance companies to remove these financial limits.  Arguably the ACA has tilted the playing field, extending government involvement while at the same time making it much harder for private insurers to keep costs down.  It is this combination that caused many people to suspect that the real purpose of the ACA was to undermine our free-market healthcare system and lay the groundwork for an eventual government take-over of healthcare.

And so the conundrum facing our country – the ACA makes it very hard for insurers to draw reasonable boundaries around covered care, and much of our population doesn’t trust the government to draw the boundaries.

There is an alternative – we could let the group members themselves do so.  We could allow individuals to come together to form their own healthcare groups, and then decide democratically how to draw the boundaries around the coverage that their healthcare pool will pay for.

In some ways this would be a radical transformation – we would actually be trusting the people receiving the care to set the limits they are willing to live with.  But the beauty of this approach is it fits easily within our existing healthcare system.  We already have an infrastructure in place comprised of underwriters, brokers, consultants, claims processors and wellness companies that help employers shape and manage employer-funded health plans.  This same infrastructure could be used by self-created and managed groups to shape and manage their plans.  And we have the legal structure in place as well – every state has some version of a mutual benefit company that could be used for self-managed health plans started by neighborhoods, political organizations or even large extended families.

Letting individuals form self-managed healthcare plans won’t immediately bring down healthcare costs, and it won’t make the decisions on how to draw the boundaries any easier.  But at least it will be the people actually receiving the care deciding on the limits they can accept.  And these decisions will have a legitimacy that neither the government nor private insurers can match – they will have the legitimacy of democracy.

Our healthcare system is already moving in the direction of self-managed groups.  Large employers are implementing private exchanges that allow their employees to select from a range of group plans.  The ACA establishes exchanges for employees of small businesses.  It’s a short step from letting the members select from a limited number of groups to letting the group members decide what their group plan should cover.  Self-managed buying groups would offer a uniquely American approach to improving healthcare in the United States, an approach that even the Tea Party could support.  We need to amend the Affordable Care Act to allow self-managed healthcare groups.

Blake is the Chief Product Officer of HealthSight, LLC, a technology company that has developed an innovative approach to using social networking and group financial transparency to engage the members of a healthcare plan

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annearkham.comextra maleWilliam Palmer MDArt Fougner MDBarry Carol Recent comment authors
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annearkham.com
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William Palmer MD
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William Palmer MD

@Ashby How does your thinking re consumer operated and oriented health plans , the coops that were allowed by the ACA for the individual and small group plans… how do these jibe with your own ideas above? As of Feb, 2014, there were 400,000 folks signed up in these non-profit plans, but the going is tough because the HHS won’t allow them to use seed money–the ACA gave them some–for advertising and marketing. I think that groups can begin insurance plans. The Alameda Contra Costa Medical Association created its own physician malpractice insurance plan. It took extreme work to do… Read more »

William Palmer MD
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William Palmer MD

“Many buyers/many sellers” what does this mean re numbers of bits in the system?

William Palmer MD
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William Palmer MD

@ Peter 1
Demand is still there. Now you live with queues, plus you don’t know what to produce and how much because most of the systems’ information is gone.
Come on. Japan and Germany have many payers.

Peter1
Guest
Peter1

“Now you live with queues”

What you mean is everyone has the same chance to queue except just the ones who can’t afford coverage. The trick is to triage the most pressing.

Canada’s wait times due to an aging population were put to the test and with more money, targets and resources were improved.

“most of the systems’ information is gone”

????? Where does it go – a black hole? Maybe you should visit CIHI to see how much information is just on that site.

http://www.cihi.ca/CIHI-ext-portal/internet/EN/Home/home/cihi000001

I’d take the German system.

allan
Guest
allan

I will admit Peter1 that the German system is one of the better systems, but even their own leaders recognize the system is unsustainable. Are you willing to wait on line for your wife’s or children’s healthcare? …And longer if the quarterly medical budget is exceeded? …And have limited choice as to the specialist you can see? Is it OK with you to wait while private rich patients get to the head of the line for appointments and the leading specialists? That was something you didn’t like in the American system where most are treated in a more similar fashion… Read more »

Peter1
Guest
Peter1

allan, the planet is unsustainable.

If you’re asking me if I’d rather put up with the deficiencies of other systems over this one – you’d be right.

I found the cost of a new hip here uneconomical – I went to india, like many Americans.

allan
Guest
allan

Peter1, there is no doubt that one day the earth earth will become uninhabitable either because of global warming or global cooling or some other catastrophe. Maybe the earth will crash into the sun. The idea is to handle the manageable problems that occur long before the others. It seems in your case you went to India for your hip just like many Germans. It looks like our systems are more similar than we might realize. I guess you might be one of the uninsured. Healthcare abroad is a good option because of the market forces you don’t seem to… Read more »

Peter1
Guest
Peter1

@allan,

Their marketplace, not ours.

Germans going out of country for health care is a failure of their system, but U.S. patients doing same is a success??

Out of interest, how is your health care paid for?

allan
Guest
allan

Peter, I am not saying that the Indian’s use of the marketplace demonstrates a success in our system rather it demonstrates a success in their system and highlights the former success of our own. Even you entered into the competitive marketplace to have your hip surgery. That tells us a lot. Individuals that think the marketplace is a failure in healthcare can and will utilize it for themselves. You are living proof. You point to the German system as one you would like to emulate, but when told that the German system was unsustainable you essentially said ‘so what’ in… Read more »

Peter1
Guest
Peter1

@ allan, “rather it demonstrates a success in their system” You have a perverted sense of success if India is held up as an example of one. I happen to have be able to take advantage of their present system to get a great price – talk to the millions of poor in India about what they think success looks like. Your personal coverage in this discussion is very much everyones business – it gives context to your point of view. HSA’s help upper earners, not low paid workers – glad to see you had enough to purchase. I assume… Read more »

allan
Guest
allan

Perhaps there is a lack of understanding on your part. India is by no ways near the development of the US, but as it has moved towards the marketplace it has become more successful as noted by its much higher GDP than the US and the fact that you had your hip replaced in India. It is remarkable how the shift in medical tourism has shifted from the US to other places and now simply includes the US. You are living proof of how a market system helps the world progress. “Your personal coverage in this discussion is very much… Read more »

Peter1
Guest
Peter1

@ allan,

“There are other reasons and they make the cost saving far greater than many expected.”

Certainly the 100% tax deductibility makes them attractive – sounds like a government program to me.

allan
Guest
allan

Re HSA’s: “Certainly the 100% tax deductibility makes them attractive – sounds like a government program to me.” Peter1, Think about it for a moment. Low deductibles mean higher premiums that are excluded from the tax deduction. The person with the high deductible loses out on the tax deduction so the HSA gives it to him. There is still too much government intrusion, but at least in this case the government has leveled the playing field a bit. What do you find wrong with leveling the playing field? What do you find wrong with the individual saving on premiums that… Read more »

Peter1
Guest
Peter1

@ allan, “but at least in this case the government has leveled the playing field a bit. What do you find wrong with leveling the playing field?” I don’t find anything wrong with government getting involved in leveling the playing field – in fact in health care it’s necessary. If you’re going to participate in Medicare (I assume you will) that would be the government “leveling the playing field”. Exactly what the Germans are doing, the French are doing, the Canadians are doing and what the ACA is attempting to do – even though poorly. I think health care should… Read more »

allan
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allan

“We’re just going to have to continue to disagree.” Peter1, all the examples are examples of the marketplace making things better. You received care in Canada, not because of socialism, but because of a market place for healthcare tourism that adds greatly needed dollars to the system. You might be against the ‘rich’ getting privileges here in the US, but you weren’t against it when you sought out a capitalistic marketplace solution in Canada. You were given someone else’s slot and moved up to the front of the line. Same thing in India. In the past India felt as if… Read more »

Peter1
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Peter1

“You received care in Canada, not because of socialism, but because of a market place for healthcare tourism that adds greatly needed dollars to the system.” allan, you don’t know what you’re talking about. My PRICE in Canada was due, to a large part, on their government control of health care. I had my cataract surgery in a hospital and was charged according to their price controls. The surgeon was private, as all docs in Canada are, but his charges were also reduced because of controls and low overhead of hospital facilities. All due to government controls. If you want… Read more »

Barry Carol
Guest
Barry Carol

Conversely, Arab Sheiks and other wealthy foreigners can and do come to the U.S. for medical treatment and willingly pay our famous academic medical centers their full chargemaster rates. I guess that’s a market too. Even Peter’s willingness to fly to India for his hip surgery would probably be unaffordable for the majority of Americans who lack health insurance and need to self-pay. This is why people need insurance especially for hospital based care. Primary care is a different story. I don’t expect my car insurance to pay for oil changes and HSA’s are fine to help the upper half… Read more »

allan
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allan

Peter1, get over the idea that everything is pure. Why would the Canadian system take you and bump one of their own citizens? Do you pay Canadian taxes that helps fund the system? Medical tourism brings in money to the system. That is part of a market place. I’m not sure what you were charged, but surely you understand that Canadians pay taxes that help support their system and its infrastructure that you utilized. Thus you, in some people’s thinking, exploited the Canadians though their price was much higher than prices in the third world. I am not saying Americans… Read more »

allan
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allan

“full chargemaster rates. I guess that’s a market too.” Yes, Barry, that is a market as well, but is limited. ” HSA’s don’t work as well for low income people as they are likely to avoid as much necessary care as unnecessary care because they can’t afford the high deductibles.” It will be easier for more affluent people to purchase an HSA, but an HSA will have a greater positive effect on the less affluent. If the individual truly can’t afford the high deductible he can’t afford the premium of the low deductible. They are actuarially matched, but the low… Read more »

William Palmer MD
Guest
William Palmer MD

If we took anything that man liked and felt he needed and made it tax deductible, what would happen to the demand for this thing? Now, if some of us can’t deduct this because we are in the wrong set of people–say we are too old and are not working–and we were able to get government to buy this for us, what would happen to the demand for this thing? What difference would it make if these things were, say, for automobiles or homes or hairdos or vanity surgery or cosmetic dentistry? We would still see almost unlimited demand. And… Read more »

Peter1
Guest
Peter1

“However the patient participates we don’t want her to avoid necessary care and we don’t want her to be intimidated by the priesthood.
Surely there are bright world class solutions to this failing market.”

True single pay – even with all its own problems.

Art Fougner MD
Guest
Art Fougner MD

To paraphrase Jaime EscaLante, patients will rise to the level of expectations. Also. Folks can use HSA to purchase insurance

Barry Carol
Guest
Barry Carol

For the first 10-12 years I worked for my last employer, our health insurance had a $1 million lifetime limit which is not hard to exceed in the NYC metro area. This caused some anxiety among our NYC based employees. Eventually, the company raised the lifetime limit to $5 million. For employer plans, the most expensive cases tend to be treating low birthweight premature babies, especially multiple births. The medical bills for these cases can and often to run into seven figures and no family can forecast in advance that they will have to deal with such cases. I support… Read more »

Art Fougner MD
Guest
Art Fougner MD

Expand and raise the cap on HSA’s. Transfer the employer deduction to the individual. Allow groups of disparate individuals to come together to form purchasing groups, getting the same preferred pricing as employers get. Allow all healthcare related expenses to count to the deductible. I’m sure there’s more you can think up.

Balboa
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Balboa

Sorry to burst your bubble but this won’t work. The majority of healthcare dollars are spent on the few minority. 5% of Americans spend almost 50% of healthcare dollars. Democratic groups will shun the most sick individuals from joining their plans. They’ll also try to avoid coverage for the rarest and typically most expensive conditions. Problem is that health is unpredictable and someone in that group is going to contract that rare disease and go bankrupt at some point. Insurance companies have already tried to reduce benefits to contain costs and have offered a variety of plans in the past.… Read more »

allan
Guest
allan

@Balboa: ” Democratic groups will shun…” Risk rating. Classical insurance depends upon the transfer of risk. The ACA already is in trouble: 1) the deductibles for the mid to low income groups is very high and the copays high as well for such incomes. 2) insurance companies have already decreased the panels so that one might sign up and find their doctor on the panel, but not the specialist or the hospital 3) many people didn’t feel insurance was worth it before the ACA and that number will dramatically increase 4) the mandate might disappear. The mandate was used to… Read more »

Balboa
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Balboa

The trouble with the ACA is that we needed less insurance not more. Right now our system shouldn’t even be considered insurance since it really is just a prepaid health plan. Instead of insurance companies our premiums should go into an account that accumulates value and all services paid out of pocket through this account, like an HSA. Let market forces control costs. Let people be accountable for the services they purchase and have providers honor their charge masters as the true price. Singapore has a system built like this and I think it would be a great idea. David… Read more »

allan
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allan

Balboa, I agree with your comments about the ACA and I also agree with HSA’s. If market forces prevail then insurers will create an insurance system that meets the needs of the insured rather than the political needs we see today.

Peter1
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Peter1

“If market forces prevail then insurers will create an insurance system that meets the needs of the insured”

Pre-exist exclusion – market forces, high deductibles – market forces, co-pays – market forces, the uninsured – market forces, reduced coverage – market forces, narrow networks – market forces.

Market forces made private public transportation unprofitable, yet without it our large cities would be unmanageable. Health care is not “market forces”.

Balboa
Guest
Balboa

@Peter1: Insurance hasn’t been subject to the market because they opperate in a bubble. Ask your provider how much it cost for an MRI and they’ll dance around the question. Ask your insurance company how much the benefit is for the same service and they’ll dance around the question. Everywhere else if I ask how much something costs I get an answer, except healthcare.

The market force your citing is the actions of 3-5 major health plans and not those of the possible 300 million.

Peter1
Guest
Peter1

@Balboa,

The reason they “dance” is because of contract privacy. – a vary “market force” component.

allan
Guest
allan

Peter1, you really have to distinguish what is caused by government micromanagement and what is caused by the insurer. I will repeat what was stated to you in another thread as well as this one. The idea behind traditional insurance is the ***transfer of risk.*** Government is the entity that causes “Pre-exist exclusion” and higher prices along with a host of other undesirable things. In fact under the ACA those in the middle class not getting subsidies and not on Medicaid will be paying a higher price than before. We will also have higher levels of uninsured and people that… Read more »

Barry Carol
Guest
Barry Carol

Private insurance could not offer health insurance that the vast majority of the elderly could afford prior to 1965 and that was at a time when medicine could do far less for us than it can today. Medicare was passed largely in response to a market failure. So was Medicaid for that matter. Even today, the vast majority of people buying health insurance on one of the exchanges qualify for a subsidy to help them pay the premium. Before the availability of subsidies, they couldn’t afford it. By contrast, car insurance is comparatively inexpensive in most markets and those with… Read more »

allan
Guest
allan

“Private insurance could not offer health insurance that the vast majority of the elderly could afford prior to 1965″ Barry, in 1965 health insurance was in its infancy and growing. The senior population was also obtaining private insurance and the numbers were likewise growing. The passage of Medicare prevented continued growth in this sector and guaranteed tremendous fiscal problems in the future. Medicare has been trying to control costs almost from the very beginning of the program and has totally failed. To say that there was a need is not in question. Your conclusion of a market failure is strange.… Read more »

Peter1
Guest
Peter1

@ allan, Allan, you’re the one who wants to transfer risk that you don’t want to share to the government. The “government” legislated inclusion of all risk in the risk pool under the ACA – yes that made coverage more expensive for those with no subsidy or employer coverage. One major weakness of the ACA is the assumption that subsidies are not needed above about $63K for a single person (higher for families), and that if one family member has access to employer coverage the other is also not eligible for a subsidy. But it seems your fix would be… Read more »

Barry Carol
Guest
Barry Carol

“Today Medicare is increasing faster than the GDP. If one draws the two lines eventually Medicare surpasses the GDP so the program as we know it is in great jeopardy.” allan, That’s not accurate. This year is the fifth in a row of Medicare costs coming in below initial government (CBO) estimates. For the first nine months of fiscal 2014, total Medicare spending is up only 1.2% according to the most recently Monthly Budget Review from the CBO and that’s with 3% enrollment growth now that the baby boomers are becoming Medicare eligible in significant numbers. Medicare Part B premiums… Read more »

allan
Guest
allan

Peter1 “you’re the one who wants to transfer risk that you don’t want to share to the government.” You don’t get it! Insurance companies exist to make money not to benefit society though they do greatly benefit society in the process of making a profit. Thus they are willing to take on risk as long as at the end of the day the risk leads to a satisfactory chance of profit. As individuals we want to get rid of risk because high risks can lead to bankruptcy. The insurers recognize that most of the individual risks will not happen. You… Read more »

allan
Guest
allan

Barry, First don’t go year by year, but go by the trend. Based upon your profession you should already recognize that. Secondly take note and compare with the GDP NOT CBO estimates. If you want to look at the CBO look at its latest report which if you are able to read into will find frightening. Once the government has to let interest rates rise and other countries start to seriously devalue our currency you will note us being forced to act, but having our own eyes covered we will not see what is coming so there will be a… Read more »

Peter1
Guest
Peter1

“but insurers actually have very little to do with rising costs” They also have very little to do with controlling costs. They’re a big part of the problem. “But at least it will be the people actually receiving the care deciding on the limits they can accept. ” No, the limits will be what they can afford. The poorer will have lower limits the rich higher. “…they will have the legitimacy of democracy. So how do you think this democracy is working now? I want to form a private risk pool of just men, between 20 – 45 years ,… Read more »

Saurabh Jha
Guest
Saurabh Jha

Co-ops won’t work in healthcare simply because people don’t stick to the co-ops when ill; it is not easy to partition what one has paid for. In this system will ambulance services be provided by the market or the government? Let’s assume people get what they pay for, and some choose to pay for less and accept getting less. If I suddenly collapsed in a shopping mall how will the passerby know whether to call Ambulance Caviar for the Hot Heart Institute with a door to balloon time of 15 minutes, or Ambulance Good Enough for the Oliver Twist Institute… Read more »

Vik Khanna
Guest

In other words, we’re screwed and will continue to be so for the foreseeable future.

Saurabh Jha
Guest
Saurabh Jha

It’s the biggest generator of jobs. I think we’d be more screwed without out national obsession with HC, at this stage

allan
Guest
allan

Saurabh, ambulance service is very much determined by the states and their localities. We need to move all of healthcare in that direction. Insurers make money by insuring rationally. Most people act rationally. Put the two together and let them decided the terms. Government can help as a regulator and even in providing targeted resources. In that fashion normal intelligent people will decide what is best for them and those requiring a bit of assistance will get it. Remember, those bureaucrats that decide our fate come from the same gene pool as the rest of the population. Thus if as… Read more »

Saurabh Jha
Guest
Saurabh Jha

Agree about bureaucrats and their own biases.

Not sure you can rationally make people pay the marginal costs for the marginal benefits. This is essentially how a rational insurer would work.

Not sure you can stop diffusion of costs.

In little regulated markets such as India, which is nearly entirely cash payment from patients, the market is segmented. That means there are people who literally die because they can’t cough up the money.

If that happened here Anderson-Cooper would be all over it and before long you’d have a legislation. This is a democracy, after all, and a socially aware one.

allan
Guest
allan

“Not sure you can rationally make people pay the marginal costs for the marginal benefits. This is essentially how a rational insurer would work.” Why would one want to incentivize people to pay for marginal benefits? “Not sure you can stop diffusion of costs.” Which specific costs are you referring to? Re India: Is India better off or worse off in accepting the marketplace and moving away from socialism? It’s economy is growing much faster now. Same with China except China is ahead because it moved toward a market system earlier than India. Anderson-Cooper isn’t paying the bill and has… Read more »

Saurabh Jha
Guest
Saurabh Jha

My simple point is that the popular mood in your country will not accept the consequences of a free market in healthcare. And when that happens the government will legislate & regulate.

This is notwithstanding the known advantages of a market on the growth of the economy, or the known burden of the state on small businesses.

And a mixed economy in healthcare, with the pretense of a market & a pretense of government ownership, will produce the expensive, inefficient behemoth you have today.

allan
Guest
allan

Saurabh, that is your political opinion. Based upon the studies I have read the mood of the public is center right though the media leans towards the left. You can draw your own conclusions with regard to what the public will tolerate in healthcare. If you are Indian by birth then look at the important sectors of your own country and take note of what is generating a rise in the standard of living and thus a rise in health and lifespan. Look back to the 50’s (?) when India received food and medical support from the U.S. without attention… Read more »

Saurabh Jha
Guest
Saurabh Jha

“If you are Indian by birth then look at the important sectors of your own country and take note of what is generating a rise in the standard of living and thus a rise in health and lifespan.” I’m not alien to the benefits of the market. But it doesn’t matter what you or I think should happen. It matters what is. I don’t believe that this degree of government involvement is possible without popular will, even if implicit. Paul Starr in “Remedy and Reaction” made a very good point. The biggest opponents of ACA was not the “live free… Read more »

allan
Guest
allan

Saurabh, you are right even some of the Tea Party group didn’t want their Medicare touched. That is the problem with socialism. It creeps into the fabric of a nation and then everyone is on the dole and no one wants to give up anything they have until they are forced to by a severe economic downswing, stagnation or a political revolution. I believe popular will in America is for a marketplace where people have certain protections. Remember healthcare in the U.S. has not truly been in the marketplace since WW2. A marketplace solution could almost immediately reduce total cost… Read more »

Saurabh Jha
Guest
Saurabh Jha

Well there is another chance to verify your premise in 2016. 2012 didn’t inspire much in the way of confidence that the majority of the country were looking for a market solution to HC,

I’d like to see GOP run on a “repeal and replace” platform for ACA that relies extensively on the marketplace, and win.

Seriously. I dare them!

allan
Guest
allan

Saurabh the election of Obama had to do with a lot of things. I did a quick search on Rasmussen and this is the first direct answer I found to what I think is your basic contention. Nov 12 2013. 35% believe the law is good for America 55% favor repeal of obamacare We are seeing Democrats shying away from Obama and from the ACA. Though the mainstream news media says there is no Republican (impure marketplace) plan many plans have been promoted. Most of the impure market plans that I have seen want to solve the problem of pre-existing… Read more »

allan
Guest
allan

You seem to be trying to take something that is permanently broken and fix it using the same broken logic.

Along your lines of thinking is a simple solution. Start by going back to before ObamaCare and get rid of third party payer by changing the tax law so it is equal for both the employee and the employer. This would “allow individuals to come together to form their own healthcare groups, and then decide democratically how to draw the boundaries around the coverage that their healthcare pool will pay for.”

Vik Khanna
Guest

Allan is fundamentally correct. If we were really smart (and patient and diligent and willing to endure some discomfort), we would indeed go all the way back to the post-WW II era and tell employers, “Gey, folks, might not be such a good idea to create a health insurance benefit.” But, once benefits take shape, are codified, and create profits for lots of people and organizations, it’s nearly impossible to get rid of them. There is value, however, in asking the question of why is that of all the forms of insurance I purchase (long-term care, personal and professional liability,… Read more »

Talos
Guest
Talos

What a great idea to allow self-managed healthcare groups to form — maybe we can let the IRS approve them using the same great approval process used for the conservative groups seeking non-profit status. I hear that the Tea Party groups really liked that process. As to the ACA as the “law of the land”, well, the nice thing about laws are that they can be changed, and the ACA has been changed so much by Presidential Executive Orders, Exemptions, Waivers, and Delays that the CBO can no longer score the costs associated with the ACA. So, I find it… Read more »