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Reference your question "If the government pays, who needs insurance?" It's simply a matter of the Government paying the provider and the Government collecting from the insurance company ON YOUR BEHALF. What gets totally eliminated is the insurance companies' ability to "stall" reimbursement in the hope you'll die before you win in court to make them do what they're supposed to do. In Germany, they add a wonderful policy: The compensation for the insurance exec is based on the number of policy holders they attract. So for the CEO to get a raise the company has to offer a BETTER deal to consumers and attract more policy holders..
Some of your comments I agree with, but not what comes first! I'll try to comment after your statements in bold.
So you agree that ACA is likely to increase the overall cost of health care as I've been writing all a long!!! Instead of a massive set of pages that mostly try to change who and how health care is paid for,mostly by tax payers , we needed more attempts to reduce the cost and price of health care and drugs for everybody first. You have written about the bad result of employer paid health insurance and ACA makes government like an employer paying for much of health care!!!
Posted by krlklar
This will happen over time. We didn't get in this health care mess overnight. It took years of ignoring the problem and patchwork solutions that are like giving morphine and bandages to someone who has cancer rather then attacking the cancer. Those may patch the wounds and mask the pain, but the cancer is still there.
That's what most of ACA does!
First get everyone insured somewhere. There is no rational or sane reason why the United States should have as many as 50 million of its citizens uninsired at any one moment.
if government pays who needs insurance?
Then the next step is to develop some form of universal standard for health care pricing and payment. The system of health care pricing in the United States makes no sense whatsoever. What one pays for any medical services or even a prescription drug can be all over the map. That has been posted and documented many times on this discusison board.
Agreed . Medicare and Medicaid have made the disconnect between prices and real cost greater than ever. (unreimbursed cost excuse)
Yes, this will involve the strong arm of the government as well. We could begin with what Medicare pays for the standard and encourage every private health insurance company and plan to adopt the Medicare standard. When everyone is insured somewhere, there should be no uncompensated care which will go a long way to ending the practice of cost shifting.
Price fixing is not simple and requires constant monitoring of reasonableness by the governing board.
Then Medicaid needs to be reformed. It should be taken away from the states and completely federalized. Because Medicaid is handled by the states, each state does it differently and has different levels of benefits, coverages and payment levels. Plus a Medicaid card in one state is no good in a neighboring state. If someone from MIchigan is visiting a family member in Ohio and needs medical care, it is a real hassle for the doctor to get payment from an out of state Medicaid program. Very often any medical care is emergency care because it is mandated and it is treated as if the person is uninsured.
There ARE differances in costs and availability from state to state , but it shouldn't be so hard to get care in any state. Not sure federalization of the whole medicaid program would work, but there has to be better across state line coverage.
In addition Medicaid reimbursement rates need to be equalized so they are identical for the same medical services as Medicare payments. We cannot have Medicaid become a second class form of health insurance simply because the reimbursement rates are so low that many medical providers refuse to accept Medicaid. Right now in many areas it is impossible to find any dentists who accept Medicaid payments. There was a scandal in Chicago a few years ago where a boy who had a severe abcess in one tooth died from sepsis because no dentist would accept Medicaid and he never got that infected tooth treated. Only until it got so bad that he had to be admitted to the hospital was this brought to the attention of anyone. The boy died a few days after showing up in the ER. That is unacceptable in this country!
Are Medicaid reimbursements part of the problem of trying to set prices? Price fixing has problems unless they are realistic. Won't there be similar problems with Medicare care availability if the rates are too low?
The ACA offers a good start toward actually getting everyone insured somewhere and by reining in skyrocketing health care costs. But the rhetoric from the right has obscured the act and your moaning about the act being over 2000 pages long does not help one bit. Any act of congress that affects so many people in different situations and tries to address what is wrong with a major sector of the economy needs to be very long. if we wanted a single payer system like expanding Medicare for everyone, then it could be digested down into a fraction of what the ACA was when it was passed.
There should have been a split between attempts to contain and reduce the price and cost of health care and the attempt to change who pays for it so that the first part could be started immediately and the second debated and simplified before enactment. The mistake was in trying to do everything at once when so much didn't take effect for years anyway. Separating would reduce the complexity and increase understanding of the "whole thing"
Who needs insurance if government is the single payer?
We didn't get into this health care hole overnight and it will take a long time to get out of the hole. But at least we have stopped digging and are now have a way out of the mess. Whether or not it works depends on how it is implemented and I have posted numerous posts on that subject. For if the ACA fails in its objectives of insuring just about everyone and bringing down the rate of increase of health care costs; the alternative will be government administered single payer.
I don't see how ACA is "stopping the digging" in the price and cost hole significantly. Bringing down the costs is such a small part of ACA. I I don't see single payer solving that problem even if it would cut out the insurers profits.
Posted by golfinsailor
Posted by krlklar