If You Like Choice, Competition and Entrepreneurship, You Should Like Obamacare

[n2doc]

By Gene Sperling

Free market competition. Informed consumer choice. Greater freedom to start a business. These values are often espoused by critics of the Affordable Care Act. Yet too many of those critics ignore the law’s fundamental reliance on market principles of choice and competition to drive better deals for consumers and the government, or the degree to which it unlocks the possibilities of entrepreneurship.

Prior to the ACA, there was little about the individual health insurance market that supported competition or consumer choice. Most individual markets were being dominated by just one or two insurance companies. In 2012, two insurers covered more than half of the individual market in 45 states and the District of Columbia. In 29 states, a single insurer covered 50% or more of all enrollees. Without competition, prices rose – by as much as 15% a year for those renewing in the individual market.

Further, where choice among insurers did exist, consumers were not able to meaningfully compare their insurance options. If grocery shoppers could not tell how many ounces were in a bottle of milk–or whether the milk was skim or whole–it would be impossible to have sound competition. The same is true for health care. And, consumers were routinely forced to undergo underwriting screens–often with a different questionnaire for each plan offered–that would disqualify applicants for any perceived risk to the insurer, making any choice that did exist illusory at best.

The Affordable Care Act’s new health insurance Marketplaces are bringing millions of Americans into a truly competitive insurance market for the very first time–and competition to attract these new customers is on the rise. One in four insurers in the federal Marketplace are new entrants to the individual market. On average, there are 8 different health insurers participating in each of the 36 Marketplaces being operated by HHS, with as many as 169 plans for consumers to choose from.

more

http://www.forbes.com/sites/theapothecary/2014/03/28/if-you-like-choice-competition-and-entrepreneurship-you-should-like-obamacare/

Send it to the righties you know, just to make their heads explode. From Forbes, no less.

[Sarah Ibarruri]

1. It is the first time that any sort of insurance is offered to uninsurables and everyone

It's the closest the U.S. has come to anything close to this. It's a wonderful program and I'm glad I'm here to see it.

The Republicans had no intention of anyone ever having coverage, and the whiners have never had 1 idea of how to implement any programs to cover everyone. I've yet to hear one. They had no ideas, and have none now. They just whine about pie-in-the-sky.

[OmahaBlueDog]

2. It solved the main problem for individuals buying insurance -- becoming part of a "group"

It enables those who don't work for a big company or governmental entity to get quality insurance that covers maternity and pre-existing conditions.

[Sarah Ibarruri]

4. It's a fantastic first step, one which no one before had accomplished, and which

the whiners could not have accomplished. In fact, the whiners couldn't have accomplished anything, and still cannot, and never will be able to.

[MrMickeysMom]

3. Let's face it, it's better than what was in place, but will not prevent the exploding ...

… cost of the health care delivery system on all of us. I cannot understand out of pocket costs for some persons in this system. It's a matter of how many hoops there are and if they stay employed. The very people who deliver this system are making less than $11.00/hour taking care of patients in the in patient and out patient part of the system. The weakest portions of the system are under-employing or under-paying to deliver it. I know. I work with them.

It took me a long time to even be eligible for HC, and when dealing with ACA in terms of what my employer offers, I can afford to be in the Gold Plan. But, neither this, nor Silver will offer the kind of care that reduces a growing cost. The surrounding business and residential communities of America are being swallowed up. Less time, more work, and a dwindling tax base in this country have made what was offered, which was better than what we have, not good enough to stymy off many working people's ability to save money and get out of debt. Meanwhile, the health care debt is growing and we have major problems with ensuring everybody's on board to deliver the care.

I've said it before… Medicare for All. It was THAT important.

[OmahaBlueDog]

6. At the moment, the ACA actually is slowing exploding costs

Medical inflation is at the lowest levels in years.

Part of the rising costs were a constant spiral: uninsured persons needed treatment; they had no money to pay; their unpaid costs got passed on to the insured. The ACA should help alleviate that. Another part of the equation that should be helped by the ACA - people with no or bad (i.e. Maj Med) got no annual physicals or other preventative care, and ultimately ended up getting their treatment in the ER (the most expensive care out there).

All one can do is speculate on "what if", but I doubt Medicare for all would have passed, and if it had, would have had its own issues. Ask anyone on Medicare -- it's not perfect. It has holes, and not every doctor accepts it. I suspect Medicare for all would have driven many physicians into the private pay market, out of the country, into research, or out of the profession.

Also, I think the insurance companies get too much of a bad rap here on DU. I'm not saying they are not greedy. I am saying they are no less greedy than the other players in the medical system. I made that point in this post in which the poster indicated that ".....physicians are placed in an “ethical bind” as they practice under “a corporate medical model that threatens to squeeze the humanity out of our interaction with our patients.” :

I don't see physicians as victims of a soul-crushing corporate system. I see them as equal players in a game that has four players: the physicians, Pharma, the for-profit health insurance market, and hospital networks. As with all games, the players are sometimes partners and sometimes opponents, but they all have one goal -- skim as much money from the system as possible.

Yes, all of these players, at some level, are there to help people and improve health outcomes -- in the same way that American Eagle wants to sell you trendy clothes or that Chipotle wants to sell you addictive, overly large burritos. However, the principal goal of all of these enterprises is to make money.

The amount of money the physicians and hospitals (not to mention skilled nursing and assisted living facilities) rake in is especially appalling in light of what you correctly indicated:

The very people who deliver this system are making less than $11.00/hour taking care of patients in the in patient and out patient part of the system. The weakest portions of the system are under-employing or under-paying to deliver it. I know. I work with them.

Long story short: We had to start somewhere, and whether we like the ACA at this point or not, it's a start. Nothing more, nothing less. We still need to get everyone with some level of coverage and simultaneously start moving to reduce costs on the provider and pharmaceutical sides of the equation.

[MrMickeysMom]

7. The reason I could not disagree with you more is based on real experience...

...and really being educated as a health care provider who has managed part of the system through various versions of health care "reform" and practiced across the entire continuum. Regarding the spiraling cost of the health care delivery system, accelerating medical inflation is strongly correlated with a growing separation (wedge) in the medical market between doctors and patients created by third parties. Reform policies that increase this separation, such as those reforms based on President Obama's priorities, can be expected to increase medical price inflation.

There should be small doubt that large health care delivery system, such as the one I work for, should be less expensive in terms of service delivery, but that is not so. And we who deliver it are paid paltry wages in one of the biggest systems in SW PA (I'll leave you to guess which one). The outcomes still show revolving door outcomes on the biggest diagnostic related group being "served" care. It's not getting less expensive, it's getting more expensive.

To say the insurance companies are no less greedy than the other players in the medical system is redundant. They are one and the same here. It follows the same economic model that is supposed to have been cheaper, but remains more out of reach unless you blow through your out of pocket expenses. Not much left over to budget the activities of every day living, I tell you.

It's not a matter of Medicare for All (which you doubt would have passed) would have had it's problems, too, as Medicare still has it's problems… I say to you… ask ONE of the people receiving Medicare to switch to something else…. I dare you. I double dog dare you.

We VERY WELL COULD have Medicare for ALL. Why? Because, it is going to cost MORE later if we don't. The ongoing analysis AND data show this. Where do you think local tax bases are going? They are wringing out people in fixed incomes like an over-used rag.

This business of ACA being a starting point… Woooh… it sure is….

[OmahaBlueDog]

9. You make many points, so I'll respond

To say the insurance companies are no less greedy than the other players in the medical system is redundant. They are one and the same here. It follows the same economic model that is supposed to have been cheaper, but remains more out of reach unless you blow through your out of pocket expenses. Not much left over to budget the activities of every day living, I tell you.

They are not one and the same. The providers and hospitals spend a lot of time and invest a lot of money gaming the systems set up by the insurers, and also game Medicare and Medicaid. DUers spend a lot of time criticizing the insurance industry. I think some of their anger is legitimate, but the bulk of their anger is misplaced -- it should be directed at the hospital networks and the providers themselves.

I say to you… ask ONE of the people receiving Medicare to switch to something else…. I dare you. I double dog dare you.

That's a really silly double dog dare, since Medicare is designed to insure a market that the private sector won't insure, and to care for non-income earning retirees. So it's like asking me to ask people to choose whether they'd rather have insurance or none at all. Of course they'd rather have insurance. Ask them if they are thrilled with Medicare. Some will undoubtedly say yes. Others will tell you it's a major pain in the ass. Most Medicare recipients I know pay for supplemental plans, and most I know are screwed if their doctor prescribes anything formulary -- which generally depends on how influenced the provider is by their Pharma reps. I have an older friend in South Florida who was told straight up by his provider that he "didn't believe in prescribing generic medications."

Regarding the spiraling cost of the health care delivery system, accelerating medical inflation is strongly correlated with a growing separation (wedge) in the medical market between doctors and patients created by third parties. Reform policies that increase this separation, such as those reforms based on President Obama's priorities, can be expected to increase medical price inflation.

I'm not doubting your personal experience, but the industry-wide numbers don't lie:

For decades a common refrain was that the rapid rise in health spending hurt the competitiveness of American businesses and ate into workers' take-home pay. Businesses and politicians from both sides of the aisle agreed that something had to be done to slow the growth of health-care costs. New data Monday from the Centers for Medicare and Medicaid Services show that we are making important progress. From 2010 to 2012, health spending grew at an annual rate of just 1.1% in real per capita terms—the lowest rate in the 50 years we have been collecting these data, and a small fraction of the 6% rate that inaugurated the past decade.

http://online.wsj.com/news/articles/SB10001424052702304617404579304483562111024

Already sluggish health-care inflation is expected to slow down even more in 2014 as consumers, employers and the federal government continue looking to cut medical costs, a new report said Tuesday.

And the rate of health-care inflation—as distinct from total medical spending—could drop further in future years as the Affordable Care Act rolls out and employers and consumers pay greater attention to costs, suggests the report by the professional services firm PwC.

In 2014, the health-care inflation rate is projected to slow to 6.5 percent, according to the "Medical Cost Trend: Behind the Numbers" report by PwC's Health Research Institute. That's 1 percent less than the 7.5 percent inflation rate for 2013 that HRI projected last year.

http://www.cnbc.com/id/100822251

We VERY WELL COULD have Medicare for ALL. Why? Because, it is going to cost MORE later if we don't. The ongoing analysis AND data show this. Where do you think local tax bases are going? They are wringing out people in fixed incomes like an over-used rag.

Maybe we could. Maybe we couldn't. I support the ACA. I'm a fan of government -regulated private-sector solutions. I like the idea of private innovation and incentive that is coupled with a mandate that 85% of the revenues have to be spent on care.

My family experience with Medicare is a mixed bag (I have one relative working full time at approaching 81 because he wants to keep his insurance and wants nothing to do with Medicare), and while I think other government health care systems are better than nothing (e.g. the VA, the BIA, etc.) I've seen a lot in providing care to veterans and Native American health that could be improved.

The CNBC article above mentioned this:

About 33 percent of the businesses the HRI surveyed in another study indicated they planned to partner directly with high-performance health networks, which offer high-quality care at lower prices. One example is cardiac care offered by the Cleveland Clinic, which is being used by Lowe's, Boeing and Wal-Mart, the report noted

You mentioned your personal experience, so I'll mention mine. I had an HMO in Florida that I thought was dreadful until I discovered they covered providers at Cleveland Clinic. Anything bad that I have to say about providers and hospitals does not apply to them. They manage to deliver consistently excellent care at both the primary and specialist level, and control costs. Were I still in Florida (or, in Cleveland), they would be my provider. They are the model for providing care that I wish others would emulate.

[MrMickeysMom]

11. I don't think you understood about them being "one and the same"

When a HCDS also is the insurer, they ARE the same. The hospital network is also one of a dual system of where the insurance company bought the health care delivery system, or vise versa. I'm insured by the hospital system who decided to go into the business of health insurance.

As you said, "Medicare is designed to insure a market that the private sector won't insure, and to care for non-income earning retirees." Medicare is administered by private insurers, you have to know and it operates with such efficiency, regardless of Medigap co-insurances that people buy into. The dare is still on. You are NOT going to get that type of coverage outside of Medicare. That's why retirees can get buy, and very well get by if they have also managed to put aside some money (another issue, which due to the jobs market, is horrible). The dare is still on.

The concept of ACA presents itself when health care costs are already at the breaking point. I find it interesting that you use a Wall Street Journal and CNBC reference to tell me that the inflation slows down and that's a good thing. It may not be as bad of a thing, but it certainly isn't good now. Its not a sufficient thing to keep it from imploding altogether.

Cleveland Clinic is great, and how many workers of Wal-Mart are insured, now? What do they make, now? How are those incomes from workers in big box stores enabling them to NOT draw from state resources, due to their low incomes? Medicaid costs more the the state in this demographic.

Any good points about ACA (and there are good points) have quite simply arrived too late to stop the bleeding. The only thing that will change that prediction is for the United States to ACUTELY increase a livable jobs market and/or increase the living wage.

Now, which one of these things (living wages, job markets, Medicare for All) do you think will happen first?

[OmahaBlueDog]

12. No, I understand. I just disagree

When a HCDS also is the insurer, they ARE the same. The hospital network is also one of a dual system of where the insurance company bought the health care delivery system, or vise versa. I'm insured by the hospital system who decided to go into the business of health insurance.

Insurers, physicians, hospital networks, and Pharma are four separate players. They may, in certain cases, be allies working together because it serves both of their interests at the moment, but if one feels they are losing out on the arrangement, they will divorce in an instant.

The dare is still on.

Your "dare" is a laughable proposition. Of course those who can't buy insurance elsewhere are going to opt to keep what they have. If seniors were eligible to buy into the ACA as an alternative, maybe you'd have a case. They're not. It's a moot point.

I find it interesting that you use a Wall Street Journal and CNBC reference to tell me that the inflation slows down and that's a good thing.

What? Democrats aren't allowed to cite respected business publications or networks? I'm planning to attend the Berkshire Hathaway stockholders meeting. Do you find that interesting as well?

Cleveland Clinic is great, and how many workers of Wal-Mart are insured, now? What do they make, now? How are those incomes from workers in big box stores enabling them to NOT draw from state resources, due to their low incomes? Medicaid costs more the the state in this demographic.

Well, in two days every Wal-Mart worker who is not already insured is supposed to have purchased coverage under the ACA. If they have not done so, I'd urge them to go to www.healthcare.gov tomorrow.

If they are working Wal-Mart as their sole source of income, I agree that their $7.75 an hour is insufficient to keep them out of government programs and subsidies. I think it's not necessarily a correct assumption that most are doing that. To be sure, some are. I mostly shop at Target (same idea, but with happier workers) and Costco. Costco pays well. Target offers insurance to full time employees. In the cases of Target and Wal-Mart, many of those that I've talked to at any length (working in my area- YMMV) have a spouse/SO making a substantial income and are supplementing a family income -- not providing sole support. Having said all of that, raising minimum wage to at least $10.10 (I think $15 is a better target) is a splendid idea.

Now, which one of these things (living wages, job markets, Medicare for All) do you think will happen first?

Wages. I know of few businesses that actually pay $7.75 now, although some would if they could. Even McDonalds here starts at $8.60, and they still are always screaming for workers. I think outside of the hard core wing nuts who want no social safety net whatsoever, I think that there is increasing consensus that a really easy way to cut government spending and raise revenue is to raise the minimum wage.

[MrMickeysMom]

13. Reality is a bit away from what you described to me. Let's get real.

Look, I take no offense that you find some of my attitude laughable, but if you think that among insurers, physicians, hospital networks, and Pharma, if one of them feels they are losing out on the arrangement, they will divorce in an instant, you must never stuck around long enough inside the experience with any health care system, especially when one of the biggest health care systems owns one of THE biggest insurance providers. Choice is not the word I'm thinking of... neither is divorce of how these things work together between the employee's enrollment periods.

And, since you feel that given the choice of wages, job markets, and Medicare for All, the one that stands to change first is wages… well, then we have a much longer wait for any improvement in parts A or D in Medicare, much less a chance to evolve the present choices and costs through the ACA to something this country can survive with. Again… we have to institute immediate changes in the ACA. You may not realize it yet. That's yours to discover.

Better you should stick to stockholder meetings where your can ask each other why Warren Buffet goes on about paying fair taxes as he pioneers new ways for Berkshire Hathaway to avoid hundreds of millions in it's taxes.

No wonder you don't quite get what the consumers of health care policies are experiencing under the low wage experience. You're ride looks like it's on cruise control in the other lane, OBD.

[OmahaBlueDog]

14. Apropos of nothing, Warren Buffet supported Barack Obama

...and Berkshire owns no healthcare stocks.

By the way, I qualified for a subsidy under the ACA, so don't go leaping to assumptions about my wages or lack thereof.

Anyway, we're done discussing this. I'm sure there are other issues upon which we agree, but this is clearly never going to be one of them.

Peace.Out.

[MrMickeysMom]

15. Yeah, there is nothing to add here...

I make no assumptions about your income, just the moral placement of Buffet's Berkshire… It matters not where these stocks are invested, as the point was the moral implication of those like Buffet who gains notoriety for pointing out the unfair taxes of a secretary versus what he pays, then does what all unfettered capitalists do by corporate welfare.

To better times, OBD...

back at ya…. MMM

[Junkdrawer]

5. Before the ACA, there were only two ins. choices in Pgh. Now there are two choices...

positioned so as not to compete with their non-ACA policies.



Damn these lying eyes...

[YoungDemCA]

8. How about equality and human welfare?

Yes, I said it. "Equality" is not a bad word. "Welfare" is not a bad word, either. "Promote the general welfare", anyone?

Those of us on the Left need to own our words, not let the Right define words for us. And I don't like it it when we buy into the libertarian narrative with words like "Choice" or "Competition" or "Entrepreneurship." We're Democrats and progressives, not libertarians.

[OmahaBlueDog]

10. I think you have Democrats confused with Socialists

As a Democrat, I support free enterprise, innovation, and competition. However, with that needs to come regulation, and safeguards to insure that those doing the work get a reasonable share of revenue in proportion to those who supervised the work and those who supplied the capital. Those who have profited most from the system should be expected to give back. Those who do the day-to-day work should be able to form groups to negotiate the best deal they can make for pay and benefits. Why not? managers and purchasers negotiate for the best prices from suppliers and the best price from purchasers. Why shouldn't labor be any different?

At the same time, what is equality in human welfare. We should all get three meals, but should we all eat the same thing? Do we all even want to eat the same thing? Personally, I hope a Union Carpenter does live better and earn more than his non-Union counterpart.