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I think you should post some links to relevant sections of the ACA and show me where they take specific actions to drive down costs. I will tell you that I've

by Nrsolis 10y ago

I think you should post some links to relevant sections of the ACA and show me where they take specific actions to drive down costs. I will tell you that I've seen scant evidence that it's working. A wishlist of initiatives isn't a plan for action that drives down costs. Allowing Medicare to NEGOTIATE prices for drugs is a plan to drive down costs. The insurance companies wanted to GROW the per-capita spend on healthcare. That benefited them. It's really really unclear if it benefited the public right now. Forcing people into a market they don't want to be in isn't reform. The way to solve this problem is to make being a part of the market ATTRACTIVE. IMHO we really missed an opportunity to affect behaviors. For one thing, Romneycare incentivized people to skip insurance until they needed it. That was a recipe for adverse selection. The way to help this is to provide incentives for people to get in WAY EARLY and pay for their OWN care long before they may need it while also providing a measurable benefit to those who get in early right away. People are capable of responding to incentives and I'm convinced that there exists a Nash equilibrium in healthcare that helps everybody win. Remember, the same people who gave you "the Internet is not a truck" are the same people you're expecting to solve healthcare affordability. Think about that.

ubernostrum 10y ago
I work for a company which operates in the Medicare Advantage space. A provision of the ACA sets a minimum medical loss ratio for us. In simpler terms: it puts a legal cap on our profit margin, by requiring a minimum percentage of the money we take in to be spent on benefits to our members (such as paying their claims). That is almost certainly going to get repealed.
- Nrsolis 10y ago
  In that scenario, are your interests served more by spending via medicare increasing or going down? If your incentive is to maximize the absolute amount of actual profit you earn and the ONLY way you can do that is to push more money towards healthcare providers, then what do you think will actually occur? Because once you have achieved that spend level on provider care, you're in the clear. The ONLY way for you to increase profit is to ensure that more procedures happen.
  - ubernostrum 10y ago
    We don't profit from paying out to providers; we're an insurer. We profit when people are healthy.
    - Nrsolis 10y ago
      I think you misunderstand my question. In a perfect world, you'd keep 100% of the premiums and never pay a cent to a healthcare provider because everyone is healthy, right? In a terrible world, every single one of your insured has a chronic, long-term expensive to treat condition that requires you to pay tons of money to providers. In the first/perfect case, premiums are zero, right? In the second/terrible/worst case, you're not making zero money because your (collected premiums - minimum payout) > 0. See where I'm going with this? In a world with healthy people, there is little need for health insurance and spending trends towards zero. There isn't a need for an insurer. Your company can only exist in a world with sick people.
      - tunesmith 10y ago
        I don't see how that point has any value. It's kind of like calling Social Security a ponzi/pyramid scheme. It's only true if children cease to exist. Similarly here, your point only has value if sickness and accidents cease to exist. But that won't happen. The market for health insurance naturally exists already. And the incentives for increasing health care costs are very much what the ACA is about - those incentives are being affected by things like the ACA rewarding quality-of-care instead of fee-for-service, etc.
        Nrsolis 10y ago
        I'm for aligning incentives. Quality of care is a good direction but doesn't go far enough. We need to get real price transparency into the market so people understand what it costs to treat lung cancer and what the probabilities are that they'll actually get better. Do you think the average person on the street really knows what it costs to undergo a round of chemotherapy? Does the EXACT SAME procedure performed in different hospitals across town cost the same? These are important questions and there doesn't seem to be any political will to actually answer them. And my suspicion for this state of affairs is that the interests of the players in this game is for nobody to really know what things cost because if they did the game would change. And we can't have that, now, can we.

by Nrsolis 10y ago

ubernostrum 10y ago

I work for a company which operates in the Medicare Advantage space. A provision of the ACA sets a minimum medical loss ratio for us. In simpler terms: it puts a legal cap on our profit margin, by requiring a minimum percentage of the money we take in to be spent on benefits to our members (such as paying their claims). That is almost certainly going to get repealed.

Nrsolis 10y ago
In that scenario, are your interests served more by spending via medicare increasing or going down? If your incentive is to maximize the absolute amount of actual profit you earn and the ONLY way you can do that is to push more money towards healthcare providers, then what do you think will actually occur? Because once you have achieved that spend level on provider care, you're in the clear. The ONLY way for you to increase profit is to ensure that more procedures happen.
- ubernostrum 10y ago
  We don't profit from paying out to providers; we're an insurer. We profit when people are healthy.
  - Nrsolis 10y ago
    I think you misunderstand my question. In a perfect world, you'd keep 100% of the premiums and never pay a cent to a healthcare provider because everyone is healthy, right? In a terrible world, every single one of your insured has a chronic, long-term expensive to treat condition that requires you to pay tons of money to providers. In the first/perfect case, premiums are zero, right? In the second/terrible/worst case, you're not making zero money because your (collected premiums - minimum payout) > 0. See where I'm going with this? In a world with healthy people, there is little need for health insurance and spending trends towards zero. There isn't a need for an insurer. Your company can only exist in a world with sick people.
    - tunesmith 10y ago
      I don't see how that point has any value. It's kind of like calling Social Security a ponzi/pyramid scheme. It's only true if children cease to exist. Similarly here, your point only has value if sickness and accidents cease to exist. But that won't happen. The market for health insurance naturally exists already. And the incentives for increasing health care costs are very much what the ACA is about - those incentives are being affected by things like the ACA rewarding quality-of-care instead of fee-for-service, etc.
      - Nrsolis 10y ago
        I'm for aligning incentives. Quality of care is a good direction but doesn't go far enough. We need to get real price transparency into the market so people understand what it costs to treat lung cancer and what the probabilities are that they'll actually get better. Do you think the average person on the street really knows what it costs to undergo a round of chemotherapy? Does the EXACT SAME procedure performed in different hospitals across town cost the same? These are important questions and there doesn't seem to be any political will to actually answer them. And my suspicion for this state of affairs is that the interests of the players in this game is for nobody to really know what things cost because if they did the game would change. And we can't have that, now, can we.