How would you improve the ACA?

[hobbsyoyo]

So, how would you improve the Affordable Care Act, also known as Obamacare?

I suppose half are going to say "UHC BABY" and the other half "DITCH IT", but I'd like to focus on potential fixes for the law that are legislatively possible.


A couple of things about the law irk the crap out of me:

1)Subsidies come back to you after you file your taxes. This is just stupid to be blunt. If you have low-enough income to qualify for subsidies, why should you have to pay everything upfront only to get it back at the end of the year? I understand that the plans are already subsidized so, for example, I would only pay $300/mo for a plan that would have cost $800/mo before the ACA and then get a chunk of that money I pay back so that it winds up costing around $250/mo all told. However, it just doesn't make sense to me to have people pay the full price up-front. I can see no good reason for this at all other than maybe it's easier for the tax authorities to handle the subsidies/penalties this way. It's definitely a hardship for a lot of folks and is inconvenient and confusing.

2)Costs need to come down across the board; coverage should go up or both. I know that with the subsidies, insurance for individuals is now actually somewhat affordable. As with my earlier example, I really would have to pay $800/mo for coverage before the ACA. Now the government takes on the role that employers have traditionally played by paying for the bulk of the coverage and having individuals pay a smaller portion of it. However, the rates are still too high to be popular in my opinion.

Yes, what is popular isn't necessarily good public policy. But in this case, people like me are having to decide if the almost-unreasonable rates are worth it or if they'll just eat the penalty. When it is the case that a lot of young, healthy people like myself are faced with this choice, it's really going to hurt the effectiveness of the law and drive up costs when we opt-out en masse. I am really struggling justifying paying for coverage that is a big chunk of our income for less-than-stellar coverage.

I don't go to the doctor and don't usually have need to. The one thing the coverage would be great for someone like me is if I got hit by a bus or something. However, the crappy coverage means a massive deductible that is big enough that if I were hit by a bus I would still go bankrupt which defeats the purpose of the law.

I understand that it's very difficult to have good coverage with low deductibles that are cheap. It's really not possible to be cost-effective that way. But on the other hand, if something isn't done to either make the law cheaper or increase coverage/lower deductibles, a lot of people are going to be skipping on healthcare coverage. At the end of the day it will be cheaper to just eat the penalty than it is to pay for the coverage that I don't really need and won't really help me when I need it most such as getting hit by a bus.

In any case, while I think cost-effectiveness/cost-controls are great, the primary purpose of this law should be to provide affordable coverage to anyone who needs it. On that point it's failing I think.

I'd mention the website as well but that issue speaks for itself.

What say you all?

--Oh crap, one other thing:

They need to make the damn law easier to understand. I'm an informed consumer and I go out of my way to figure out stuff with regards to implementation of the ACA and even I am confused a lot.

 

[Murky]

I would do a state by state phase-in of a single payer system (with state buy-in) so there is time for the economy to absorb the job loses from the health insurance industry. States that want to stick with private insurance would have that option but they would be leaving billions on the table that would otherwise be allocated to paying for single payer health care.

 

[GenMarshall]

I'd like to see the employer mandate and the individual mandate dropped out of Obama Care. The employer mandate is only going to cause employers to reduce part timer's hours to be under the threshold for compliance. Killing off part time hours. As for the individual mandate, I don't want to pay a penalty tax just because I don't have health insurance. Worst of all, the penalty goes up each tax year.

 

[KmDubya]

You should cancel and repeal the whole thing. You just can't polish this turd.

To reform healthcare costs you should instead look to deregulate the insurance companies to allow them to offer plans in every state, and especially to institute tort reform to get lawyers out of the system. Defensive medicine due to fear of frivolous lawsuits drive the cost up for everyone.

This of course will not happen as trial lawyers are a huge political donor and the government likes the power of now controlling healthcare in the US.

The scary, but inevitable, final solution will be when costs are reduced by stopping care 6 months prior to death as this is when most of one's healthcare costs occur. We won't call it killing but instead treat it like a really late term abortion. Maybe have a big going away party before sending the old people out of our misery. Might even need to set up a special police force to catch anyone who runs away.

Since you won't know when the last six months will occur, the government will have to pick an age for this to happen, you know just to be fair. Remember it is not about life but "quality of life"

 

[Antilogic]

Deregulation, eliminating liability, and death panels, why am I not surprised.

NOTE: Insurance companies can already offer plans in every state if they meet local requirements, what does this talking point even mean?

 

[DroopyTofu]

I know very little about all of this, but as I best understand it, the law will increase costs for large numbers of Americans. That seems pretty backwards for the Affordable Care Act. So I guess change it to lower costs instead of increase them?

 

[KmDubya]

Deregulation, eliminating liability, and death panels, why am I not surprised.

NOTE: Insurance companies can already offer plans in every state if they meet local requirements, what does this talking point even mean?

Individual States have unique coverage requirements and mandates. All states do not let all companies in. Companies that are in a state already lobby politicians to pass regulations and laws to keep competition out. It is cheaper to pay off a politician then to offer a better product.

More regulation = less competition + more cost

Tort reform is needed for any meaningful attempt to reduce costs in the US. Winning millions for burning oneself with coffee while driving should never happen in a sane and just world.

It is the younger people who should be more upset with this. Higher costs, employers rewarded for using workers 29 hours per week. Combine this with the larger student loans, higher housing costs, high unemployment rate and the outstanding 17 trillion in debt and your generation is going to be economic slaves.

There are people who work for a living and people who vote for a living. When there are not enough people pulling the sled (workers) the whole system will crash.

 

[Antilogic]

Yep, no standards shank-or-be-shanked health insurance is definitely the only solution. I can't believe nobody thought of this before.

 

[sophie]

Tort reform is needed for any meaningful attempt to reduce costs in the US. Winning millions for burning oneself with coffee while driving should never happen in a sane and just world.

Tort reform was instituted in Texas. Healthcare costs have not been meaningfully been reduced in that state as a result (as I recall reduction in costs was something to the order of less than 2%).

Anyway, if I could do anything short of instituting an actual UHC, I would like to see a public option. I feel like that is the piece of the equation that's preventing the personal mandate from really working.

Also, obviously, getting a large player like the government into the health care business negotiating medication costs (rather like medicare does now) would really help cut down the cost of medicine in this country.

 

[Tahuti]

First, impose price controls on basic insurance. A federal bureau should keep track that the prices are not too low to cause shortages but as low as possible still. Also impose maximum prices on medical services and goods acquired through medicare to reduce and rollback medical inflation induced by medicare, and gradually phase-out medicare (since insurance should be affordable enough to not necessitate medicare any longer). Eliminate the legislative numerus fixus on medschool enrollees and non-medical (costs) related aspects of ACA.

 

[amadeus]

I'd scrap the whole thing and get the government out of it―start with ending tax breaks for employer-provided coverage and allowing people to buy coverage from across state lines.

 

[hobbsyoyo]

I know very little about all of this, but as I best understand it, the law will increase costs for large numbers of Americans. That seems pretty backwards for the Affordable Care Act. So I guess change it to lower costs instead of increase them?

Yeah going from $800/mo to $300/mo was a huge increase.

 

[Azale]

I know very little about all of this, but as I best understand it, the law will increase costs for large numbers of Americans. That seems pretty backwards for the Affordable Care Act. So I guess change it to lower costs instead of increase them?

Even if this were correct, and it's not, the point was to provide near universal coverage and contain long term healthcare costs as a percentage of 1. individual's budgets 2. the federal budget. Plans offered before often did little but place people deep in debt once actual health problems showed up.

But there has been no sticker shock. The worst case scenario is a very small number of people sign up, the pool of healthy people becomes small, and premiums increase but that has definitely not already started occurring.

Can't wait to hear from the libertarians how the government is a greater evil than the insurance companies. Health market is one of the more cut and dry cases of a market failure.

 

[Cutlass]

You should cancel and repeal the whole thing. You just can't polish this turd.

To reform healthcare costs you should instead look to deregulate the insurance companies to allow them to offer plans in every state, and especially to institute tort reform to get lawyers out of the system. Defensive medicine due to fear of frivolous lawsuits drive the cost up for everyone.

This of course will not happen as trial lawyers are a huge political donor and the government likes the power of now controlling healthcare in the US.

The scary, but inevitable, final solution will be when costs are reduced by stopping care 6 months prior to death as this is when most of one's healthcare costs occur. We won't call it killing but instead treat it like a really late term abortion. Maybe have a big going away party before sending the old people out of our misery. Might even need to set up a special police force to catch anyone who runs away.

Since you won't know when the last six months will occur, the government will have to pick an age for this to happen, you know just to be fair. Remember it is not about life but "quality of life"

This will raise the costs of the system and lower the lifespans of the American people. But what will it accomplish otherwise?

 

[downtown]

I think I'd probably scrap most of it and try to rebuild something else, including a public opinion. It sucks, given all the money that's already been spent on this, but I am pessimistic that buy-in will ever be enough to make the ACA work as intended, thanks to administrative bungling and the massive, unrelenting forces to prevent any kind of worthwhile health care reform.

 

[Antilogic]

I'd scrap the whole thing and get the government out of it―start with ending tax breaks for employer-provided coverage and allowing people to buy coverage from across state lines.

So who sets the standards for minimal coverage? Or are there no standards?

Health market is one of the more cut and dry cases of a market failure.

A million times this.

I think I'd probably scrap most of it and try to rebuild something else, including a public opinion. It sucks, given all the money that's already been spent on this, but I am pessimistic that buy-in will ever be enough to make the ACA work as intended, thanks to administrative bungling and the massive, unrelenting forces to prevent any kind of worthwhile health care reform.

What do you mean by most of it? The preconditions provision? The extension of parental insurance for their children? The only real sticking points that gain political traction is the Medicaid expansion and the goofy single-state exchange markets that might actually be set up by the federal government.

The massive unrelenting opposition imbues me with a very different pessimism--that price is already paid for the ACA, so we are unlikely to see a single payer or public option for a long time. People won't want to touch this again.

 

[JollyRoger]

Tort reform is needed.

Absolutely. There are far too many hoops to jump through when one is a victim of medical malpractice or wrongful breach of contract by insurers . All the special litigation rules set up to protect and coddle medical providers and insurance companies should be eliminated. Make such litigation just like a standard lawsuit. It has be over a decade since a patient has won a case against a doctor or insurer in the Texas Supreme Court. Reform and rollback is long overdue,

 

[Cutlass]

The problem is, that without the public option, at the very minimum, the law was never sufficient to the need in the first place. The second main problem being that the law tried to balance being way too nice to employers with not ending the employer provision of the bulk of health insurance. So we are at best in a realm of half-measures. Nothing Congress was willing to touch was sufficient to the need.

Now, short of putting in a UHC, what might fix the problems? To start with, letting employers avoid paying for part time workers was a mistake. How the law should have read was that for any employee, in a company of any size, including temporary and contract employees, if the company does not provide health insurance, then they have to kick in a FICA like tax as a percentage of all the pay to the employee. And if they have an employee copay as part of their company health insurance, they company has to pay on the portion that they do not provide to the employee. That will raise the money from the employer to pay for the cost of the public option.

And then you do the public option. In short, everyone in the country is automatically enrolled in the public option, unless they opt out because they have, verified, other insurance through personal or group policies.

It's that simple: Everyone is enrolled, every employer pays.

And then you need to go for some actual cost controls to the system:

• A US government plan, any part of the government, pays the lowest price for prescription medicine that that medicine is sold for anywhere in the world. If any other customer, worldwide, pays a lower price, the US government price is automatically lowered to that amount, or less.
• The US government, any branch of it. is prohibited from paying for any prescription medication that is marketed to the general public.
• The Medicare Advantage program is abolished.
• A set of strict accounting standards is set up, and all medical providers are required to adhere to it at all times.
• A standards board is set up to reduce excessive testing and drug prescriptions.
• Limits need to be placed on end of life care that has no chance of really extending life.

 

[amadeus]

So who sets the standards for minimal coverage? Or are there no standards?

You and your insurance company.

 

[Antilogic]

You and your insurance company.

You, as an individual, have so little bargaining power over the company that your answer might as well be the insurance company alone.