Perhaps the most fundamental principle of health insurance is to pool risk – the high costs of the few are distributed amongst all participants in the pool. Since health care has become so expensive, distributing costs has made each person’s share – the insurance premium – unaffordable for many.
Paul Song’s article is particularly helpful in understanding the health care reform challenge before us in that it describes one of the most successful programs in the nation – California’s – while noting the gross inadequacies of reform limited by our current federal laws and regulations.
We hear often of healthy individuals remaining uninsured because of the very high cost of health insurance, but it is a risk that they are willing to take because they have very few health care needs…though they hope nothing really bad happens. Well, bad things do happen, and this study confirms that 70 percent of those who lost the bet face destitution.
Believe me. Take a few minutes (9 to be precise), and read this (at link above). Then send it to others and strongly recommend that they read it, and then have them send it on to yet others who might also care. This needs to go viral. You will not find a better description of why we need a single payer system.
Under the MACRA replacement for the flawed SGR method of determining Medicare payments, CMS is moving forward with shifting the delivery system into alternative payment models, the predominant model being the accountable care organization (ACO). This study of one of the premier ACOs in the nation (Partners HealthCare) should make us question whether such a shift is wise policy.
The United States is unique in having a massive amount of personal medical debt when we are spending twice the amount per person on health care than the average of other wealthy nations in which medical debt is much less common. What is wrong here?
In her book, “An American Sickness,” Elisabeth Rosenthal has provided an excellent description of the dysfunction of the business model of health care delivery in the marketplace. On this basis alone it is an invaluable resource for every health policy library – home or institutional.
Would people prefer that their health care coverage be adequate and affordable or would they prefer that their insurers thrive in the market even if to the detriment of the beneficiaries? That’s a ridiculous question though the Trump administration has given a ridiculous answer: cater to the private insurers and forget the patients.
The Medicare Payment Advisory Commission (MedPAC) is an independent federal commission that advises Congress on the administration of Medicare. It currently is evaluating the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) established by the Medicare Access and CHIP Reauthorization Act (MACRA) – the replacement for the flawed Sustainable Growth Rate (SGR) method of determining Medicare payments.
Health care is, or at least should be, about the patient. This study shows that physicians are splitting their time fairly evenly between direct face-to-face patient care and desktop medicine, especially through the electronic health record.
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