While pharmaceutical firms and insurers stand out for having reputations of placing profits over patients, the rest of the health care industry has not totally escaped the perception of this blemish in its ethics.
Once again about 60 percent of Americans say that the government should be responsible for ensuring health care coverage for everyone. There are a couple of observations in this particular poll worth considering.
So far Congress has initiated a process to eliminate health plan subsidies and eliminate individual and employer mandates authorized by the Affordable Care Act. This update estimates the numbers who would be uninsured and estimates the increase in non-group insurance premiums that would occur if insurance reforms such as guaranteed issue remained in place.
Of the OECD nations, the United States ranks near the bottom in health care justice. And yet Congress is moving forward with legislative action that likely would further diminish justice within our health care system.
Linda Blumberg and John Holahan explain why premiums in non-group insurance markets can be high, and they suggest policies that can improve the stability of premiums. The proposals would increase the administrative complexity in our system when we are already tremendously overburdened with administrative excesses, and, further, they are designed to protect the private insurance industry – an approach in which providers and patients are considered a nuisance which must be accommodated to benefit the insurers.
There are two main reasons that the Republicans want to convert Medicaid to block grants for the states. Instead of paying a percentage of Medicaid costs, block grants can be set at an amount of payment that is lower and that does not increase at the same rate as health costs, thus shifting Medicaid costs from the federal government to the states. Also, the states are given much greater leeway on how the block grant funds can be spent, reducing federal regulatory oversight.
One of the problems with the various pay-for-performance schemes is that social risk factors play a major role in health care outcomes. Dedicated physicians and hospitals who take care of patients with greater social risks tend to be penalized for factors over which they have no direct control. This 374 page ASPE report was generated at the request of Congress to define this problem and consider solutions.
Considering the amount of money we spend on health care in the United States, we should be making special efforts to see that we spend it right. This Lancet series, “Right Care,” is helpful because it defines for us where we are not providing enough care (underuse), leaving too many with unmet health care needs, and where we are providing excess care (overuse), wasting resources that could be used elsewhere, not to mention that excessive care is sometimes harmful.
What is the point of today’s message? Virtually everyone wants affordable access to health care, for themselves at least. Most want a better system than what we have under the Affordable Care Act. But the nation is divided as to whether ACA needs to be repealed prior to improving the functioning of our health care financing system.
The negative consequences of repealing the Affordable Care Act without replacing it with measures that address some of the problems that ACA was designed to fix have been well publicized. President Obama is right to warn us about repealing ACA without replacing it. But the full story is more complex.
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