Open enrollment periods for the ACA exchange health plans are limited in duration to prevent people from buying insurance only when a need arises, and then canceling the insurance after the need is met. This “adverse selection” would reduce premium revenues for the insurers while increasing expenditures for medical benefits. This drives up the cost of premiums for everyone else which can cause the healthy to bail out, driving premiums up even more and resulting in the “death spiral,” which is very disruptive to insurance markets.
As our health care system is being refined to supposedly replace quantity with quality in the delivery of health care services, we should learn from the experience of the National Committee for Quality Assurance (NCQA) – one of the more credible and experienced organizations attempting to improve quality in health care. Their founder and president, Margaret “Peggy” O’Kane, has a few lessons for us.
In his opinion piece, Thomas Friedman calls for electing a nonpartisan extremist for president. The first in his recommended list of extremist policy positions is a single payer universal health care system. Great!
Congress is divided on what to do about our expensive but highly dysfunctional health care system. Congressional opponents of the Affordable Care Act (ACA) today will vote for the 62nd time to repeal the Act without offering any replacement, and President Obama will veto the legislation. In contrast, supporters of health care reform would like to improve the system so that it works better for everyone.
These excerpts from the Kaiser Family Foundation/New York Times Medical Bills Survey of adults 18 to 64 confirm once again that our multi-payer health insurance system falls far short in preventing financial insecurity for those with medical needs. This survey expands on our knowledge base by demonstrating the deplorable consequences of the financial hardships created by this system.
As we struggle to bring to America a better health care system for all, it seems appropriate to cap the year with the final words from David L. Adams, M.D., of Cousins Island, Maine.
As Michael Marmot explains so well in “The Health Gap,” our health inequities stem from our failure to implement “proportionate universalism,” which he describes in the excerpts above – a must read. In fact, after reading the excerpts, you may agree that his entire book is a must read.
It seems that the current policy fixation in health care reform is on paying for value instead of volume. This really plays into the hands of the medical-industrial complex.
Physicians celebrated the passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) since it brought an end to the much despised SGR (Sustainable Growth Rate) method of adjusting Medicare payment rates. Though SGR was rarely implemented, it carried forward a massive deficit that would have required major reductions in Medicare payment rates. Besides, MACRA included the reauthorization of the Children’s Health Insurance Program. The trade-off, which was largely ignored, was the requirement to establish the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). CMS has now released a draft of the Quality Measure Development Plan for transitioning to MIPS and APMs.
This is just one more study that shows that far too many individuals who need health care still face excessive financial burdens in spite of being insured. Instead of merely trying to tweak our dysfunctional system, we should go ahead and replace it with one that works – a single payer national health program.
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