Quote:
Originally Posted by GoldenRivet
@ Oberon
...
I almost lean toward scrapping the ACA altogether and letting free market capitalism run with the ball, when insurers are tripping over their own asses competing for customers the premiums will invariably be reduced. besides... anyone with nary a single dime to spare cannot be turned away from medical treatment - hospitals already receive a ton of tax incentives for treatment of those who are unable to pay as is.
...
|
There are a few problems with that idea. There was, for the most part, a very much free market capitalism situation in terms of health insurance and health care. The result had been the excesses of the insurance industry, and by extension, the hospital and pharmaceutical industries; the result of letting them have their own lead was ever-increasing and skyrocketing medical care and medicine prices and the exclusion of a very sizable percentage of the population due to the insurance industry's cherry-picking of clients they would accept and the restrictions placed upon those who were accepted in terms of type of care and and the extent to which the industry would cover their clients. Remember, the calls for health care reform were the result of the pretty much unfettered free market capitalism insurance/health care industry, not just a mere political whim. The medical care horror stories heard prior to the ACA were as bad, and maybe even worse, than post ACA. Also remember, taxpayers were already paying for the care of those under-insured or uninsured; many of those people could not afford preventative care and went to ERs usually when their conditions were so far advanced as to require far more extensive, and expensive, care, at taxpayer cost, than if they had been able to seek preventative care. And, speaking of ERs, the ACA has provisions penalizing ERs and hospitals who engage in a sort of "put a band-aid on gunshot wound" sort of care where they do just enough to get the patient out the door, dealing with symptoms rather than causes, resulting in the same patients having to make repeated visits to the ERs, again at a repeated cost to taxpayers. Now ERs who show excessive return visits are required to justify their decisions and are fined if it is shown they take the "easy way out" when dealing with ER patients. As someone who has made a few ER visits in recent years, I can say the thoroughness of treatment post-ACA is noticeable; the 'here's a couple of aspirin, go walk it off' attitude is fading; also, the formerly packed to the gills ER waiting rooms have thinned out very noticeably. Even the Free Clinic in my neighborhood is handling a lot less traffic. The indications are that if you deal with a health problem properly when it is relatively small and relatively inexpensive, the less likely it will have to be dealt with when it is major and very expensive...
The upper management of health care is also an issue; gone are he days when hospitals decisions were made by capable medical practitioners who had at least some empathy for the patients; now, decisions are are made by corporate bean counters who have very, very little to no concern for individual patient care and are more concerned about optimizing profits for shareholders of their corporations and in meeting targets to trigger their own bonuses and perks...
California voters, years ago, in response to skyrocketing insurance rates and hikes, gave the state insurance commissioner the authority to set ceilings for insurance rates and rate hikes for automobile insurance; insurance companies had to justify the need for rates and hikes by presenting all the evidence to justify their increases. When the law passed, the insurers stormed and bellowed, threatening to pull out of CA and never sell policies in the state again. The law went into effect and, lo and behold, the rates not only stabilized, most of them actually went down and there were even rebates. Most of this was due to the greater transparency in the rate setting process, and a lot of it was also due to something the free market didn't provide: competition. While the major companies bellowed and cursed, smaller companies were able to compete as they filled the voids left by the larger companies. Consumers had far more choices and the big companies began to relent: California is a huge consumer market and the majors could not afford to lose their shares. The experience with the auto insurance industry has led to attempts to put healthcare insurance under the same requirements, but has so far been unsuccessful; the major companies, with their lobbying clout, have thus far been able to dodge and/or suppress any effort to make them as responsible for their actions as are the auto insurers. Maybe it will change soon; the November 2016 ballot had a measure putting e-cigarettes under some of the same law as regular cigarettes and the tobacco industry spent a whopping US $71+ million dollars to defeat the measure and
lost by a a result of 64% in favor of the taxation of e-cigs against 36% against; more and more it seems big money is having less and less influence, at least in some states; how this will change, now that Daddy Warbucks is in charge, remains to be seen, but he has already indicated he wants to allow some facets of the ACA to remain intact, and not just minor aspects...
<O>