Folks in the general community are starting to notice something interesting about the Patient Protection and Affordable Care Act (PPACA): It probably won’t do much, if anything, to reduce private health insurance costs.
For people with good group health benefits and young, healthy, high-income people who have individual or family health coverage, the total amount of cash forked over for health insurance premiums, deductibles, co-payments, etc. could go up quite a bit.
Obama hinted while PPACA was being jammed through Congress that PPACA was not really truly actually about fixing what ails the U.S. health care system.
PPACA is about getting health care for poor people and sick people who urgently need help; trying to pick the very, very lowest hanging waste, fraud and inefficiency fruit; and getting the future health care gladiatorial arena nice and clear, to make sure spectators get a good view of the spurting blood and hacked-off limbs as health insurers, doctors, hospitals, health insurance brokers, third-party administrators, technology vendors, actuarial consulting firms, acupuncturists, drug makers, groups of sad parents, giant companies masquerading as groups of sad parents, and other combatants try to gouge one another’s financial eyeballs out.
Today, just about the only strategies the United States has for holding down health care costs are to use what amounts to a roulette wheel to decide what level of care poor people and sick people get, and, in some cases, to make poor people and sick people feel like worms when they go seek care.
Of course, using a roulette wheel to provide access to health care for poor people and sick people helps hold down the cost of commercial health insurance in states that allow medical underwriting, but it doesn’t do much to hold down the country’s overall cost of care. And, it’s mean.
Maybe you could make an argument that the poor people really are worms and just don’t deserve to have much, if any health care, because they’re poor, and therefore bad.
But what about sick people who actually had health coverage when they got sick and now have a hard time keeping and getting health coverage simply because they got sick? Everyone who’s being sincere will admit that that’s an absurd situation. The only reason health insurers got into that situation is that the law let their more desperate competitors make aggressive use of underwriting.
PPACA lovers will say that PPACA will reduce the cost of care for those poor and sick people by getting them reliable access to preventive care. Critics say that the poor and sick people will just use more preventive and routine care and still get sick a lot.
Maybe the truth is that today’s uninsured people are so hard to reach that no one will have any success whatsoever in getting them insured.
But, regardless: Intentionally keeping health insurance rates for young invincibles low by shutting out poor sick people does not have much consumer curb appeal.
Of course, health insurers already operate with low profit margins.
Maybe you brokers who are reading this still have higher margins and are good turnips to squeeze some blood out of, but, certainly, within a year or two, the market will get any available blood out of you turnips.
That leaves doctors and hospitals.
PPACA causes so much legislative and regulatory commotion in need of coverage I barely even have time to cover news about what health insurers and brokers actually do. I look at survey reports that might have gotten major play a few years ago and just kind of squint at them briefly with what PPACA Federal Register documents have left of my eyesight.
Here’s a good survey report: The International Federation of Health Plans 2012 Comparative Price Report, which is methodologically sophisticated enough to use the systematically negotiated prices U.S. insurers pay for care in the U.S. price data column, not the ultra-crazy prices U.S. providers quote uninsured patients.
The bottom line: U.S. providers charge a zillion times more for care than equally competent Dutch providers charge for comparable services. And doctors and hospital administrators in the Netherlands live very well and party on the Riviera in the summers, so, it’s not as if the Dutch hold down care costs by bringing in slaves with medical degrees from Surinam.
Here’s another really important document: A summary of the fable “Belling the Cat,” which, of course, is essential reading for anyone interested in U.S. health policy.
Right now, the cat is U.S. health care providers. Everyone is afraid to bell the cat.
On the one hand, if you make health insurers mad, they might, um, finance some U.S. Chamber of Commerce lobbying campaign that loses a few supportive votes in the Senate.
On the other hand, if you make health insurance brokers mad, they might fly somewhere and walk around with a clipboard looking really angry.
On the third hand, if you make doctors mad, they’ll make patients wait for five hours in the waiting room before anyone will look at their sore throats.
The great thing about PPACA is that, whether on purpose or not, it is, basically, a scary, randomizing monster that goes into a hoarder’s house and piles all of the hoarder’s belongings in a chaotic heap in the middle of the living room, and eliminates even the faint illusion that, just because all of the bottle caps were in one drawer and all of the used paper cups in another, the home was sort of functional. The heap shows how dysfunctional the home has been for quite awhile.
PPACA is about to pile much of what’s wrong with our health care finance system in a giant, scary, smelly, disgusting, apocalyptic pile and initiate the hour of the gouging of eyeballs. Especially of the cat.
Maybe we’ll gouge the right eyeballs — including the cat’s eyeballs. Maybe not. But, at least we’ll have to come face to face with what a mess our system is.