Wednesday, May 25, 2016

The ACA Complaints

I had a friend complaining about the ACA and the costs. While costs go up, a few reports have shown that costs have gone down overall, thought plenty of individual complaints about rising costs. Also, companies pulling out of exchanges. I’m not sure that’s because of not being financially viable. I think it’s more greedy, not enough profit viable.

However, someone posted the Heritage plan from 1989 and said it was dramatically different from the ACA. My response.

I read the pages, and I agree with xxx. The plans are very similar. Require everyone to have insurance, mandate this, provide subsidies, and impose a fine through a check at tax return time. The requirement of family v employers is divergent, but that's not what I'd call very different. It's a step from where we were to where we would like to be. I'd like to see all health care outside of employer plans, but that's a big step to take. Lots of people disagree, and I've yet to see anyone on the GOP side propose this as a modification of the ACA.

I didn't se anything about catastrophic plans and self-insurance. There is hedging about having the government have some input into plans in a limited basis, which could be debated.

I would say that the ACA is a good step forward. Certainly it can be improved, it also should be better implemented in different states. I can find plans that are in the $12k range (silver) and gold plans in the $15k range in CO. Some of the problems exist in that insurance is state based, which causes dramatic swings in prices. So if you're a states’ rights person, this is how things work. If you're a federal rights, you bemoan this. Neither is right, just different.

I think in the discussion of the ACA we've lost some objectivity and rationality. I think the goals and aims were worthwhile and mostly achieved, but there is some failure. Some is poor design (employer burden) some is poor implementation and obstructionism by the GOP, who have continually and constantly refused to try and put the citizens of this country above their party success. Fuck them.

At the end of the day, insurance companies are greedy bastards that want to make millions (for a few people) while there is relatively little concern over the actual health of individuals. There is a need for regulation if we are going to use insurance companies. I'd like to see a high guideline (And limit) at the federal level, but really more state/local review of what profits are allowed. I'd also want to require complete pricing disclosure. Transparency would help.

I have no idea how to get consumers to better manage healthcare. If the costs are low, they will abuse and overuse the system, as pointed out in the Heritage document. Not many, but perhaps we should manage or limit those individuals from using the system this way rather than limit everyone. How we do that? No idea. Someone smarter will have to come up with ideas.

However if costs are high, people avoid healthcare and possibly preventing other issues. Not to mention cultural issues of people not actually wanting/trying to take care of themselves.

This is a mess, but blaming the ACA or the GOP isn't helpful. Come up with something workable and talk to your congress people. Sticking with talking points and parties continues a mess.

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