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ACA Agonistes
Healthcare Priority for the New Government: Cost, Cost, Cost

More Americans than name affordability as the most important problem with America’s healthcare system than at any other time in the last decade, according to a new Gallup survey, likely reflecting the impact of decades of cost inflation in healthcare and several years of steep premium hikes in the Obamacare exchanges.


Throughout President Obama’s first term, as the above chart shows, Americans were more worried about access to healthcare than the price tag. The Affordable Care Act mainly addressed the former issue: By expanding Medicaid, subsidizing private healthcare purchases, and mandating that insurance plans offer comprehensive coverage, the law expanded access significantly. But subsidies, mandates, and regulations also reduced competition in the healthcare sector and contributed to rising costs, forcing many middle-class families to pay much more for their coverage. Since 2012, as Obamacare began to take effect and the economy improved, Americans have grown less concerned about healthcare access and increasingly concerned about affordability.

The next administration and Congress should put the access question temporarily on hold and adopt a laser-like focus on bringing healthcare costs down overall. That means opening up competition among insurance companies by allowing them to offer a wider range of plans, arresting or reversing the trend toward hospital consolidation, and making a full-court press to apply the gains of the information revolution to the healthcare sector. Because in the long run, as we like to say, affordability is access, and leveraging the market to slow healthcare inflation so that care is increasingly affordable for a growing middle class is a better approach to health reform than simply expanding ever-more expensive care with a growing array of subsidies and mandates.

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  • Beauceron

    This can’t be right. Those people are rubes. After all, it’s called The Patient Protection and Affordable Care Act .

  • Disappeared4x

    Making medical insurance portable is another idea gone missing since McCain2008 got drowned out. More important, when will anyone, besides us consumers, notice the real problem with medical care in the USA is the way doctors are trained to FIRST prescribe an expensive FDA-approved drug with side effects that beget another prescription?

  • rheddles

    The only way for the Federal government to bring medical costs down is to open a medical school, or 15.

    • f1b0nacc1

      Another way would be to deregulate medicine, and allow more flexibility in treatment. Not everything requires a board-certified MD, and in fact the role of state licensing boards (and their federal counterparts in lobbying) have done more to drive up prices than all the evil insurance companies in the world.

  • FriendlyGoat

    “Opening up competition among insurance companies by allowing them to offer a wider range of plans” means allowing insurance companies to write policies with thinner benefits or thinner networks. It does not and cannot mean anything else. If you do this “across state lines”, it means the federal government telling 49 states that they may not retain rights to define the standards for policies sold in their home states? Why not say so in a place like this? (Since nearly no one understands what the heck this is even about.)

    • f1b0nacc1

      Whether you like it or not, that is precisely what is about to happen, and the results will be quite positive. Why should a 25 year old male in perfect health be required to get the same sort of plan as a 60 year old woman in lousy health or a 30 year old woman who is expected children? Why should someone trapped in a Blue sewer be forced to deal with their nanny-state mandates (or those of federal ‘crats) when they neither need nor want them? I thought Lefty’s were all about ‘choice’, or is that only the case when it comes to abortion? You love to scream ‘race to the bottom’, and while there are times that it does have some validity, that is hardly the case all of the time. Lets be blunt, if lower costs in lightly regulated markets were all-conquering, then MIssissippi would be an industrial powerhouse (as would Zimbawe or South Sudan), and the only retailer would be Amazon. Even if this were so, and healthcare was something magical where we could guarantee that a race to the bottom would happen, what precisely is the problem with it? Obamacare is generating its own race to the bottom and insurers are simply exiting states that are too expensive or have populations that cannot be covered given the excessive mandates.

      The truth of the matter is that healthcare in the US is expensive (a huge part of that is what we pay healthcare workers), and the only way to change that is to introduce competition and restore price signals. This is hardly enough, but it is a first step in the right direction.

      • FriendlyGoat

        I don’t think there is necessarily a lock on “across state lines” if journalists would get busy telling people what it is. It is an invitation for employers everywhere, especially the small ones, to shop for far lower standards and inform the employees when those will be going into effect. People tend to think this is all about those poor schmucks buying a subsidized policy on the exchanges. Not the case. This is about providing employers a path to “cost control” for the groups. That’s why Republicans have been talking about it in generalities for five years and not a damn one of them has ever given a citizen a decent detailed explanation of what it is for or how it is to work.

        Don’t bother brow-beating me on this personally. I’m on Medicare (and not charging it any claims, BTW.)

        • f1b0nacc1

          Some employers absolutely wish to control costs, and I don’t blame them a bit, but they are hardly the only players in the game. Many (mine, for an example) see good benefits as a way of retaining talent, and explicitly engage in the pattern of retaining good benefits to do so. My point is that there isn’t a mechanistic race to the bottom for everyone, merely for some part of the market, so your argument about motives is hardly demonstrated. Like most things in the real world, there are lots of different motivations for different players…one size doesn’t fit all. I know that this is not pleasant for you to understand, but it doesn’t change reality….

          The GOP has not ‘talked in generalities for five years’, there have been numerous plans with quite a few specifics out there for more like 10 years, many of them referred to you in these threads. You keep ignoring them to focus on a talking point….I wonder why?

          • FriendlyGoat

            It’s true that the American Health Care Reform Act of 2015 was a real bill. It’s also true it was known to be DOA when introduced and never explained to any Republican voters.

          • f1b0nacc1

            So in other words, ‘they didn’t mean it’ and hence a real, concrete proposal doesn’t count? The GOP made two proposals that you admit to….their names are on them….they have in fact been excoriated in various electoral venues as a result (it didn’t do the Dems any good, but they tried), but that doesn’t count? You are reaching here, and even by your standards, that isn’t particularly convincing.

            While *I* am in tech, my company is not. In point of fact my group is a very small part of a company overwhelmingly dominated by call-center folks and drivers, as blue-collar as you can get. The benefits are the same (based upon seniority, etc. of course) for all of us. Management has taken the attitude that good employees are hard to come by, and employee churn is VERY expensive to cope with…cheaper in fact, than higher benefit costs. Other companies may have other ways of doing things, but that is the whole point of CHOICE….

            0-2, you really need to up your game….

          • FriendlyGoat

            1) Well, of course they “didn’t mean it”. If they had, you would see them now pass that particular bill by February 1st, have the new president sign it and the tell the GOP voters how happy they will be with its immediate implementation. You may have noticed that absolutely no one in GOP-land is planning to do any such thing. They are scrambling for a repeal and delay scheme involving the 2018 election precisely because they know that their “concrete proposals” of the past aren’t worth a hoot and would be rejected by most of the people who just voted for them—-let alone those who did not.

            2) As for your company, perhaps you are against PPACA and your company isn’t. Or, If it is, perhaps you could explain why a successful and generous company with a good plan is bothered by minimum essential coverage standards you are claiming it wants to exceed anyway.

          • f1b0nacc1

            Well, it isn’t February 1st yet, so lets see what happens. I would be quite pleased with a return to the pre-Obamacare status quo, but I rather doubt that is in the cards. One position of Trump’s that I am not crazy about is that he wants to retain the politically popular parts of Obamacare (regarding pre-existing conditions, insurance of ‘children’ till age 26, etc.) while scrapping the rest. That these nonsensical aspects are popular is no surprise (freebies are ALWAYS popular), but that doesn’t make them good ideas. There are numerous suggestions about what will replace Obamacare, so rather than there being no details, there are too many at this point. Lets see what happens post inauguration, and revisit that then. In the meantime, your refrain that there are no details being proposed remains disproven and dead, whether you like it or not.

            My company is run by people who make me look like Ezekiel Emmanuel, so there is little chance that they approve of Obamacare or anything associated with our soon to be former president. They believe that to retain employees that it is best to be generous, but they acknowledge (and I know this from a direct conversation with the head of the company and its major stockholder) that this is hardly a universally held, or universally appropriate, point of view. Even if it were, they oppose the government imposing it upon everyone else…strangely enough, they believe in choice. Now why don’t you believe in choice?

          • FriendlyGoat

            Your company’s owners, like all people in real businesses which depend on employees, are always caught by “what do we have to do to be competitive in retaining good ones?” They also realize, however, that they do not necessarily have to offer a “really good” health plan as long as other employers’ plans are not enticing the workers away to something better. The labor market in an industry or in a place is always relative. “Is the compensation here good? This is only really ever compared in owners’ minds to “What else is available to these particular workers at this time?” Except for citizens changing the debate from time to time with unions or government, that is the only game going on since the time of Charles Dickens and proceeding to the present moment in all countries.

            So, I think all employees everywhere should be concerned about the start of any market-strong trend to lower standards in health plans.
            Too many people are feeling too secure in their groups as though what they have been getting is not subject to reduction. After they “dumb around” and repeal both federal standards AND standards at their own state level, my suggestion to them would be “Watch Out!”

            I never said no details were “proposed”. I said no details were “explained” to voters on either left or right. “Proposing” is what goes on in the Chamber of Commerce or The Heritage Foundation or in a party caucus. “Explaining” the realistic effects on real people of a real Obamacare replacement absolutely has never been done by Republicans anywhere. If it had been, they would lose elections.
            That’s why they don’t do it for years running. As of now, it looks as though they may continue the shroud-over right through 2018 midterms.

          • f1b0nacc1

            You really should stick with things that you know about, though I do realize that would pretty much stop you from commenting altogether. My company has one serious competitor, and they have labor practices that make Scrooge (pre-ghosts) look like Silicon Valley in the 90s. We have had a few cases of serious financial loses connected to too much labor churn, and management (who I tend to respect) decided to take steps to avoid it in the future. There is no union or regulator pressure, and virtually no competition for workers in my industry. Your theory, like so many others you espouse, has very little connection to reality here.

            When employees are necessary, they are treated well by employers, for reasons that I imagine should be obvious to you. When they are not (fast food and university adjuncts come immediately to mind, though they are hardly alone), then employers tend to deprioritize their interests, also for obvious reasons. One might regret this (and actually I do, these are people, after all), but the solution (if one exists at all) is for those workers to make themselves necessary, not simply to pretend that they can use governments heavy thumb to skew the measurements of their value. When a worker is less productive (at the margin) than the cost of their labor, they are no longer valuable to their employer, and that employer will do away with them. The idiocy of Obamacare (and other Lefty pipedreams like the $15/hr minimum wage, regulatory changes, etc.) is that it increases the cost of that labor without providing any extra value for it. Businesses can and will respond to this, and we can see this already in the growth of automation for low- and semi-skilled jobs, restructuring of working hours to get around Obamacare regulations, etc. The losers in this particular game are the workers, who will find their jobs significantly degraded, or even eliminated so a few well-connected ones might benefit. Markets are dynamic, and the one-size-fits-all mentality that rejects consequences for change that characterizes the Left cannot and will never be able to overcome this simple truth.

            So we have gone from ‘specifics weren’t provided’ to ‘specifics weren’t explained’? Come now….I know that this is football season, but you keep moving the goalposts more than is necessary. Given that you embrace a policy that ‘we had to pass it to see what was inside it’ and that failed on almost every single one of its rather vague (dare I say gauzy?) promises, you are working from an almost embarrassingly incompetent double-standard. Even Obamacare architects (Gruber comes immediately to mind) acknowledged that the only reason the thing passed in the first place was that the population didn’t actually bother to get any real details on what was being sold to them. The details of several plans have been out there for years, suggesting that they should be held to a higher standard than you do for your own proposals is not going to fly.

            You can whine about it all you want, but you lost this round, and if you are the best your camp can provide in response, you had best get used to losing a LOT more.

          • FriendlyGoat

            Oh good grief, you moron. I am not losing anything. I argue only on behalf of a whole class of people who are. As for the GOP with Obamacare, they are beginning to understand the mess they are in for having lied their asses off about “replace”.
            You haven’t grasped this yet, but serious Congressmen and Senators on the right have.

    • Boritz

      Defense of states’ rights?

      • FriendlyGoat

        Yes. Accurate words if you’re not going to have any federal policy standards. Most states’ residents may prefer to write their own rather than have those from the worst-regulated state in the country become operative everywhere.

    • Anthony

      FG, contradictions or muddleheaded thinking (in the last 35 years, health care costs in U.S. have risen from an average of 4.5% of worker compensation to about 10% of total pay for those with coverage provided on the job). And here’s the conclusion: “that’s why stemming the sharp rise in health-care costs, and lifting some of the severe restrictions that Obamacare places on how companies can design their health coverage, could be a boon to blue collar America.” Go figure – can you really have it both ways.’s-shore-thing-14888.html

      • FriendlyGoat

        There is a difference between being a boon to blue collar employees and being a boon to their employers when we speak of Blue Collar America. We just elected the latter on health care and every other subject.

        • Anthony

          The point most relevant to your contention; and reason I raised connection and linked regarding exchange.

  • Boritz

    “By expanding Medicaid, subsidizing private healthcare purchases, and mandating that insurance plans offer comprehensive coverage, the law expanded access significantly. ”

    Access to a paper policy to put in your file cabinet is mainly what was expanded. Actual treatment after plunking down the deductible, not so much.

  • ljgude

    Picture an automobile market in the US where cars cost about twice as much as they do elsewhere in the developed world. Both the article and the discussion are like debating ethanol subsidies and air bag safety instead of starting to look seriously at medical tourism. Book a particular procedure from whoever has that particular surplus capacity in their system.

  • Frank Natoli

    Cost? Cost is the problem? The Messiah promised $2,500 per annum reduction in family health care insurance. Instead, the reverse was delivered. Why is “cost, cost, cost” the concern starting only in 2017?

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