Obamacare or nobomacare, it makes no difference to me or the patients we care for as long as it serves our needs at a reasonable cost.
Something has gone off the rails in Washington, as the partisans politicians fight to defeat Obamacare. These sets of rules and regulations, already present in New Jersey before Obamacare were designed to make it easier for individuals to buy healthcare coverage.
Obamacare markedly increased buyers of insurance by expanding Medicaid through exchanges and by giving subsidies to those under a certain income bracket so they can afford to insure themselves and their families. From this perspective, the plan worked however, health insurance premiums, already increasing before Obamacare continued to increase while insurers made sure we paid more not only in premiums, but also paid more out of pocket as we had higher deductibles, smaller networks and plans that no longer gave us the option to receive care out of their provider networks.
Recently, the banter in Washington has “created uncertainty” with insurers who have been steadily backing out of exchanges. What Obamacare did right was expand coverage. Most American’s now agree that access to healthcare that is affordable is a right.
Our for profit system of hospitals, networks, insurers, doctors, suppliers and drug companies is a nightmare of complexity that is the real problem. Doctors are getting out of school with loans they may never pay off by the time they retire, requiring higher salaries for what they do. Primary care being is squeezed financially, forcing many doctors to forgo private practice, sell their practices to hospital systems or join large provider groups that have pricing power with insurers. These activities predatory activities have helped increase the costs of care for all of us.
Replacing Obamacare is not the answer, since people who are now insured like the rules and most people would prefer if our government improved the way it works instead and include a public option such as the ability to buy into Medicare at a younger age. Uncertainty is something investors and insurers do not like, but use as an excuse to increase our costs, such as the 25% increase in yearly premium my family just experienced.
Recently, insurers have made things even more complex with their dual tier plans, which reward large monopolies and punish good doctors trying to do a good job. Patients are stuck in the middle and no longer trust this system but they may trust their provider if the plan lets them do so. Patients are now finding that they may need to again switch providers of care just because of a change of tier, a large problem in NJ with Horizon’s Omnia as well as other plans. This shell game is not about your health, but about profits and relationships of the larger health care businesses in NJ, and we are merely pawns paying for years of insurance company mismanagement of the healthcare systems.
Drug companies have been hitting us with double digit increases, and nobody knows what any of the drugs cost to produce, but it is quite clear they are keeping our local network television stations in business, based on the volume of their advertising. It is also quite clear that these businesses are taking advantage of the system that pushes drugs and gave us opioid addiction.
Many doctors and specialists charge pie in the sky prices, even though insurers pay only a portion of that amount. They are regulated to death, and spend more time on electronic notes that they might with a patient, something that has to change. Why would a patient trust most doctors who appear to gouge us if we are uninsured, but give the illusion that being insured by them is our savior as they continue to charge us more yearly to appease their stock holders. Perhaps this is why most insurers no longer will pay for out of network care; this is the only way for them to control a game they are partly responsible for.
So far, the Medical home and experiments such as the ACO which has teams of doctors managing the care one doctor can likely do has saved little or no money. Does putting a pig on a diet make him a thinner pig; probably not. Are people really healthier using this method?
New payment mechanisms may or may not work and the latest experiment by United Healthcare paying chiropractors a global fee is a money loser for the providers. The plan is making out great and the providers who saved United a lot of money over the years with cost effective care are leaving, reducing access to great providers, and harming patients who must make tough choices after their provider leaves the network.
Wouldn’t expanding Medicare to everyone be more appropriate, to reduce complexity and to begin the process of reducing the cost of healthcare for us, while improving access. Medicaid is a state to state mess that does delivery only in select clinics and hospital settings. Other countries seem to have figured out how to make care affordable to most of the populace, why can’t we?
The great American healthcare experiment is failing due to a failure of vision an leadership in Washington, who do not understand that large groups reduce the cost of care for everyone, and state by state insurance plans are not cost effective or groups that are large enough. Furthermore, our politicians do not have problem, but would things be different if they did? More and more, expanding to a Medicare for all solution seems like the only real solution.
If this sounds like a rant, it is because like you, I am a consumer too. 25% increases are hard to swallow for those of us who work hard, play by the rules and need to be insured for our families sake, but at what cost?
For another point of view, I came across this recent article by a doctor in NYC who made some interesting points. You can read it here.
As for now, me and my wife would love to be able to buy into Medicare early. Most Americans would as well. How is it we as a nation cannot get there. The answer is, follow the Money.