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Old 12-27-2013, 12:25 PM  
HonestChieffan HonestChieffan is offline
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Replacing ObamaCare . The next big step for Washington

The number of people who still hold on to the hope that the ACA will survive is growing terribly small. Even progressive pundits are distancing themselves from the disaster called ObamaCare. Before long only Alan Combs will be left selling this .


The future holds some great opportunity to replace ACA with something that actually does improve HC in the US is huge. Doing the right thing will be a two stage effort. Eliminate all memory of ObamaCare and replace with something that works.

Interesting take from WSJ:


By JOHN H. COCHRANE

The unraveling of the Affordable Care Act presents a historic opportunity for change. Its proponents call it "settled law," but as Prohibition taught us, not even a constitutional amendment is settled law—if it is dysfunctional enough, and if Americans can see a clear alternative.

This fall's website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and "accountable care organizations" will take their turns in the news. There will be scandals. There will be fraud. This will go on for years.


Yet opponents should not sit back and revel in dysfunction. The Affordable Care Act was enacted in response to genuine problems. Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs.

There is an alternative. A much freer market in health care and health insurance can work, can deliver high quality, technically innovative care at much lower cost, and solve the pathologies of the pre-existing system.

The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a "certificate of need" before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.

We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. We'll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service.

The Affordable Care Act bets instead that more regulation, price controls, effectiveness panels, and "accountable care" organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked? Did we get smartphones by government pressure on the 1960s AT&T phone monopoly? Did effectiveness panels force United Airlines and American Airlines to cut costs, and push TWA and Pan Am out of business? Did the post office invent FedEx, UPS and email? How about public schools or the last 20 or more health-care "cost control" ideas?

Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.
Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses.
People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence. Businesses cannot establish or contribute to portable individual policies, or employees would have to pay taxes. So businesses only offer group plans. Knowing they will abandon individual insurance when they get a job, and without cross-state portability, there is little reason for young people to invest in lifelong, portable health insurance. Mandated coverage, pressure against full risk rating, and a dysfunctional cash market did the rest.

Rather than a mandate for employer-based groups, we should transition to fully individual-based health insurance. Allow national individual insurance offered and sold to anyone, anywhere, without the tangled mess of state mandates and regulations. Allow employers to contribute to individual insurance at least on an even basis with group plans. Current group plans can convert to individual plans, at once or as people leave. Since all members in a group convert, there is no adverse selection of sicker people.

ObamaCare defenders say we must suffer the dysfunction and patch the law, because there is no alternative. They are wrong. On Nov. 2, for example, New York Times columnist Nicholas Kristof wrote movingly about his friend who lost employer-based insurance and died of colon cancer. Mr. Kristof concluded, "This is why we need Obamacare." No, this is why we need individual, portable, guaranteed-renewable, inexpensive, catastrophic-coverage insurance.
On Nov. 15, MIT's Jonathan Gruber, an ObamaCare architect, argued on Realclearpolitics that "we currently have a highly discriminatory system where if you're sick, if you've been sick or you're going to get sick, you cannot get health insurance." We do. He concluded that the Affordable Care Act is "the only way to end that discriminatory system." It is not.
On Dec. 3, President Obama himself said that "the only alternative that Obamacare's critics have, is, well, let's just go back to the status quo." Not so.

What about the homeless guy who has a heart attack? Yes, there must be private and government-provided charity care for the very poor. What if people don't get enough checkups? Send them vouchers. To solve these problems we do not need a federal takeover of health care and insurance for you, me, and every American.

No other country has a free health market, you may object. The rest of the world is closer to single payer, and spends less.

Sure. We can have a single government-run airline too. We can ban FedEx and UPS, and have a single-payer post office. We can have government-run telephones and TV. Thirty years ago every other country had all of these, and worthies said that markets couldn't work for travel, package delivery, the "natural monopoly" of telephones and TV. Until we tried it. That the rest of the world spends less just shows how dysfunctional our current system is, not how a free market would work.

While economically straightforward, liberalization is always politically hard. Innovation and cost reduction require new businesses to displace familiar, well-connected incumbents. Protected businesses spawn "good jobs" for protected workers, dues for their unions, easy lives for their managers, political support for their regulators and politicians, and cushy jobs for health-policy wonks. Protection from competition allows private insurance to cross-subsidize Medicare, Medicaid, and emergency rooms.

But it can happen. The first step is, the American public must understand that there is an alternative. Stand up and demand it.

Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business, a senior fellow of the Hoover institution, and an adjunct scholar of the Cato institute.
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Old 12-27-2013, 12:36 PM   #2
jiveturkey jiveturkey is offline
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I like a lot of this. Up front pricing/advertised pricing for providers would make a huge difference.

Disconnecting insurance from employment is another solid idea. If an employer wants to contribute to my plan then goodie for me.
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Old 12-27-2013, 12:55 PM   #3
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Personally, wouldn't have a problem with a lot of this. At the minimum it acknowledges that there is a problem and offers a solution (don't know a lot about the feasibility of it) rather than just throwing poo on the wall and screaming for an appeal.
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Old 12-27-2013, 02:19 PM   #4
BucEyedPea BucEyedPea is offline
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Replace it with nothing if you're asking for a freer market. Chicago school is not exactly free-market and Cato was taken over by neo-mercantilists.
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Old 12-28-2013, 11:24 PM   #5
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Originally Posted by BucEyedPea View Post
Replace it with nothing if you're asking for a freer market. Chicago school is not exactly free-market and Cato was taken over by neo-mercantilists.
Let's just play identity politics and reject a plan based on guilt by association.

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Old 12-29-2013, 10:18 AM   #6
BucEyedPea BucEyedPea is offline
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Originally Posted by HonestChieffan View Post

The future holds some great opportunity to replace ACA with something that actually does improve HC in the US is huge. Doing the right thing will be a two stage effort. Eliminate all memory of ObamaCare and replace with something that works.
Government "replacing [ACA] with something that works" is a pipedream.
Repeal it and replace it with nothing except rollbacks of thousands of mandates and interference in HC markets by govt---which has been the cause of our broken HC system.

We don't need some sort of Republican progressivism either.
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Old 12-29-2013, 10:26 AM   #7
BucEyedPea BucEyedPea is offline
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Originally Posted by JohnnyV13 View Post
Let's just play identity politics and reject a plan based on guilt by association.

BEP: If it doesn't come from 1) Ron Paul, 2) Rand Paul, 3) Lew Rockwell, 4) from the ghost of Murray Rothbard, 5) doesn't have anarcho-capitalist or 6) doesn't validate my rightness for the last 10 years in some way then it must be wrong.
Nope. That's all equally true for you as in... IF it doesn't come from the state or some sort of Progressivism (the cause of our HC crisis). I just happened to follow the takeover of Cato in the past year and it was ugly. Outside of that FREEDOM works. It's happen right now, with HC servers going free market by accepting cash.

But carry on on with your logical fallacy of ad hominem. I see you've got nothin'!
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Old 12-29-2013, 11:59 AM   #8
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The biggest problems are with government and regulation getting in the way, but the free market has some glaring inefficiencies too.

PUBLIC SECTOR PROBLEMS: The government needs to get out of the way. The inefficiencies are stunning. The heavy regulatory environment cripples insurers, especially when it comes to interstate commerce and state-by-state rules. I'm sure compliance too. The claims and reimbursement system is so ridiculously complicated that doctors with no business experience now have to hire highly skilled office administrators just to understand the Greek. Doctors have to triple check and often present conservative solutions, and too often care is dictated by government-approved scripts for how to handle patients with absolutely no flexibility to go off-the-cuff. Because the reimbursement system is so complicated, Doctors can't consistently price and too often over-price. And standardizing pricing is oversimplified -- it's hard to price services because every patient case is different.

PRIVATE SECTOR PROBLEMS: Don't excuse the private sector. Their analytics are ridiculously flawed and need to start moving to focusing on outcome-based care. Doctors and hospitals too often price based on benchmarking other care providers, instead of offering consistent pricing. Doctors need to be held accountable for malpractice, but we need to cut a lot of this BS out -- malpractice should be focused on gross negligence only.

OUR PROBLEMS: We eat disgustingly and throw hissy fits whenever anyone dare question our eating habits. We have to take accountability for our own health. I love the private sector model of rewarding insureds who do take noticeable steps to improve their health

PRIVATE SECTOR SOLUTIONS: Private sector firms need to continue leading the charge on corporate-wide wellness programs. I am all for any private or public solutions that encourage wellness. This leads to better workers, better retention of workers, and a healthier America. The public sector should follow suit.

PUBLIC SECTOR SOLUTIONS: There needs to be a smart effort to combat obesity. As I've always said, don't ban stuff like soda, but rather empower consumers to make better decisions. That means better health education especially in the schools, and holding food/drink providers accountable for the food they serve.

MARKET INEFFICIENCIES: I don't know the answer to most of these, but no person should struggle to find reasonable care, even if you're poor and have pre-existing conditions (and no, I don't believe vouchers adequately addresses it). We can't pretend that the lack of "invincibles" in the system isn't seriously hurting ability to provide reasonably priced coverage, especially if they are mooching off the system later in life. We have to figure out how to stop freeloaders who don't have insurance but consumer emergency care even if they can't pay it; at the same time, I don't feel comfortable with a system that denies patients the care they need.
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Old 12-29-2013, 12:09 PM   #9
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The biggest problems are with government and regulation getting in the way, but the free market has some glaring inefficiencies too.
Oh brothah! No system is perfect but free-market system is still the best of all. Please don't compare it to any utopias.
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PUBLIC SECTOR SOLUTIONS: There needs to be a smart effort to combat obesity. As I've always said, don't ban stuff like soda, but rather empower consumers to make better decisions. That means better health education especially in the schools, and holding food/drink providers accountable for the food they serve.
Such efforts rarely handle such problems. The best is the free-market where those who eat crap pay the price as it doesn't encourage moral hazard. Your last sentences sounds as if irresponsible people could sue.

Although, I'm fine on better education...I doubt govt schools would do a great job. Afterall, the govt food pyramid is a joke.

Quote:
MARKET INEFFICIENCIES: I don't know the answer to most of these, but no person should struggle to find reasonable care, even if you're poor and have pre-existing conditions (and no, I don't believe vouchers adequately addresses it). We can't pretend that the lack of "invincibles" in the system isn't seriously hurting ability to provide reasonably priced coverage, especially if they are mooching off the system later in life. We have to figure out how to stop freeloaders who don't have insurance but consumer emergency care even if they can't pay it; at the same time, I don't feel comfortable with a system that denies patients the care they need.
No one was turned away when govt was not involved in health care markets. Dr. Ron Paul practiced medicine during such a time and he said no one was turned away. There are charity/religious hospitals and there were doctors that did forgive bills. There's no such thing as market inefficiencies....that all depends on viewpoint and opinion regarding outcomes each seeks.
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Old 12-30-2013, 06:20 AM   #10
Loneiguana Loneiguana is offline
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No one was turned away when govt was not involved in health care markets. Dr. Ron Paul practiced medicine during such a time and he said no one was turned away. There are charity/religious hospitals and there were doctors that did forgive bills. There's no such thing as market inefficiencies....that all depends on viewpoint and opinion regarding outcomes each seeks.
See, don't you people understand? Or is it all going over your head?

If the government wasn't around, these hospitals and charities would be able to treat all the healthcare problems of people who lack the income to pay for it.

But, because the government is around, these charities go "nope, not going to help everyone in the country". See, they choose not too. Because of the government.

So, get government completely out of healthcare, and these charities will choose to step up and ensure that everyone has quality affordable healthcare.

These charities can sooo do that... just got to get rid of the government.

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Old 12-30-2013, 06:42 AM   #11
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I see idiot boy made his return.
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Old 12-30-2013, 06:57 AM   #12
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All we really need to do is reduce costs. That's why the public says it should be replaced with a nebulous "something".

The primary cost driver is government interference, such as the woeful underfunding of all programs where government is the payor. If they had fully funded these programs instead of trying a government takeover the whole system, we'd have gone a long way toward fixing these issues.

Some common-sense regulatory measures like enabling insurance to be sold across state lines would be good, but all we really need the government to do is to stop passing the check for the promises they have already made and already weren't paying for off to people who pay for their own coverage.
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Old 12-30-2013, 07:16 AM   #13
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All we really need to do is reduce costs. That's why the public says it should be replaced with a nebulous "something".

The primary cost driver is government interference, such as the woeful underfunding of all programs where government is the payor. If they had fully funded these programs instead of trying a government takeover the whole system, we'd have gone a long way toward fixing these issues. .
Uh, the biggest cost drivers are (1) demographics which have seen a near inversion of medical actuary tables and (2) perverse incentives whereby nobody really owns their own costs so they "toss it on the house credit card" for payment. Our health costs will never change no matter what system we put into place until we tackle these 2 issues.
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Old 12-30-2013, 07:21 AM   #14
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Uh, the biggest cost drivers are (1) demographics which have seen a near inversion of medical actuary tables and (2) perverse incentives whereby nobody really owns their own costs so they "toss it on the house credit card" for payment. Our health costs will never change no matter what system we put into place until we tackle these 2 issues.
So how do we do that?
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Old 12-30-2013, 07:44 AM   #15
BucEyedPea BucEyedPea is offline
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So how do we do that?
"We", since you still seem to believe a collectivist approach is the answer, get the govt out of healthcare altogether starting by rolling back all mandates. Let competition drive down rates. Stop suppression of alternative health care by it's competitors. IOW end the corporatism that you lefties claim to hate.
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