How to Fix Obamacare's Marketplaces
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- Опубликовано: 21 окт 2024
- Obamacare's marketplaces were supposed to give consumers choices of health plans from insurers that compete to keep premiums down. But fewer insurers are participating, and premiums are increasing sharply.
Fixing this problem will obviously be politically difficult with a Republican-controlled Congress that has vowed to "repeal and replace." President-elect Donald J. Trump has also said he wants to get rid of the ACA, although he amended that recently by saying he'd like to keep some elements. Replacing the law, without a Senate supermajority, would also be politically difficult.
From a policy standpoint, however, some solutions to problems facing the marketplaces are ones that Republicans have endorsed before: for Medicare. That's the topic of this week's Healthcare Triage.
This episode was adapted from a column FOTS Austin Frakt wrote for the Upshot. Links to further reading and sources can be found there: www.nytimes.co...
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
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So the you have it, GOP. He just gave you the all the answers. Now all you have to do is not be stupid. We'll see if you can manage that.
Shanockdotcom If you're talking about Universal health care, that won't happen under this administration.
Shanockdotcom What do you suggest, then?
Actually, throwing money (subsidies) at the problem may be a temp fix, but what we really need to do is transform our healthcare system to a Singapore model. High quality of care, at a very low price.
Shanockdotcom You can do some things to reduce the cost of healthcare but that doesn't mean that greedy insurance companies won't still charge a fortune, deny pre-existing conditions, have yearly or lifetime caps or drop you like a hot potato if you get sick. You must have regulations and mandates or take insurers out of the picture and go with Medicare for all.
Shanockdotcom Universal healthcare works in every other industrialized nation in the world and it's less expensive. Medicare has been working very well for many years and there is no reason not to use that as our universal coverage.
I know that my thanks for this post is late, but thanks. I especially appreciate your post that remind us that health care is not a "free market". As a social activist, I frequently site your work.
T. Dingman from Newark, NJ, USA
I'm always highly skeptical when private companies say they need to increase their prices so they can stay afloat. Surely this is code for "we refuse to lower the profits going to shareholders and the board of directors, so instead of taking a small paycut, we'll just pass on the expenses to the consumer"?
I like the requirement of insurers to participate in broad regions idea and the public option idea.
Thank you for this, Dr. Carroll.
WisMicYal11 +
I feel like this video is a great example of HT not properly using the video medium. This is an essay read aloud, with the visual aid of Aaron talking and text on screen. The point of educational video is to teach the lesson visually and audibly. If you were just going to use words, a blog post or podcast would communicate just as effectively. I understand that animation takes time(and therefore money) and that stock images cost money. Even Aaron using his hands to help us visualize a graph would be preferable to this. The text on screen is boring, and I felt myself not being able to concentrate on the content of the video when it was up. I respect what you guys do, I just hope you see this and consider it in the way that it is intended. Thank you for what you do.
simple fix. Socialize the Medical System
Because that wouldn't take a years long, highly expensive, politically monumental effort before we would see the benefits? Believe it or not, socialising one of the most complex industries of a developed nations is not that easy. Still, long term it pays off, and i hope you americans sort it out sometime in the near future, but saying that it was in any way simple is either very dishonest or dangerously dumb.
Zeke m "simple" fix?
the sooner you start, the better
decisiondata.org/news/how-much-single-payer-uhc-would-cost-usa would save the US Population 600billion dollars a year
+Zeke m www.huffingtonpost.com/dr-behzad-mohit/universal-health-care-can_b_201154.html It would probably save closer to a trillion dollars a year.
Imagine that. Competition and choices, also known as capitalism, drives cost down.
It's not pure capitalism though... Because the government has to incite the competition
Mixed economy seems to be the thing that works.
I know, but so many people are vilifying capitalism and blaming it for all our problems. I felt like I should point that out. Quite often it is a merging of ideas that produces the best solutions.
Oh, yeah... I agree...You need competition, but sometimes companies are only competitive in name, in that they're different from one another. But they don't actually compete with one another.
I think most people vilifying capitalism are doing it in the sense of pure capitalism which is what the Libertarians and what a lot of the GOP has latched on to recently. This weird obsessive worship that government can't help the private sector in any way and doing so corrupts the system.
I personally dont think throwing more money at it will fix it. we need to look at why its so costly from a supply side. its nice to subsidize it but if its a lack of supply subsidizing it will only drive prices higher. maybe Insurance isnt the problem but the symptom of a much larger issue
Joseph Fox Because you're not negotiating prices, you just pay.
The ACA has done a fair amount to reduce costs of care, and increasing the number of people getting the low prices of medicare would be a great first step for a more pro-consumer congress.
risk corridor for the aca expired, renew it
Well, our healthcare system along with most of our US system are fucked. Singapore Healthcare is the best model for the United States.
***** i haven't read into Singapores system. I will through
Cost of care is a much bigger driver of premium rates than insurer competition. The minimum loss ratio laws already limit how much they can increase premiums in the absence of large increases in cost.
could you possibly make an episode explaining how countries with "free health care" like canada, the uk, and Switzerland make that work?
I am confused subsidizing the insured or the insurers?
For those of you who are stating, "It's simple, just do X," I ask you think a bit more deeply. There is no such thing as a "solution." There are only different systems, each of which has its own strengths and weaknesses. All must face the "economic problem;" that is, how to best distribute finite resources in the face of unlimited demand.
Wait, I thought the ACA allowed people in any county to buy plans based in any other county? If that's not the case, why aren't conservatives and/or liberals trying to make that happen? What's the argument against it?
A. Trump has suggested it. and here is an article for an argument opposing cross state line health insurance www.forbes.com/sites/brucejapsen/2016/10/10/sorry-trump-selling-health-insurance-across-state-lines-wouldnt-lower-costs/#41a4a2425f01
I personally think the ACA was a problematic even if it was cross state lines and it doesnt address the underlying issue of lack of Supply in healthcare. given any other good or service a rise in price would be assumed to be a lack of supply except healthcare which people seem to focus only on subsidizing demand.
Joseph Fox That's good, but I'm still surprised it's only him. Congress should be able to all agree on this easily.
George Cataloni
probably people from both sides have talked about it but its sort of like the voucher school system. everyone in congress knows its a good idea but the parties would kill them if they said it out loud. or the fact that Social security is Buying US Bonds and thats causing the system to fall apart but without it we would have to either spend less and tax more or devaluate our currency and no one wants to be responsible for that. its the easy answers that are the hardest. one must remember that the driving force for a politician isnt ideology or morals but Machiavellian and protecting their power.
if you ever get a chance read "power" by Robert Greene. often criticized for being Machiavellian and amoral it does ring true for how people in power act so irrational
The ACA does. The problem is that the providers usually work with specific doctors. A provider in Texas is going to be better suited to work with their doctors in Texas. This wouldn't help someone in another state. I believe Healthcare Triage did a video about this a bit ago.
Braden Jensen That doesn't make sense, because all insurance companies do is take calls, money, and pay for stuff... Also, your comment with the link is marked as spam, but I'll find it.
Here's an idea: a livable wage. Consumers would have enough to cover insurance, say bye-bye to food stamps, welfare, and most social services except for those without jobs/the elderly. Right now, social services are effectively subsidizing private businesses with these services.
socialdeviant13 inflation if everyone given randomly $5 that $5 is then worthless
puddingninja Wages haven't grown with inflation.
puddingninja 1. wages haven't kept up with inflation already.
2. These people aren,t being given anything. they are working for it. And you, as a taxpayer are subsidizing their wages with things like food stamps and TANF. Walmart increasing their starting wage to $10/hr has reduced the number of people and families on welfare in LCL states, like Florida and Tennessee. In turn, Walmart is noticing a GROWTH in profits because their workers can buy things like lunch at work or nonessential goods they wouldn't otherwise be able to afford. Businesses who choose to pay better wages are also shown to have less employee turnaround, which reduces the cost of training, and more customer loyalty, which increases ensured profits.
I've watch these videos and learned a lot about the complexities of this issue. Seems there really is an solution to the problem. Mathisen has made the videos short, using an enjoyable format wth helpful and colorful charts.
Thank you triage your information has been accurate and very informative
I'm a pharmacy tech, and Medicare part D has a huge hole in it called the coverage gap sometimes referred to as the "Donut hole." That makes a huge problem for senior citizens on fixed income by making them pay up to 60% of the drug costs out of pocket. That makes drugs like insulin cost paients upwards of 300 dollars a month until they hit catastrophic coverage on the other side of the gap. It's very unfortunate but I do like the ideas presented in the video. Just leave the donut hole out of it.
what an optimistic video
another great video
The problem that *I* have with the penalties is that even though they're cheaper than the subsidized premiums... it's still more than even *I* can afford. It makes absolutely no sense to me to shove something like this down the throats of Americans that can't even afford the penalties WITHOUT offering ANY sort of public option whatsoever for those Americans that literally cannot afford private insurance at all.
My philosophy is if the government is going to require us to have something like insurance that costs money, the government must AT MINIMUM provide a free or ultra low cost barebones minimum for those who can't afford the private alternatives. This even goes for auto insurance, among other things.
I hate the idea of raising the penalty also. For my healthy family of 4, the cheapest insurance we could possibly get is over $9000 a year with a $6600 deductible per individual. At that point, the cost/benefit analysis no longer makes sense. We are on the cusp of receiving subsidies, but that is still 10% of our annual gross income. We're paying the penalty this year.
By the gods, that's absolutely ridiculous right there. o.O
Calyo Delphi You're absolutely right that there should be a public option. My fear, though, is that that will probably never get through congress.
A public option would solve this. If people who can't afford proper insurance could turn to the government for help, the competition aspect could resume. The death spiral created by these laws is killing the already crippled system.
TIL; there is an American Journal of Health Economics.
My premium nearly tripled since Obamacare
Premiums were going up long before the ACA. Every 2-3 years my coverage would nearly double. I ended up going without insurance about 3 years before the ACA became law because my company wanted nearly $700 a month which was outrageous for a healthy person in their low 30's.
More International Health Care Systems Videos, please.
*+*
If we are going to continue private insurance based system, we are going to walk in circles.
Quite forcing people to pay for health insurance.
Quite letting healthcare facilities write legislation to force competitors out of their region.
Deregulate insurance so I can shop a la carte for policies all over the world.
Replace the FDA with consumer reporting and quality assurance agencies.
Allow private accreditation for healthcare professionals.
You know that there is very good evidence for free market failure with respect to the FDA, right? The supplement industry is pretty much entirely unregulated and is a cesspit of false advertising and products that don't even have the ingredients that are on their labels.
Chengyan Boon Sure. Maybe you should come up with a free market solution to do consumer reporting or quality assurance.
I mean there's literally an organization called Consumer Reports that does this, but that does nothing to stop faulty supplements from being wildly successful.
Chengyan Boon If individuals can smoke cigarettes, eat fast food, skydive, or work on Alaskan fishing boats, then I don't care if they want to take bunk supplements. I do care that apologists for the F.D.A. think extortion(taxation) is appropriate for generating revenue for quality assurance and effectiveness. Obviously there are models that exist that earn their revenue through voluntary means.
I draw the line when it goes beyond the individual. Before the FDA, in the deregulated medical industry, it was not infrequent to market opium medicines for babies. (See: Paregoric). But I suppose babies should go read the consumer reports and make an informed decision for themselves.
Subsidizing is EXACTLY THE WRONG THING TO DO! The problem is that the cost of medical care (not insurance premiums) is out of line with other goods and services.
To be blunt, INSURANCE IS THE PROBLEM, not the solution. Paying for someone else with someone else's money is the least efficient.
Duh.
so you're suggesting we just throw more money at it and that will fix it
That was the Republican solution to problems with Medicare Advantage plans.
Single payer FTW
Wouldn't it make more sense to implement universal health care, implement a tax that everyone pays to help fund medicare and offer coverage to everyone, allow Medicare to negotiate with hospitals, suppliers and pharmaceutical companies for a bulk price that could help drive down ridiculous medical costs in America and do away with the stupid networks system.
I mean a public option would definitely be an easier fix than copying Bush. Plus I'm for single payer and that could stop all this shit with price gouging health care insurance.
Single payer!
No
Sooooo, in other words, not much has changed.
these videos always hurt my brain
More competition = cheaper price
socialized medicine sounds nice but seriously stop comparing us to small countries with single payer. While Canada has a population less than California it's easier for them to implement a system. This kind of thing in the US would require much more money networking and public support than currently exists.
NOW ITS A BUNCH OF FUCKING CON MEN CALLING MY PHONE ALL DAY DIGGING FOR PERSONAL INFORMATION
The only solution you seem to have for fixing Obamacare is throwing more money at it. Subsidize it more! You admit this won't directly fix the problem but are predicting it will influence the decisions of the Insurance companies. That is an awful big gamble. You admit that Obamacare miscalculated who and how many would enroll and that has caused premiums to rise. All of this has been a big guessing game and it has failed.
Mary Hornsby how about we socialize medicine. ACA is a republican plan to begin with
Ultimately Insurance Companies are a business and in a free market economy they are entitled to decide how to run their companies. The problem of Single payer systems is that I will be paying (through taxes) for every smoker's cancer treatment, every obese man's heart prescription, and every person's bad decisions when it comes to health. And I have a problem with that. Hospitals and Insurance companies profiting at the expense of sick people leaves a bad taste in my mouth, but they have a right to make some kind of profit for their businesses. Nurses deserve raises, new medical equipment needs to be bought, and Private Insurance companies have employees to pay. I think a greater transparency in how much procedures will cost will be a the key to lowering costs of healthcare. There was no way for me to know what the Hospital was going to charge me for giving birth their for my two children. I may have gone to a different hospital or facility all together if there was some way for me to know what an epidural would cost and how much of that the insurance was going to cover. That is where real competition would benefit the market.
Fuck the insurance companies. would you rather pay more for less care (insurance companies) or pay less for more care (single payer) decisiondata.org/news/how-much-single-payer-uhc-would-cost-usa
Well I'm sure that having insurance will just encourage people to get cancer, right Mary?
"Obamacare miscalculated ... big guessing game ..."
I mean, sort of. Obamacare had calculated risks, and then Republicans did everything in their power to ensure the gambles would fail. As the video points out, more elderly entered the pool than predicted, increasing costs. But the only reason that "guess" was wrong is that Republicans turned down billions of Medicaid dollars.
This is why we just need a univeral health care system in the U.S. There's no reason we couldn't extend the medicare system to everyone. The infrastructure is in place already.
Single payer Medicare for all.
Fuck off snowflake. Free market innovation for all.
trumpcare for all!
gskibum Doesn't that emotional response make you the snowflake?
+WisMicYal11
No it does not.
If I had composed some reply along the lines of:
/limp wrist on
Da da da yes I totally agree. Free healthcare for all. Peace. Love. I forgot to wear my safety pin today do you have one I can borrow?
/limp wrist off
Then yes, that would have been a snowflake post.
However forcefully asserting the fact that the notion of Medicare for all is a snowflake idea does not make one a snowflake.
Anyway, Medicare for all happening in this country is about a likely as a 3,000 sq. ft. home with a 3-car garage for all.
Single payer would save the money. Completely free-market on medicine/inelastic goods have always ended up garbage.
One of the huge problems with politics is that it often sticks us with things like this. As I understand it, Obama -actually- wanted a single payer system, but knew that the Republicans would never let it pass, so we had to go for a compromise. But there is a reason people say "no half measures".
So, the solution is throw more of our tax money into the problem? I wonder if that has ever worked....
It did. He listed several instances where the exact same thing helped Medicare. It was in the video.
$20T in debt and $104T in unfunded liabilities. No it didn't work it just delays the inevitable.
Sorry, is there any consensus on the Medicare being effective? I think there's not a consensus on that one, I would like to be proven wrong - and stating that the GOP likes it or defends it, means nothing to me.
Ricardo de la Cruz Martínez Ocadiz
Yep, just ask literally all the countries.
Nice, so, has it worked well for which countries? What's the debt like of such countries? How are the tax in those countries structured. I hope you realize by now that is not only a matter of: throw some more money into the problem.
Step 1) Make it single-payer
Step 2) Block any repeals
Fuck single-payer. The Singapore model is much better.
***** It's better than the US system, but I believe people should have a right to life and not to pay for an unfortunate circumstance like cancer.
+Carl Grime's Eyepatch In Singapore you catastrophic care coverage. If you spend over 3,000 or something a year all of the rest of your bills are covered. Also they have the best healthcare system in the world while Canada spends 12% of gdp, and America at 16%. Singapore merely spends 4% and have the longest life expectancy in the world.
***** Sure, its good healthcare, but what is private insurance like over there?
All of this was predicted by people who opposed the ACA. It was easy because it is just simple economics.
Single payer system / medicare for all
It shouldn't matter how many insurers are dropping out because there should only be ONE insurer the US Government.
Logan Hessefort if that were the case we would all be fucked with the same stupid plan. if you governmentize it and eliminate other options then progress stops. the idea of capitalism is important to keep us progressing but it can't be the dominating factor. the dominating factor needs to be to fill the needs of everybody. once there is only one available option, the needs of the people are set aside in the name of burocracy.
Truth Is Relative The United States is the ONLY country that doesn't have socialized medicine our system now has slowed progress. Watch the movie sicko.
Logan Hessefort I understand that but currently we have two extreme positions, either force a complete 100% socialized health system or none at all. neither are good choices. if we are going to go the way of the rest of the world we need to make sure it is in steps that are easy for everyone. any good psychologist would tell you that you can get a cow into a trailer but it takes time and patience. you can't just throw a 2000 pound animal.
s
Just get universal healthcare. Seriously. You guys are making this WAY over-complicated.
Really bad ideas - lame thinking. Glad I stopped by to hear some really dumb ideas.