Is The ACA As Big A Mess As Everyone Says?
Maybe. But many of the problems the Affordable Care Act (ACA) is now encountering – insurance companies on the exchanges pulling out, large premium increases in some states – are not unexpected given the design of the program.
Major problem? The Patient Protection and Affordable Care Act bill set the penalties for not having insurance too low. Far lower than the cost of the insurance to begin with. So there is little incentive for healthy people to enroll. Without healthy people enrolling, it was only a matter of time before the death spiral began.
It’s a simple equation: Sick people + no preexisting condition restriction – healthy people = high spending that outstrips existing premiums.
To add insult to injury the government was too lenient in allowing people to sign up outside of open enrollment, ie, when they got sick and needed the insurance. Plus, as The New York Times explained in a recent editorial, insurers set premiums too low in the beginning in order to attract enrollees.
Is the ACA dead? Should we scrap … Continue Reading
Really scary story in The Wall Street Journal this week about a dramatic increase in double mastectomies in this country — and not for women who need them.
Do you know how much that 50-inch, flat-screen TV cost? How about your car? The cashmere cardigan you just had to have?
So I did something last night that I’m not proud of. I got into an argument – complete with raised voices – with a friend. Over health care and the Affordable Care Act (ACA), of course. (Note that he continually called it “Obamacare” in a somewhat sneering tone, which, as those of you who read my blog regularly or know me, know I consider a derogatory term for a very important piece of legislation).
I knew this would be the toughest audience yet in my three years of teaching/speaking about the US healthcare system and healthcare reform. I even put on a flak jacket at the beginning of my talk as a way of breaking the ice (and protecting myself; I mean, these guys pack scalpels!). And I made it through the two-hour talk and their anger without losing my composure or my sense of humor (thank god for that sense of humor).
The serendipity of the universe never ceases to amaze me. A couple of days ago I gave the keynote speech on healthcare reform at the Texas Medical Association’s CME Association’s annual meeting in Austin. A physician in the audience brought up an issue that was trumpeted in the press when the health care exchanges rolled out for open enrollment; namely, that people had lost their insurance and couldn’t see their doctors. I knew that a very small minority of people had actually “lost” their insurance, and that, in most cases, that insurance provided pretty bad coverage at fairly high prices. But I didn’t want to get into it with him, so I just agreed that yes, the Affordable Care Act certainly has flaws, then moved on to the next question.
Twenty-three years ago I married an amazing man who just happened to be Scottish. Real Scottish, as in, grew up in Glasgow and attended the university there. In the process, I gained a wonderful sister-in-law and, later, her husband (brother-in-law?).