(03-31-2017 02:27 PM)Machiavelli Wrote: [ -> ]Read this JMU and Owl and you will see how I formed my opinion. They sabotaged it.
http://www.cleveland.com/metro/index.ssf..._owed.html
To reiterate:
One, we were promised the the risk corridors would be deficit neutral. All this did was require them by law to be deficit neutral. So there are two and only two possibilities--either were were lied to one more time in order to get votes for the bill, or this action had no effect. There are no other possibilities. Which one do you choose?
Two, the risk corridors were supposed to expire in 2016. That means anything that happens this year or from now on had absolutely nothing to do with whatever was done with the risk corridors.
There are two economic realities that cannot be escaped:
One, you can't drive down the price of health care to consumers without driving down the cost that providers must incur to provide that care, or else you will get reduced quality and shortages. Price = cost + profit. If you reduce price without reducing cost, then you reduce profit. That will reduce the attractiveness of the health care professions to precisely the kinds of people that it needs to attract. That is an economic fact that cannot be avoided. Never in the recorded history of earth has anything ever worked contrary to that. I can pretty much guarantee that this time won't be the first. And Obamacare contained virtually nothing to reduce costs incurred by providers and added a bunch of administrative overhead to increase those costs.
Two, you can't achieve universal health care without inserting some money from outside the system. Obamacare foolishly tried to increase the number of insureds and pay for it by jacking up premiums to young healthy adults who have en masse made the economic decision that they don't need health insurance.
These are both pretty typical of the left's failure to understand market economics.
An intelligent health care bill would contain provisions to reduce provider costs--things like malpractice reform along the Swedish no-fault lines (which also serves to get bad docs out of the system faster); provisions that encourage greater use of NPs and PAs for routine, intake, and gate-keeping functions; something to reduce the cost of medical school so docs don't start out so far in debt. I could see a Bismarck system that incorporated a couple of French ideas--one, you get med school paid for if you commit to work for a fixed salary on the "free" side for 10 years, and two, once you get to the "pay" side, as long as you commit to provide so many procedures per year for the "free" side, you can participate in a reduced cost malpractice pool (Swedish malpractice sort of reduces or eliminates the impact of this latter one).
I want universal care. I don't want single-payer or single-provider, because I want the health care that I receive to be what my doc and I determine that I need, not what some bureaucrat put in the budget a year ago. Bismarck gives me the opportunity to do that on the "pay" side, which works pretty much like our old system here (when my mom had her hip replaced in Paris, the docs and hospital took Blue Cross, if that gives you an idea). Like any universal system, Bismarck will require outside funding from somewhere. I favor a consumption tax to provide that, and also to provide enough to balance the budget while lowering and broadening and flattening income tax rates. The consumption tax has one further advantage in that it levels the field with the rest of the world in terms of trade protection. I'm not big on protectionism, but I'm also not a fan of shooting ourselves in the foot.
Bismarck has one pretty simple cost control feature--design to cost. The government tells the insurers, "We are paying $2700 per person next year. Design the best plan you can for that." The insurers want that business, even if they don't make money off it, because that's where they get the mailing lists to sell the supplemental policies on the "pay" side, which is where they make their money. So they compete like hell to provide as much as possible in their basic policies. I could see this being where the impetus would come for the cost saving measures like PAs/NPs and paying for med school for docs in return for putting them on a salary for 10 years. I could see health insurers getting into the doc in a box business in a big way. I would see that kind of competition driving costs down significantly more than draconian command and control measures.
