Bacon's Rebellion

Democracy Thrives in Sunlight

Getting the Healthcare We Deserve

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by

James A. Bacon
in

transparency

Here’s the good news on the transparency of health care prices in Virginia: The Old Dominion is one of the five top-rated states in the country rated by the “Report Card on State Transparency Laws” for its laws and regulations.

Here’s the bad news: We rated a C. We look good only because 45 other states scored F. Maine and Massachusetts laws rated the highest, with Bs.

Price transparency for medical procedures is fundamental for a market-based health care system: Without prices, a market cannot function; consumers cannot shop for medical services. What we have in the United States, and Virginia, may be described as a non-governmental health care system but it is not a market-based system.

The way we frame the debate over healthcare in the United States largely determines the policy outcome. Obamacare has sucked up all the oxygen in the room. Here in Virginia, the healthcare debate has fixated on the Medicaid expansion envisioned by Obamacare. Maybe we’ll get a bigger Medicaid program, maybe we’ll get bigger subsidies for poor peoples’ health plans. Whatever the result, the focus is on who pays and how much. It’s a zero-sum game: Some people win and others lose. The debate is not how to empower consumers to become better buyers of healthcare. The debate is not about how to improve the productivity and quality of Virginia’s healthcare system. 

We Virginians lack the imagination and creativity to come up with anything better. I guess we get the government and health care system we deserve.

— JAB

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14 responses to “Getting the Healthcare We Deserve”

  1. Peter Galuszka Avatar
    Peter Galuszka

    Agree that prince transparency is crucial but lacking in going for better health care.

    But I don’t se how Obamacare is sucking the oxygen out of the room. If anything, it doesn’t go far enough in switching over from the price blackouts orchestrated by Big Insurance. Sadly, I am self employed and over 60 so I pay a lot for little coverage. I have no idea when what deductible kicks in and when it doesn’t.

    Another point on prices — one that i have had issues with you about for years — is that health care cannot be commoditized like a spare part for a jet engine or a car. You can erect a more efficient system but when you’ve been in a car wreck and you are suffering a collapsed lung and a compound leg fracture you are not exactly going to drive around town looking for the best price advantage.

    Also, I can’t see how expanding Medicaid to 400,000 out of 8 million Virginians changes the equation other than providing better health care to more people, helping ERs in hospitals pay for things and boosting the state overall.

  2. James A. Bacon Avatar
    James A. Bacon

    When I said that Obamacare was sucking all the oxygen out of the room, I meant it in the context of the *debate* over healthcare. Right now, Obamacare is getting about 95% of the national attention, all other healthcare-related issues 5%. The only thing people are talking about is, who pays and how much — not how we improve productivity and quality.

    I’m not placing partisan blame for that fact. I’m just lamenting it.

  3. Breckinridge Avatar
    Breckinridge

    My wife was one of those who liked her health insurance plan but couldn’t keep it, and the better of the two alternatives she was offered was an HSA coupled with a high deductible policy. Boy has it been an eye opener. Having to pay the first $2,500 out of pocket (admittedly, out of the pre-tax HSA money) does bring home the cost of things. One prescription drug in particular had just a silly price, even for a 90 day supply and even with the Anthem negotiated price. I really do believe behavior and usage would change radically if the true costs were known.

    1. larryg Avatar
      larryg

      re: ” My wife was one of those who liked her health insurance plan but couldn’t keep it”

      how many people did that happen to BEORE ObamaCare?

      It was totally dumb for the POTUs to make that promise when the standard procedure is for insurance to make a contract with you – for one year.

      Then when it expires, when it expired in the years prior to ObamaCare what happened?

      Did people who got sick lose their insurance? How about employer-provided insurance? Did it change? Did Premiums and co-pays go up and other things in the fine print get changed” Did employers who changed their insurance providers end up with different provider networks?

      Be honest. what happened before?

  4. TMT Avatar
    TMT

    We certainly could have more transparency on drug prices. Any drug store or pharmacy plan with a website and that takes any government money could be made to post the retail prices for the 250 most prescribed meds.

  5. larryg Avatar
    larryg

    we know the problems.

    how about some ideas for fixing them?

    does anyone here really think if the doctor says you need a bypass or an Aneurysm repaired that you’d go “shopping” even if you had the prices?

    I won’t make this partisan but of the folks who think we’re going down the wrong path with Obamacare and who talk of things like transparency , etc.. where is your plan to achieve these things?

    how would you suggest getting transparency without the govt?

    see we have this thing going on where everybody and their brother cites the litany of the govt health care “sins”… from A to Z – 24/7 and they talk about a whole host of things like “don’t let the govt get between you and your doctor”, ” patient-centered healthcare”, portable insurance between states, and of course the Perennial favorite – “transparency”.

    but how do you get these things from a free and unfettered market?

    where is the “beef” of the “better” way to do healthcare?

    I still maintain if there was a real alternative – the debate would be far different – and BOTH SIDES would then have to respond to the flaws in each of their separate proposals – instead of this being a one-sided rant against one proposal .

    1. TMT Avatar
      TMT

      I proposed a partial solution. If it takes money and has a website, a pharmacy or drug plan needs to post prices for the 250 drugs it sells most. Wouldn’t that help some people find better prices for at least some drugs?

      I’ve never argued there is no role for government in the economy. It can set reasonable requirements for disclosure and punish evildoers. But it isn’t very good at making economic decisions.

      1. larryg Avatar
        larryg

        I never argued that it should not be done by government. The opponents of what we are pursuing right now have decried the involvement of government.

        what I’m asking is:

        1. – what you would do
        2 – what role you’d have government doing.

        opposition to ObamaCare centers around the fact that it’s govt-directed – i.e. don’t let uncle sam get between you and your doctor.

        tell me how you’d do what you say you’d support and what govt’s role in that is.

        if you don’t like Obamacare because it’s “govt” – then show me a better way and be clear about your role for govt.

        1. TMT Avatar
          TMT

          Healthcare doesn’t seem very big on Virginians’ minds. http://www.wjla.com/articles/2014/03/poll-shows-mcauliffe-approval-rating-at-44-percent-101544.html

          My problem about Obamacare is that it’s based on lies. It doesn’t work unless there is government coercion to force people to pay subsidies they did not expect to pay. If you like your health insurance you can keep it. If Obama had told the truth, the ACA would not have passed. If private industry had done that, the FTC would have shut them down.

          Grandfather everyone’s plans. Sell Obamacare plans on their benefits. If people like reform, they will buy into the plans. If they don’t, they won’t. It’s wrong to force people to join more expensive plans when they were told they wouldn’t need to move.

          1. larryg Avatar
            larryg

            re: ” If you like your health insurance you can keep it.”

            really? how did the term “pre-existing condition” come into the lexicon before ObamaCare was even an idea?

            Obama never said those words before the vote.. is it a lie to say he did?

            you’re still not giving the non-Obama plan.

            how can one be a principled opponent and not give their proposal?

            what is your plan and what role will govt play?

            how principled is it to attack something you hate – but now give your plan that is better?

            The reason the GOP “repeals” but does not “replace” is that they’d have to have the government involved.

            how can you have portable insurance, not allow insurance to deny pre-existing conditions, or require posting of prices without government?

            where is the opponents counter-proposal?

          2. TMT Avatar
            TMT

            Larry, I’ve set forth a plan numerous times. Grandfather every insurance plan out there. If people like what they have, they can keep it. No government agency can shut them down absent fraud. If people don’t want to pay more to get more or to subsidize others, they don’t need to do so.

            Allow the Obamacare plans to operate as proposed, but with no forced march into them. If people like Obamacare features enough, they will buy them. If coverage for preexisting conditions is important to people who don’t have that, they will leave their existing coverage freely and buy ACA policies. If people don’t, the premiums for the Obamacare plans will be very high.

            Any Pharma selling drugs overseas to OECD countries must match the price in the United States. People can buy insurance policies across state lines.

            Government regulates insurance just like it does today except states cannot prevent someone from other state from buying insurance in another state. The states and the feds can run their Internet sites. Healthcare.gov Begin a phase out of the free ER care statute.

            My big difference is that the federal government cannot use the coercion of canceling plans that don’t have enough subsidies in them to force people into Obamacare.

          3. larryg Avatar
            larryg

            re:

            ” Larry, I’ve set forth a plan numerous times. Grandfather every insurance plan out there. If people like what they have, they can keep it. No government agency can shut them down absent fraud. If people don’t want to pay more to get more or to subsidize others, they don’t need to do so.”

            so the company could cancel you if they wanted to?

            “Allow the Obamacare plans to operate as proposed, but with no forced march into them. If people like Obamacare features enough, they will buy them. If coverage for preexisting conditions is important to people who don’t have that, they will leave their existing coverage freely and buy ACA policies. If people don’t, the premiums for the Obamacare plans will be very high.”

            so non-Obamacare plans will cancel freely and not insure anyone with pre-existing conditions and ObamaCare will?

            Any Pharma selling drugs overseas to OECD countries must match the price in the United States. People can buy insurance policies across state lines.

            Government regulates insurance just like it does today except states cannot prevent someone from other state from buying insurance in another state. The states and the feds can run their Internet sites. Healthcare.gov Begin a phase out of the free ER care statute.

            so you’d have government mandate the drugs?

            and what would you do for the people who do not have insurance and cannot go to the ERs anymore?

            how many Republican support the “close the ER” idea?

            are you essentially saying that if you do not have insurance you cannot go to the ER?

            My big difference is that the federal government cannot use the coercion of canceling plans that don’t have enough subsidies in them to force people into Obamacare.

            The govt is not cancelling the plans any more than they’re forcing you to take Medicare or Tricare both of which are entirely voluntary do not deny for pre-existing conditions, and are heavily subsidized

            if what you are talking about is ObamaCare setting minimum standards for all policies… I would agree but a whole bunch of people have these “junk” policies and think they have insurance and they do not.

  6. larryg Avatar
    larryg

    and here’s a real problem:

    * Eighty percent of Republicans favor “creating an insurance pool where small businesses and uninsured have access to insurance exchanges to take advantage of large group pricing benefits.” That’s backed by 75 percent of independents.

    * Fifty-seven percent of Republicans support “providing subsidies on a sliding scale to aid individuals and families who cannot afford health insurance.” That’s backed by 67 percent of independents.

    * Fifty-four percent of Republicans favor “requiring companies with more than 50 employees to provide insurance for their employers.” That’s backed by 75 percent of independents.

    * Fifty two percent of Republicans favor “allowing children to stay on parents insurance until age 26.” That’s backed by 69 percent of independents.

    * Seventy eight percent of Republicans support “banning insurance companies from denying coverage for pre-existing conditions;

    86 percent of Republicans favor “banning insurance companies from cancelling policies because a person becomes ill.” Those are backed by 82 percent of independents and 87 percent of independents.

    Now what I’d like to see is a proposal from the GOP on how they would achieve these things that they support.

  7. larryg Avatar
    larryg

    the problem I have with the status quo is it’s unfair and wrongly favors some and not others.

    If we truly wanted a fair system with less or no government involved for – anyone.. we’d:

    1. – get rid of the tax free employer provided insurance.

    2. – we’d allow the insurance company to deny pre-existing conditions uniformly and unilaterally for anyone including those with employer provided – including TRICARE and Medicare.

    one rule for everyone.

    or .. if you want the govt to “help” – then everyone gets the help not just some.

    For both Medicare and TRICARE you provide a voucher and you let all groups go to the open market and buy the best they can find… for the money they have – and the govt is not involved in it – if no insurance company wants to insure you or your spouse or kids – then so be it.

    but what we have right now – is a grotesquely unfair … arbitrary and capricious system where we justify value judgments against people because they have not found themselves a “good” job with “good” benefits or join the military to get “good” benefits or turn 65.

    If you are not in those favored groups – you are screwed. you pray you or your spouse/kids do not get sick but if they do you know as a last resort you can go to the ER.

    so we have two worlds. One with folks who have gotten “theirs” and the other group that has failed to get “theirs” – and the first group will be damned if they are going to let the second group get something they “do not deserve”.

    where am I wrong TMT?

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