Friday, March 31, 2017

Miscellaneous Links on Healthcare

And general Republican intransigence.

Paul Ryan, appearing on "CBS This Morning," tried to explain why he wants to lead yet another suicide charge up Health Care Hill.

Ryan said he worries that if Republicans don't repeal the Affordable Care Act and pass some sort of replacement, then President Trump will "just go work with Democrats to try and change Obamacare and that's not, that's hardly a conservative thing. ... If this Republican Congress allows the perfect to be the enemy of the good, I worry we'll push the president into working with Democrats. He's been suggesting that as much."

Republican Sen. Bob Corker of Tennessee, usually a man of measured words, responded with a barbed tweet: "We have come a long way in our country when the speaker of one party urges a president NOT to work with the other party to solve a problem."

You get the feeling that politics would be so much easier for Paul Ryan if there were no human beings involved. 

If we don't start preventing illness we're screwed anyway.

America's problem is that it squanders money on the wrong things -- expensive procedures and tests rather than preventive care and social programs. A study of premature deaths estimated that just 10 percent were the result of poor medical treatment, while 40 percent came from behavioral issues, such as obesity or alcoholism.
The Academy offers a four-point plan for altering this miserable combination of high cost and poor care. First, providers should be paid for value -- for patient outcomes, not for the volume of procedures. Second, incentives should empower people to take better care of themselves through wellness programs or lifestyle changes. Third, better connectivity is needed among doctors, patients and others to encourage data-driven advances.

Finally, the Academy argues for community strategies that target the highest-need patients, who are also most costly to treat. The top 5 percent of spenders, often with multiple conditions brought on by obesity or other chronic conditions, account for 50 percent of total U.S. health outlays.

What are the chances of getting legislators to agree on anything to bring those changes about? Back to we're screwed. We could all move to Taiwan.

 In 1995, 41 percent of its population was uninsured and the country had very poor health outcomes. The government decided to canvass the world for the best ideas before instituting a new framework. It chose Medicare for all, a single government payer, with multiple private providers. The results are astonishing. Taiwan has achieved some of the best outcomes in the world while paying only 7 percent of its gross domestic product on health care (compared with 18 percent in the United States). I asked William Hsiao, an economist who helped devise the country’s model, what lessons they took, if any, from the United States. “You can learn what not to do from the United States rather than learn what to do,” he replied.

Or we could elect this guy president.

“I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses. . . . We must have universal healthcare. . . . The Canadian plan . . . helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. . . . We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.”

We did? Back to square one

Trump has an immediate opportunity to help Americans reduce their costs by choosing to enforce and properly steward what House Speaker Paul Ryan rightly called the "law of the land." The administration has the power to impact the cost of insurance by 25% to 30% with two simple decisions.

First, the administration, with support from Congress, should commit to permanently funding payments that reduce the size of deductibles for lower-income Americans (called cost-sharing reductions). Republicans need to drop a lawsuit they filed to stop these payments, or Trump needs to say they are going to continue. Second, the administration should enforce the individual insurance mandate until a different approach can be agreed upon. Those two actions will reduce costs for millions and need to be done now before insurers submit initial premiums for next year, or inaction will drive up premiums. Americans should watch this intently.

A third step would be to grant states the flexibility to increase competition and reduce costs. Non-partisan analysts such as Standard & Poor's confirm that the online exchanges that sell ACA insurance policies are stable, but in some states the cost of insurance is out of reach for those who earn too much to receive tax credits.

And we come full circle back to Paul Ryan.  

It is the responsibility of Mr. Ryan, his GOP majority and President Trump. “Moving from an opposition party to a governing party comes with growing pains,” Mr. Ryan said. Indeed: A governing GOP would restrain its anti-Obamacare hyperbole and seek to ensure the system’s stability, because millions depend on it. Instead, Republicans still sound as though they are rooting for it to fail.

We want nice things, don’t fuck it up!

In fact, the Congressional Budget Office projected that, left to operate under reasonable management, Obamacare can work pretty well, preserving the massive coverage gains of the past several years. But one wrong move, motivated by either malice or ignorance, could send the system crashing down.

We want nice things, don’t fuck it up!

The Trump administration will face an early test in how it handles a lawsuit the House filed against the Obama administration, which the new president’s team inherited. If Congress refuses to back down or the Justice Department fails to continue fighting the suit, the result would be the loss of subsidies that help millions of low-income people pay out-of-pocket health costs. Withdrawing this support would cause insurers to flee Obamacare markets, leading to massive coverage losses. Cooperation between Congress and the White House could easily solve this problem.

We want nice things, don’t fuck it up!

Similarly, Mr. Trump must decide how he will enforce the individual mandate, a policy hated on the right that requires every American to obtain health coverage. The administration sent early signals that it would weaken enforcement, which would result in fewer people signing up and strain the system’s financial stability. But if Obamacare will be in place for the “foreseeable future,” enforcing the mandate will be essential, assuming the president wants to avoid presiding over a policy disaster for which, make no mistake, he would be blamed.

If you break it, you fucked it up.

No comments:

Post a Comment