| Greedy,Greedy,Greedy |
03-10-2017 10:06 AM |
Re: I used to be disgusted, and now I try to be amused.
Quote:
Originally Posted by LessinSF
(Post 506195)
Serious question. Why am I wrong here?
The ACA was doomed the moment it added so many people with their conditions and costs without adequately adding premium and without reducing costs. The costs would have been reduced by limiting wasteful expenditures on end-of-life care. So called "death panels" would have decided - on behalf of taxpayer, not private money, - that paying millions for machines that go ping for a few weeks was asinine and cost ineffective.
But the Republicans in their fervor to be all things anti-Obama defeated the most fiscally responsible part of the Bill. Thus, it beacame a half assed project doomed to failure. We spend close to 20% of our GDP on health care, and over 75% of that on the last year of someone's life, i.e. the machine that goes ping when your grandparent is dying but may only add days to their life, but we added millions of sick patients without the ability to limit their care.
Do the math. Trump is right here about it expoding. Obama and Congress gave the doctors and insurance companies carte blanche to raise rates (or quit) 25% this year without recourse. And next year, etc. I may be wrong, but nothing I have read from either side - other than single payer - has proposed anything realistic on the cost side, so costs coninue to rise without equivalent revenues. Well, duh, Trump is right that that is unsustainable.
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The principal cost reduction measures in ACA are just starting to take effect, including a move to outcome based payments. Most of the cost control efforts are nerdy and incremental, but cumulatively can have some significant impact. The rate of increase of healthcare costs has been steadily declining throughout the Obamacare period.
This is not to say something is not out of whack. A quick comparison of us to any other developed country says we aren't getting our money's worth as a society. But the Trump / Ryan solution is to make us less like countries that are getting more bang for their buck. Ah, yeh, sure, why not.
And what's your source for 75% being spent in the last year of life. The often-debunked statistic I'm used to seeing is one-third of healthcare costs being spent in the last year of life, a number that depends on some studies of the Medicare only population and so excludes that large group of working age folks covered by private insurance. There are other studies that look at ranges in the 12-20% range based on type of payor. 75%? Really? Seems like an alt-fact.
It would be a lot easier to fix healthcare expenses if the problem was so simple.
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