bruce0 said:
I think the ACA will have several results, many good ones, but some unintended consequences.
The best of the consequences:
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[*]We have an epidemic of part time workers in the US and the ACA will eliminate the incentive to hire part time.
I see pretty much the exact opposite.. The ACA creates an incentive for employers to hire more part time and keep workers below that threshold.
The result hopefully will be better trained workers, more full time jobs, and a force in part for improving the relationship between employee and employer.
Huh... The employees are getting squeezed in the middle, by government increasing the cost of new full time workers.
For those of you offshore... In the US you can save (as a former employer we saw) about 20% to 30% or more on your labor cost by hiring part time. This is especially true for low paid jobs (including the all important entry level it is so hard for young people to find these days. I think this is an unconscionable practice on the part of hiring managers, but follow the money. Incentives work, even bad ones.) This distorted incentive is because an employer was not required to provide health insurance to part time workers.[/list]
yup.. unfortunately... Healthcare needs to be removed from the employer's plate as a deductible expense and/or responsibility and be shifted to a personal transaction between the individuals and a competitive medical services marketplace (I find the term insurance a misnomer they way it is practiced). The employer would instead be able to pay workers the extra amount they now spend on health care, and individuals would get the tax deduction (if we don't reform taxes even more beyond that). Employers then would have no incentive to not hire new workers, or trim back hours to keep existing workers below some artificial threshold.
- More people will be cared for. More care will be provided. Maybe some good consequential change in behavior and environment will result. Certainly if you were uninsured and now you are insured, this will improve your lot in life.
It is confusing to hear the data or results as presented by both sides. I have heard some contrary reports that despite the huge amounts of money that have been spent already, only a modest decrease in number of uninsured has been realized. I am waiting to see more definitive data and results.
Less attractive unintended consequences:
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[*]Medical costs will continue to rise, with advances in care. The bargaining power of the government in this effort will not effect prices. There are lots of examples but for instance the ACA requires experimentation with "alternative payment methods" a great idea (results based payments, outcomes etc could eliminate a lot of waste). But congress added to the bill a provision that in essence provides "none of these alternative methods can result in paying doctors less than they are paid currently" (thank you AMA lobbying group).
[*]
Yes, medical costs (especially for heroic end of life care) will increase to out-strip our ability to pay... this is the elephant in the room that nobody is willing to acknowledge. The government playbook to manage cost has a short list of options. The medicare model. Is to use price fixing. So procedure XYZ can only charge $X amount. As we learned when the government tried to apply price fixing to the oil market back in the '70s, we could buy gas for the low government price, but only when the gas station was lucky enough to have gas, and then after waiting in long lines on odd/even days... Providers willing to accept medicare patients are less and less every day. Politicians are so dumb they believe they could outlaw gravity and be able to fly if the majority votes yeah.. If you fix the price doctors can charge you will end up with less doctors willing to work and lose money.
The other tool in the government tool box to manage scarce resources (medical care) is rationing. While they don't exactly say no, they make you wait so long for healthcare you can die waiting.
http://www.cnn.com/2014/04/23/health/veterans-dying-health-care-delays/ The veteran's healthcare system another poster boy for government management of healthcare, is dealing with new charges of some 40 veterans who died while waiting for doctors appointments. This is still a developing story, so lets not over react to the headline, this may be an isolated case of one horribly mismanaged region, or it could be a warning of things to come. Time will tell.
There will be tremendous success for the drug companies, insurance companies and any business that benefits from more care being provided. This may even include hospitals which have been under pressure for years as they in many cases have to provide care regardless of the ability to pay. [/list]
That was the quid pro quo promise that brought the insurance companies to the table. Hospitals remain under pressure and if anything i see more consolidation of marginal operations. Doctors with private practices are increasingly retiring, or becoming employees of regional hospitals. The jury is still out on how much money insurance companies will make and IIRC the taxpayer backstop to keep insurance companies whole, expires after two years or something like that. If after a few years, we do not get large numbers of young invincibles signing up and paying full ticket insurance to carry the load, this experiment will implode. Some fear that was the plan all along so the government could step in and take the whole thing over. I do not trade in conspiracy theory but believe it is much to soon to take a victory lap for this.
- Systems at most institutions (government institutions in particular) will be upgraded with a consequential boon for software providers and consultants.
Yup, I already mentioned the anecdote about a local pharmacy that closed down because of an $18K software upgrade required to be complaint with ACA. Another growth segment will be training to help current medical professionals meet the new ACA paperwork hurdles.
- Our private information will continue to be made less private as data about us as individuals is routed from place to place.
We had Romneycare before Obamacare implemented by governor Romney. It was almost the same thing, but with less teeth. I think it has been a good thing in our state.
Great... this should have stayed a state by state experiment. Canada's system started out as an experiment in one province only that got expanded after it was proved successful there. Reports of Romney care's success are subject to debate and I lived in MA for several years (decades ago). It is not exactly similar to all the other 49 states.
As to the original post, Rate increases, I am not sure that Rate Increase alone is a good way for a citizen to view the matter. It is about what we want our country to be, and what we want our government to require and pay for with our tax dollars. It is about the information and privacy issues that it creates, and the incentives that it provides to all involved.
amen... Some favor smaller government and less government involvement in our private lives.
And it is here to stay. No politician can stop it now (the r hard line rant is just to embarrass the d's it does not imply that given control they could or would change anything. Any repeal would disrupt someone's insurance and that would be a bad news cycle for a politician).
I find it useful when political leaders argue that it can not be repealed, to inspect why are they even saying that? If it actually could not be repealed, there would be little reason to talk about it. Unless they are trying reverse psychology (like Brer rabbit, begging to not be thrown into the briar patch. ;D ;D ). If ACA was as popular as the leaders want us to believe this would not be a topic of discussion. This will be in play for the mid term election this year.
There are a number of reforms that ACA ignored (like tort reform). There is still a lot of room for actual improvement, and if we want to expand a government run medicare-like system to all ages, we need to do a bunch more work. I wish the republicans were more vocal about presenting alternatives, but the public consciousness seems unable to hold more than one simple idea in focus at the same time, so any attempts to do so fall on deaf ears.
Of course opinions vary, and this is till a work in process. I do find it hard to be very optimistic.
JR
