Careo Boricua
Registrate para comentar.
Register to post.
Buscar
 
 

Resultados por:
 


Rechercher Búsqueda avanzada


El Obamacare segun la revista Forbes...

Ver el tema anterior Ver el tema siguiente Ir abajo

El Obamacare segun la revista Forbes...

Mensaje por Charlie319 el Miér Sep 25, 2013 9:51 am


 Por lo visto el Obamacare va a resultar en un desplome en la calidad e atencion medica...  Han visto como los viejos se quejam de MEDICARE?  Asi vamos a estar todos con Obamacare...
 
 
9/25/2013 @ 8:00AM


Obamacare's Insurance Exchanges Will Foster A Race To The Healthcare Bottom


The ObamaCare health insurance exchanges are supposed to open for business on October 1. There is a strong suspicion the 37 exchanges to be operated by the federal government will not be ready on time. Even when they do open, the administration is lowering expectations about what will happen next. Despite huge subsidies and despite daily publicity, these exchanges are expected to enroll only 11 million of 48 million uninsured Americans next year.
 
For anyone who has been living under a rock, here is the back story. The Affordable Care Act (ObamaCare) will require most Americans to obtain health insurance beginning January 1, 2014. You can be subject to a tax penalty if you fail to do so. If you don’t get health insurance from an employer or a government program, you are required to obtain it from a health insurance exchange, an online market where you can choose among competing health plans. If the administration’s estimate is anywhere near correct, three-fourths of the uninsured will ignore this mandate.
 
Those who do enroll may not be happy with their experience. We now know quite a lot about how these exchanges are going to function and the picture doesn’t look good.
 
Attracting the healthy, avoiding the sick. 
In most states today insurers are allowed to charge individuals premiums that reflect their expected health care costs. This practice is no different than it is in life insurance, casualty insurance or most any other kind of insurance. In a free market, you expect to pay premiums that are actuarially fair.
 
The Affordable Care Act will end this practice. Instead, insurers will be required to practice a form of community rating, under which the healthy and the sick will all be charged the same rate.
 
You don’t have to even be in the business to understand what kind of incentives that creates for the insurers. If the healthy are overcharged so that the sick can be undercharged, then insurance companies can expect to make profits on the healthy and losses on the sick. This means that it is in the self-interest of every insurer to attract the healthy and avoid the sick.
 
How do you do that? One way is to design plans that on the surface redistribute resources from the sick to the healthy.
 
Traditional insurance theory holds that patients should pay out of pocket for expenses that are small and over which they have a great deal of discretion. Insurance, on the other hand, should pay for expenses that are large and over which patients don’t have a lot of discretion. The insurance being offered in the exchanges turns that theory on its head, however.
 
Under a typical California plan, for example, patients will make only nominal copayments when they see a doctor, get a blood test or an X-ray exam ― activities that are often discretionary and the source of a great deal of unnecessary care. But if they go into a hospital (where patients have almost no control over what is done or what anything costs) they will be charged from 10% to 20% of the total bill. For an individual earning only a few thousand dollars above the poverty level, a hospital visit will cost $2,500. For a lower-middle income patient, the charge will be $6,350. A moderate income family can end up paying hospital expenses of $12,500 ― every year!
 
Clearly this plan will be attractive to people who don’t plan to enter a hospital and unattractive to people for whom a hospital stay is likely.
 
Race to the bottom on access to care.
Think of an insurance plan as having three main components: (1) a premium, (2) a list of covered benefits and (3) a network of doctors, hospitals and other providers. Under the Affordable Care Act, there is very strict regulation of benefits ― right down to free contraceptives, questionable mammograms and non-cost-effective preventive procedures. At the same time health plans have been given enormous freedom to set their own (community rated) premiums and choose their own networks. They are using that freedom in yet another way to attract the healthy and avoid the sick.
 
In the ObamaCare exchanges, the insurers apparently believe that only sick people (who plan to spend a lot of health care dollars) pay close attention to networks. Healthy people tend to buy on price. Thus, by keeping fees so low that only a minority of physicians will agree to treat the patients, some insurers are able to quote very low premiums. They are banking on attracting the healthy and they may even have the good luck to scare away the sick.
 
Community rating is what makes this strategy work. In the ObamaCare exchanges, if I am healthy why wouldn’t I buy on price? If I later develop cancer, I’ll move to a plan that has the best cancer care. If I develop heart disease, I’ll enter a plan with the best heart doctors. And these new plans will be prohibited from charging me more than the premium paid by a healthy enrollee. (See a more comprehensive analysis.)
As a result, we are getting a race to the bottom on access ― with private plans in the exchanges looking increasingly like Medicaid, just as they do in Massachusetts.
 
The Obama administration doesn’t seem to be bothered by this development. In fact they have been touting the fact that the premiums have been lower than expected, even though the reason is that the networks are narrower and skimpier than expected.
 
Think how different this is from what we were promised. During the 2008 election, every serious candidate for the Democratic presidential nomination repeated the “universal coverage” mantra repeatedly ― and on the left “universal coverage” means universal access to care. No candidate even hinted that access to providers might not be any better than it is under Medicaid.
 
Perverse incentive for insurance buyers. 
The penalty for not obtaining insurance is relatively small: $95 or 1% of your income in 2014. In future years it becomes larger, but for most people it will never come close to the cost of the health insurance they are required to buy. Further the enforcement mechanism is weak. All the IRS can do is withhold your income tax refund. It can’t garish your wages or attach an asset or even require you to pay a higher tax. And if you manage your affairs smartly, you will never be owed a refund.
 
As a result, the great fear of the Obama administration (and indeed the entire health insurance industry) is that millions of healthy people will decide not to enroll. This possibility is made more likely by a long, complicated enrollment form and an arduous enrollment procedure. Unless you are really sick and need health insurance right now, the temptation will be to wait to enroll until you have a health care problem. To make matters worse, the healthy, remember, are being over-charged from the git-go.
 
In Massachusetts, people who game the system are called jumpers and dumpers. They wait until they are sick to enroll (jump in). Then, after they get the care they need and get their medical bills paid, they dump the plan and disenroll. Of course, if the only people who have health insurance are people who are sick, the cost of insurance will go right through the roof.
 
To combat this possibility, the Obama administration has launched a desperate offensive ― attempting to enlist professional athletes, Hollywood actors, rock stars, librarians and anybody and everybody who can help persuade the healthy, especially the young and healthy, to join up. We’ll see how successful that effort is.
 
A better way.
ObamaCare is not the only health program in this country that requires insurers to accept all comers, regardless of health condition, and forbids charging higher premiums to people with higher expected health care costs. That’s the way Medicare Part B (doctors’ services) works, as well as Medicare Part D (drug benefit) and Medigap insurance. None of these programs has a mandate or any penalty for not enrolling. Yet they all discourage gaming. In general people have to sign up when they are eligible and if they don’t they face higher (in some cases much higher) premiums when they do enroll.
 
If we structured ObamaCare the same way, there would be no need for a mandate and no need for a great many other bureaucratic burdens.
 
But to avoid other problems, we must do more. We must jettison the whole idea of community rating. This is preventing insurers from presenting buyers with real (risk-adjusted) tradeoffs between price and access or price and benefits. It’s this artificial pricing that causes a race to the bottom, not some inherent defect in the market.
What about pre-existing conditions? There is a better answer for that as well. It is called “change of health status insurance.” People would be able to buy insurance that protects them against the cost of getting a pre-existing condition — including paying the extra premium should they need to switch to another health plan.




Preparense a pagar... Y bajo Agapito, mas vale que el bolsillo no tenga fondo...
avatar
Charlie319
Admin

Posts : 1615
Join date : 10/08/2012
Location : En el medio del Imperio

http://careoboricua.forumotion.com

Volver arriba Ir abajo

Re: El Obamacare segun la revista Forbes...

Mensaje por Charlie319 el Lun Sep 30, 2013 2:44 pm

Por lo visto,este es un temita que va a seguir dando lata...


 http://www.forbes.com/sites/merrillmatthews/2013/09/30/why-democrats-should-worry-obamacare-rollout-will-hurt-them-in-2014/


Obamacare's Rollout Could Be A Big Problem For Obama And Democrats In 2014

Merrill Matthews, Contributor
I explore public policy and politics and expose foolish ideas.

If Democrats aren’t worried about President Obama’s “Problems?  What problems?” response to the multiple glitches and snafus of his ObamaCare rollout, they should be.  The public is deeply suspicious of the law and it wouldn’t take much to create an electoral backlash that could send dozens of incumbent Democrats home for good in November 2014.

We are being inundated daily with news stories highlighting the problems with, and those caused by, the legislation.  Obama has indirectly acknowledged these problems by postponing several elements of the legislation.

While it is possible that some of the kinks could be worked out shortly after rollout, it is just as possible that some, perhaps even most, of them will plague us for a year or more.  And the public will know who to blame if those problems persist.

Impeded access to doctors = rationing health care.  The U.S. already has a shortage of doctors.  Recent studies indicate that within seven years that shortage could rise to 45,000 primary care physicians.  Fewer doctors means it will be harder to see one in a timely manner.  The Affordable Care Act will make that problem much worse by greatly increasing the demand for doctors.

The ACA is supposed to insure an extra 30-plus million uninsured.  Health care utilization for the long-term uninsured initially spikes when they first get coverage.  The result will be some lengthy waiting times as more people chase fewer doctors.
You can just imagine all those middle-class Americans complaining about how they used to be able to get in to see their doctor—until ObamaCare kicked in.  And, of course, the waiting lines will drive up emergency room use.

Timely access to a doctor is a key component of what people see as a quality health care system.  Americans will likely see it as the government rationing care, even if it is just a result of supply and demand.

Higher costs means fewer votes.  Obama once claimed ObamaCare would drive down health insurance premiums; officials now claim that with the subsidies most people will be paying less.  Don’t be too sure.

For example, National Journal just released its assessment of how ObamaCare will affect the individual market.  Two-thirds of workers with single coverage and 57 percent of workers with family coverage will see their costs go up in the exchange.  In addition, recent stories claim that some of the premiums are lower than expected because the copays and deductibles are so high.

Those forced to pay higher out-of-pocket costs, as well as higher premiums, will perceive that ObamaCare is hurting them financially and voters may well decide to return that pain on those who forced them to pay more.

Complexity = failure.  ObamaCare is complex.  There are numerous rules about who qualifies for what subsidies and additional help.  The technology was supposed to handle much of the complexity, but we hear that many of the exchanges aren’t yet ready for prime time.  That complexity could frustrate a lot of people who may see it as a failure because they can’t figure it out.

The drawbacks to clawbacks.  If you qualify for a subsidy based on your estimated 2014 income and then make more than you estimated, you will be required to pay back part of that subsidy at the end of the year.  And those who received too much subsidy may discover that problem during “open season” in 2014 when they begin considering their coverage for 2015.  That open season will start about three weeks before the November elections.  Those having to write the government a clawback check, which could easily be more than a thousand dollars, may want to engage in a little November clawback themselves.

Personal info becomes public info. A lot of people, government officials as well as non-government employees, will have access to your health information, income and other valuable data.  They could snoop or they could share it with others, even if by mistake—just look at recent incidents by the IRS and National Security Agency.

We are likely to see a lot of security breaches—indeed, we already are.  Some will be intentional, some won’t.  But there will be a lot of them.

My own sense is the public feels vulnerable right now; ObamaCare will make that worse.

It could undermine Democrats’ faith in efficient big government. Everything Obama does is based on his faith in big government’s ability to do things right.  True, he has precious little evidence for his faith, which is why it’s “faith” and not fact.
While Obama has made it clear he would prefer a single-payer health care system—any big-government believer would—ObamaCare is close enough.  But if it crashes, it will undermine his and Democrats’ claims.  They will, of course, blame others for the failure—that has been the pattern for the last five years—but the public might not buy it, and likely wouldn’t because only Republicans have been raising the red flags trying to get the law repealed or delayed.  But that might be changing.

There are reports that some Democrats—e.g., Sens. Joe Manchin (WV), Mark Begich (AK), Mark Pryor (AR) and Mary Landrieu (LA)—may be having second thoughts.  They should.

Republicans are now pushing for a one-year delay in the law, which isn’t unreasonable given the president has unilaterally postponed several parts for a year, even though he has no legal authority to do so.

Perhaps one of those Democrats can lead the way by doing what Senate Minority Leader Mitch McConnell did during the last budget standoff when he called Vice President Joe Biden and asked if there wasn’t someone there who could make a deal.

Merrill Matthews, Ph.D., is a resident scholar at the Institute for Policy Innovation in Dallas, Texas.  Follow at http://twitter.com/MerrillMatthews
avatar
Charlie319
Admin

Posts : 1615
Join date : 10/08/2012
Location : En el medio del Imperio

http://careoboricua.forumotion.com

Volver arriba Ir abajo

Ver el tema anterior Ver el tema siguiente Volver arriba

- Temas similares

 
Permisos de este foro:
No puedes responder a temas en este foro.