is the gov. a) diminishing b) leveling or c) expanding its authority to influence or mandate the delivery and financing of health care?
You have to understand, I deal in specifics, nuts-and-bolts policy. Broad pronouncements designed for rhetorical effect instead of conveying meaning mean very little to me. Government has been “influencing the delivery of health care” for the better part of a century. You understand that they
build hospitals right? Remember Hill-Burton? I suppose that means we’ve now pegged 1946 as the date of the “takeover.” Where does the majority of the financing come from in the ACA? It comes from placing limits on the existing limitless federal subsidy enjoyed by health plans in the group market and redirecting it to plans in the individual market. In the short run, a significant chunk comes from redirecting dollars that under the baseline scenario would have already gone to federal health programs.
You hint in the rest of your post at things like rate review and medical loss ratios (though you continue to avoid explicitly saying what’s bothering you, yet imply
I’m being evasive). More than half of all states already have the authority to reject premium increases if necessary and nearly all have at least some form of oversight and review authority. What most of them are undertaking now under ACA is improving their internal processes, involving the public, incorporating better technology. Some are widening their scope to additional segments of the state health insurance market. The rate review provisions are effectively a greater standardization of oversight authority across states. Does having a state insurance commissioner constitute a takeover of the insurance industry? Again, if so, that ship has long sailed.
But since "influencing the delivery of care" is apparently the calling card of an evil government takeover, I'm curious about something. Over the past twenty years, several states have reorganized their state health policy apparatus as a Health Authority. In doing so, they collect all of the state health purchasers under a single roof with the explicit aim of maximizing the state's purchasing power to influence the state delivery system. Oregon is the latest state to do this but Kansas did it a few years back and Oklahoma did it well over a decade ago. Is that a "government takeover"? If so, it sounds like a great many states were taken over by the government well before the ACA was passed; and I don't just mean states with Health Authorities, as I'm sure states like Massachusetts and Maine also meet whatever your vague definition of "government takeover" is.
I suppose the obvious question is: if ACA was a government takeover, what part of the health care system hadn't
aready been taken over (using a consistent application of your definition) by either the state or federal government and was thus subject to the ACA's takeover? What are you suggesting tangibly changed with the passage of the ACA?
Q- when Nor. Carolina BC/BS returned 155 million dollars to its policy holders, was this; a) done this through their own good graces because they felt it was 'the right thing to do', b) because the state insurance commissioners "have new leverage" c) because they had overcharged their policy holders, d) because the health care act mandated they did so, e)none of the above?
I realize you don’t do nuance but the answer is a mix of “all of the above” and “none of the above.” The reason for the refund is
fairly simple:
The refunds come from reserves set aside for these [individual market] policyholders. Some premiums in certain policies build up reserves to even out the cost of premiums over the life of the policy. The health reform law will provide new versions of these plans starting in 2014, so the current policies will end sooner than originally expected. That frees up some of the reserves to be refunded. Refunds do not apply to employer-sponsored policies.
So yes, they overcharged, but that was a practice that made sense in a disorganized individual market. Given that the state will have an exchange in a few years and a robust risk-adjustment mechanism, the reserves they were stockpiling for their individual market clients are no longer necessary (so yes, refunding the money this year is, as their CEO says, the right thing to do). State regulators don’t have new leverage over the individual market, since North Carolina already requires prior approval for premium increases in the individual market. However, while their data is publicly available, they’re exploring the possibility of posting what they call “consumer friendly” summaries so that there’s a bit more sunlight on filings--if public comment is incorporated as a component of premium oversight (see below), public knowledge of the existence of large reserves amid premium increases would potentially be damning. I’m sure BCBS also had it on their minds that eventually (though not this year) useless reserves would count against their medical loss ratio and ultimately would likely have to be partially refunded anyway.
The public comment period on the proposed rule is now open if you wish to weigh in.
Have you ever heard the phrase- “no plan survives contact with the enemy”?
Old military saying. You can plot plan and scheme, put everything in neat bundled reams of paper, all set forth; each battalion, regt. and division assigned its place, food, ammo, signals, transportation set in motion to meet them at their appointed place and time.
Guess what? The minute they move out and cross the lines, or the fleet is engaged all of it goes out the window, they are flying by the seat of their pants. Due to unforeseen circumstances and the law of unintended consequence as every action they take is met by a reaction by the other side creates a whirlpool of complex dance that loses all but facile relation to “the plan”. The opposition if you will does not respond the way you want them to or as the plan envisioned.
I asked you a question; did you think that the gov. the fed. gov was via influence upon delv. And financing of healthcare extending its influence etc. staying roughly the same or diminishing its role. You then expounded on how the states by and large are already heavily involved in regulatory engagement etc etc...the gov. buidlls hospitals and by virtue of their onw regulatory commissions licenses doctors nurses hospitals schools etc....yes, I am aware of that, I don’t even care for their central planning, the issue is the federal gov’s all encompassing top down central planning, are we suppose to that a machine by order of magnitudes larger by comparison is going to be anymore efficient, why? Because they have all the reigns in their hands, or that’s let me re-phrase are ‘influencing’ the subordinate markets etc?
Your answer summed up is, and this is not new; ‘ you already have some of that, whats wrong with more’, and then detail why it will ‘work’. Do you understand the problems many have with this thinking? Its a conceptual and philosophical influence I am not sure you quite grasp.
I asked you about rationing, your answer, in a nutshell was, well, rationing is already taking place and then went off on a nuts and bolts scheme as everything will be better this time and this is an improvement. You are a nuts and bolts guy, you may be very good at it, but a virtue may also be a handicap and yes that works both ways, you will dive into minutiae to describe how things are either half way there already and how things will be set right if we only trust a larger mechanism to take control or “influence” the device.
Maybe a little distance might do you some good. Medicare and Medicaid had the virtue of starting form a much cleaner slate, with much bi-partisan sppt as well in a much younger market.
I am sure the nuts and bolts guys told us all hey when this is enacted and actually takes effect and this is done and we have adjusted this, all will be well. Hows that working out? The budgets they forecast in 25 years below by their original forecasting by 3 orders of magnitude, think on that a moment. And they are a mess...yes yes the reps may have done this the dems that each has tinkered with the system and that’s exactly the point. BUT now, we are going to allow the feds, an even larger less flexible org. influence it all across the board and the present day cousins of those nuts and bolts guys in 65 are telling us; all is well, don’t worry....how many hiccups has Obama care hit already? If the mandate is off the table, even the truncated sniveling one they enacted, its over, oh yes slot A goes in groove b and we can work around it or we have a plan for that etc etc etc etc ...
The financing was a ghost you know it, I know it, and it has not gotten any better, with the mandate looking shaky? What then? Nope, no retreat, like a general screaming at his corp commanders who cannot take their objective ground by the day assigned- I told you follow the plan!!!!!!!
And lets remember, the plan meanwhile wasn’t even fully complete, the senate due to Scott Browns election forced the House to vote on it as it was delivered, as they could not force cloture again with Scott on board, so they could not change a thing, god knows how much worse or if the changes they envisioned would have been an improvement but here we are.
Organizations, most especially organizations in the gov. are especially territorial an hierarchal, the fed and state orgs are not are not blocks of wood ( as we have seen, you may not like what they are doing but it’s the law of unintended consequence and changes the paradigm) and neither are the other depts. grps sects either in existence now or son to be created to fill the basket of fed. control or influence that will influence the del. and financing.
Put dowel A in slot B, slide B into groove C and come up with D. To the degree you introduce MORE complexity via orgs, depts. influences, concomitantly efficiency degrades.
I will be specific as to the North Carolina issue if I may there wasa reason aside form the ‘nuts and bolts’ I asked you about this; now as I understand it, BC/BS liquidated its active life reserves, by returning them to the policy holders. Okay, now these active life reserves are funds built up over time to help pave over possible spikes if say costs rise faster than forecast...yes? They draw on the funds to even out premiums...yes?
The ind. Policy holder market will pretty much vaporize in 2014 ....yes? Anyone who modifies or changes their policy won’t be grandfathered in...yes? BC/BS’s ind. market will virtually disappear.....yes? There-fore it doesn’t need the reserves....yes? Ipso- the 2014 roll over has created a regulatory imperative, that’s why they sent the money back....did I sum this up correctly?
One last Q if you will- how would you describe the HHR’s and Sebelius explanations of, detail, general output and honesty as it applies the Obama care?
Lets consider 10 being primo?
Conceptual explanation-
Detail-
Gernral output-
Honesty-