Yet there are still many among us who refuse to believe that price honesty in an open market can “bend the healthcare cost curve” – let alone that it is essential for affordable healthcare. Not only does it work, but is less expensive for participants and also begets higher quality, being intrinsic to the proposition of a mutually beneficial exchange of value between buyers and sellers.
Alternatives to our current over-priced and dysfunctional health insurance market are often biased, and thus limited, by our current operational and regulatory structure. These structures are so entrenched in our healthcare psyche that it makes it difficult sometimes to set these aside in our minds while entertaining how another approach might work.
If we view all alternative plans to replace the Affordable Care Act from the vantage point of “what is”, then there is little room for anything other than attempts at further regulating the problems away. If one presupposes that the current regulatory framework remains unchanged, indeed the same framework has served to suppress the very market we wish create, then of course that market will not be created.
The dilemma facing alternative healthcare plans being considered to replace the ACA is particularly evident when it comes to the issue of selling health insurance across state lines. A brief on this subject published by the American Academy of Actuaries in February of 2017 speaks to the the main challenges facing the advent of a viable interstate market for the sale of health insurance.
While it is literally true that last year’s increase was the lowest since 1960, growth in 2009 was only 3.8 percent, after 4.8 percent in 2008. You do not need a PhD in economics to conclude that the recession was likely the largest factor. It is hard to detect much more than noise in the annual changes since the recession hit. This is corroborated by the fact that 17.4 percent of Gross Domestic Product is accounted by health care ― exactly the same percentage as in 2009 and every year since.
Nevertheless, CMS’ actuaries allege that Obamacare’s provisions kept a lid on costs, citing:productivity adjustments for Medicare fee-for-service payments;reduced Medicare Advantage base payment rates;increased Medicaid prescription drug rebates; and the medical loss ratio requirement for private insurers.
Yes, Medicare spending dropped from 4.0 percent in 2012 to 3.4 percent in 2013. However, Medicare’s enrollment growth also slowed, and the Republican-driven sequestration also held back spending. Medicare spending per enrollee actually rose at the same rate as in 2012. It is hard to see Obamacare’s technocratic cost savings in these figures.
Medicaid spending exploded 6.1 percent. Although government wrangled more discounts from drug makers, this did not compensate for increased Medicaid enrollment and higher fees for providers. The best performance was by private insurers, for whom spending growth dropped from 4.0 percent in 2012 to 2.8 percent in 2013. Medicare regulates health insurers’ medical loss ratio (MLR), which is the ratio of medical claims to total premium (actually, a more complex calculation than it appears). CMS’ actuaries credit this regulation with lowering the growth of private insurers’ spending.