First I would like to say the exchanges are stupid and a distraction. However, they did not disrupt a free-market insurance system. They simply replaced a crony-capitalist over-regulated health care market with a crony-capitalist over-regulated health care market that has a webpage.
Previously health care costs were too high for the value generate. The same is true now. Previously doctors and hospitals were over testing, over treating, and over charging. The same is true now. Previously the consumer did not have clarity to what he was being billed for. The same is true now. Previously the FDA would grant pharmaceutical companies inappropriate protection from competition. The same is true now. Previously doctors and hospitals were spending an inappropriate portion of dollars practicing defensive medicine. The same is true now. Previously doctors and hospitals were spending far too much of their revenue to fight off ambulance chasing lawyers. The same is true now.
The biggest problems in the system are entirely untouched, and we have moved a whopping 3% of our population onto the healthcare exchanges. Let’s also note that while this 3% is higher in average costs than its non-exchange counterparts it is lower cost than the average medicare enrollee. So for 7 years now we have been arguing over what accounts for ~2% of our entire healthcare spend. Okay, lets add in the Medicaid expansion and bump that number up to 4%. That is, the entirety of the discussion is less than the increase in the healthcare spend last year. Notice what has happened though, conservative, liberal doesn’t matter the focus is on that 2-4% of the market, and not on FDA protections of evergreening processes. We discuss co-op collapses but not tort reform. We talk about Aetna’s pullout, but not whether FNPs or PAs should be allowed to practice the full scope of their training. We talk about the latest quote from the governor of MN, but not whether it should be legal to send a patient a bill without discussing the price before hand.
Let’s imagine that every time you took your car in for work you were required to sign a form that allowed the mechanic to do whatever work he though was appropriate and send you the bill. Alternatively let’s imagine if a nurse was required to ask “Would you like to hold your baby? It will only cost $35.” “Would you like an epidural? If there are no complications it will be $3,000.” The answer to the first would be “Give me my baby and get out of this room.” The answer to the second “$3000!!?? What the [fill in your response here]? I think I can manage for the next three hours thank you.” Granted, emergency procedures would be exempt, but an epidural is not an emergency procedure. If you require hospitals to present the price before the service is provided then the conversation changes. Right now the high deductible plans are nice in encouraging consumers to shop around, but given that you can’t actually get a price or a bid you are not able to shop around. Allow patients to refuse to pay for any non-emergency procedure for which they did not approve a quote.
Allow nurses to practice the full scope of their training. Allow expedited processing for bio-similars, generics, devices, and drugs that have been approved in countries with regulatory agencies similar to ours. Allow the introduction of drugs that are less effective than current medicines as long as they are safe (drop the efficacy requirement). Institute malpractice boards composed of both physicians and lawyers on a rotating basis. If we can do all these things then we should expect the cost of coverage to drop by at least 30% without any change in healthcare insurance structure. We are allowing the elites on both sides to distract us from their crony friends. We bicker about the 4% and ignore the 30%. Let’s push our state legislators on PA and FNPs and on tort reform. Then push our national legislators on FDA. After we do the big things then let’s come back to ACA.