Articles on Health Reform

Thought I would put together a quick post of some of the articles I have seen on health reform recently, as it has been in the news constantly due to the rollout, individual market changes, and other miscellaneous happenings.

This interview goes through many of the recent issues that have been brought up by the ACA and some relatively intuitive explanations of each. Specifically, I wanted to comment on two areas.

One is the debacle on messaging that the law has faced especially in the individual market. Is this part of the “you must pass this bill to find out what’s in it” ethos? How did so much misinformation, on both sides, come out of this bill? Its contents prohibit many of the ‘features’ that these lower cost plans used to offer (high deductible and lifetime maximums and other gimmicks that kept sticker price down), so no wonder that they had to be eliminated and canceled. It is poor politicking that the political talking points that became such important campaign messages (you will be able to keep your plan if you like it) when they were so blatantly false. Looking back on Master of the Senate, the health care bill seems like the perfect candidate for a bill that required the time in debate to actually learn what was inside it and educate the public on the finer points of the law. Of course, given how information has spread on it since its passage, this might not have helped us get to the truth at all.

Secondly, the implementation of ACA is a narrative in governments efficacy. It’s truly amazing how many resources were used to put together – for the creation of a website – and how badly it has failed. Granted, it’s a complex website, but the government manages a lot of complex projects. It showcases the lack of proper talent available to solve these new digital problems, and a lack of ability to manage scale. Government is good at some things, but not at others. We should have a frank discussion about what it can and cannot do, which we often avoid.

Healthsherpa is a website build by 3 developers in a few weeks, and it manages to fulfill similar functionality of Perhaps government should figure out a way to harness the latent talent out there to solve problems (gamify it and offer a reward?). In recent years, the MTA in New York has opened contests for folks to build apps relating to the subway system. I’ll have to look into how much it has accomplished, but it is a potential model for use at the Federal level. Of course…

This article takes a more cynical view than I would, but I do agree that we need to make changes in how we deliver new laws especially as they become even more digital. Why not figure out a way to harness development outside of government bureaucracy? I think it can be done, and should be done. A slow and lumbering Federal government is I’ll equipped to deal with today’s issues; we are also seeing this with large corporations versus smaller, newer, and less rigid companies. Smaller companies have largely out-innovated their larger cousins, and are driving a lot of the new ideas and problem solving we are seeing.

Another example of how much people do not understand about the law. This particular couple had their plan canceled and replace with a worse one even though it met the minimum requirements of the law.

PPACA is, in part, a leveling exercise. Whereas previously health care insurers could segment the population much more narrowly, now they must rely on larger actuarial groups and charge the same amount for broader numbers of people (and can only alter pricing for a small number of variables). This leads some to subsidize others in a closer relationship than before. This couple may have been very healthy and ticked all of the boxes for a cheap plan, but now they are thrown in a pool with those that do not, and insurers are legally prohibited from discriminating positively or negatively to groups such as this couple. It’s one of the central purposes of the law; health insurance is a zero sum game, and to give health insurance to those that could not afford it (through subsidies from the Feds, which we pay for in taxes, or benefit gains like coverage for preexisting conditions, which is very expensive) the rest of us were always going to pay more, in aggregate.

Is this right? Probably. Health care has always struck me as one of the “economic goods” that has a most moral character, and is poorly ethically rationed by price. However, the messaging has not included the fact that we are supporting our fellow Americans in this endevour. The messaging was all gains and no acknowledgement of where the costs would lie. It should be no surprise that there is widespread sticker shock as people become aware of those costs.

I’ve always disagreed with the factors that allow differing prices: family size, age, geography, and smoking status only. I think that consumers should pay more for their health choices, much like how I would pay more for car insurance if I get into more accidents. This is made more difficult by the fact that many health conditions are not preventable, but this doesn’t mean we should completely avoid the thought. While we are at it…

What should those factors be? This quick article brings up some interesting points on what is actuarial discrimination and what is not. In health care, should we charge women more because of these factors? If we should not, why should men pay more for car and life insurance? How deeply should we regulate actuarial tables and outcomes?

While most of my commentary here has been rather anti-implementation of the law, I wanted to end with an op-ed penned a few months ago in the Guardian…

I start my approach to healthcare from two very basic premises. First, healthcare must be recognized as a right, not a privilege. Every man, woman and child in our country should be able to access the healthcare they need regardless of their income. Second, we must create a national healthcare system that provides quality healthcare for all in the most cost-effective way possible.

I’m not going to spend a lot of time going into the later parts of his argument on the benefits of single payer (everyone seems to like Medicare…), but I want to agree with his two premises. Income and economics are not a just way to ration and access health care; it just isn’t fundamentally right for a service that can separate death from life. How to do this cost effectively is a problem that only a small army of people is trying to solve today.

Let me know your thoughts!