Empowering Patients First Act

[YoungDoc25]

Advertisement - Members don't see this ad

https://www.google.com/amp/www.thef...bamacare-Replacement-Plan-0?amp?client=safari

Would love to hear some opinions on what looks to be our new healthcare policy. Whether we like it or not, our healthcare system will be changing (for better or worse). I'm not near as knowledgeable as I'd like to be with the political jargon, so I'd love to reach out to my colleagues that will certainly have different views (Democrat, Republican, etc.) and experiences involving healthcare. Please try to keep it educational and professional (seemingly impossible for these topics).

Annnnd... Go!

 

[bananafish94]

This will surely end well.

 

[YoungDoc25]

This will surely end well.

Maybe it'll exceed our expectations and be productive.

 

[general admission]

I don't see how anyone in our profession can ignore how much insurance companies directly meddle in and harm patient care. They are a direct boon to the doctor patient relationship. For touting "empowering patients" in the name, it's absolutely rolling out the red carpet for insurance companies.

HSAs and tax credits are a distastrously bad alternative to providing coverage. One serious illness, completely out of your control, will deplete years worth of saving instaneously. This is immediately evident, regardless of your political leaning, to anyone who has ever had a serious illness.

Selling insurance across state lines is bunk. There will be nothing stopping them from shoring up in the state with the least lax regulations, as has happened with the credit card industry.

I was hoping a physician would at least keep the interests of our profession in mind, and our tort reform out there, and fight against health administration bloat vs "overpaid doctors". But this plan is clearly aimed at lining the pockets of insurance companies at the direct expense of the poor and sick. It will do hardly anything to stop the astronomical rise of premiums and hand the keys directly to private companies themselves, who have already shown how horribly they behave when untamed.

 

[YoungDoc25]

By the end of the first page it will have nothing to do with your question and will be a battle between msnbc and fox news.

it's worth a shot

 

[libertyyne]

https://www.google.com/amp/www.thefiscaltimes.com/2016/11/30/8-Big-Changes-Under-Tom-Price-s-Obamacare-Replacement-Plan-0?amp?client=safari

Would love to hear some opinions on what looks to be our new healthcare policy. Whether we like it or not, our healthcare system will be changing (for better or worse). I'm not near as knowledgeable as I'd like to be with the political jargon, so I'd love to reach out to my colleagues that will certainly have different views (Democrat, Republican, etc.) and experiences involving healthcare. Please try to keep it educational and professional (seemingly impossible for these topics).

Annnnd... Go!

Seems like it would increase premium costs to middle class families that buy through their employer since employers will be limited in the tax deduction for providing plans to employees .
Poorer Americans will get kicked off of Medicaid expansion.
No subsidies and 3000 tax credits won't cover premium costs for low income Americans.
Better for high income self employed folks since HSA tax benwfit will be made larger.

Probably result in less coverage for poor Americans as a whole and higher contribution from employees towards premiums.

No idea on what the high risk pool will do. It seems like it will be underfunded.

It will look similar to America prior to the ACA.

Young and the wealthy Americans will see benefits. Older ,poorer and middle class people will pay more for premiums or loose coverage.

 

[Psai]

Really what I care about is decreasing administrative burden, spending less time on paperwork and doing actual doctor work. Having more time to talk to patients instead of worrying about the level of billing would be nice. Also notes wouldn't be such a pain in the ass to read. I wish politicians would spend some time on that.

Maybe put everyone on the same emr like epic and make it easy for people to see each others notes, decrease duplicate testing, etc. Force people to put some skin in the game so people would stop telling doctors to put their demented 80 year old mother on a ventilator for months in the icu. Have healthcare facilities post prices so there would be competition and decreased costs to the consumer. No one focuses on things that could actually make health care better and instead they waste time on nonsense like tax credits and health savings accounts.

 

[libertyyne]

Really what I care about is decreasing administrative burden, spending less time on paperwork and doing actual doctor work. Having more time to talk to patients instead of worrying about the level of billing would be nice. Also notes wouldn't be such a pain in the ass to read. I wish politicians would spend some time on that.

Maybe put everyone on the same emr like epic and make it easy for people to see each others notes, decrease duplicate testing, etc. Force people to put some skin in the game so people would stop telling doctors to put their demented 80 year old mother on a ventilator for months in the icu. Have healthcare facilities post prices so there would be competition and decreased costs to the consumer. No one focuses on things that could actually make health care better and instead they waste time on nonsense like tax credits and health savings accounts.

Tort reform, standardized EMR that talks across organizations and simplified and clear costs seems like a good plan.

 

[YoungDoc25]

Seems like it would increase premium costs to middle class families that buy through their employer since employers will be limited in the tax deduction for providing plans to employees .
Poorer Americans will get kicked off of Medicaid expansion.
No subsidies and 3000 tax credits won't cover premium costs for low income Americans.
Better for high income self employed folks since HSA tax benwfit will be made larger.

Probably result in less coverage for poor Americans as a whole and higher contribution from employees towards premiums.

No idea on what the high risk pool will do. It seems like it will be underfunded.

It will look similar to America prior to the ACA.

Young and the wealthy Americans will see benefits. Older ,poorer and middle class people will pay more for premiums or loose coverage.

Being in an open market where you can choose your employers plan or pick a cheaper one anywhere in the states, I don't really see how the costs could rise. To me, it sets up a competition between your employer and insurance companies to begin competing on costs. Or is that just way off?

How I understood it is that only able bodied individuals without preexisting conditions will be kicked off. But they would also receive tax credits for competing in the open market, along with being in a market that has (hopefully) lowered costs due to competition. No one with debilitating illnesses would be kicked off. Is that correct?

Definitely agree that the high risk pool will be way underfunded. Sad to see that. Hopefully that's up for change.

 

[YoungDoc25]

Really what I care about is decreasing administrative burden, spending less time on paperwork and doing actual doctor work. Having more time to talk to patients instead of worrying about the level of billing would be nice. Also notes wouldn't be such a pain in the ass to read. I wish politicians would spend some time on that.

Maybe put everyone on the same emr like epic and make it easy for people to see each others notes, decrease duplicate testing, etc. Force people to put some skin in the game so people would stop telling doctors to put their demented 80 year old mother on a ventilator for months in the icu. Have healthcare facilities post prices so there would be competition and decreased costs to the consumer. No one focuses on things that could actually make health care better and instead they waste time on nonsense like tax credits and health savings accounts.

Too logical 😉

 

[YoungDoc25]

I don't see how anyone in our profession can ignore how much insurance companies directly meddle in and harm patient care. They are a direct boon to the doctor patient relationship. For touting "empowering patients" in the name, it's absolutely rolling out the red carpet for insurance companies.

HSAs and tax credits are a distastrously bad alternative to providing coverage. One serious illness, completely out of your control, will deplete years worth of saving instaneously. This is immediately evident, regardless of your political leaning, to anyone who has ever had a serious illness.

Selling insurance across state lines is bunk. There will be nothing stopping them from shoring up in the state with the least lax regulations, as has happened with the credit card industry.

I was hoping a physician would at least keep the interests of our profession in mind, and our tort reform out there, and fight against health administration bloat vs "overpaid doctors". But this plan is clearly aimed at lining the pockets of insurance companies at the direct expense of the poor and sick. It will do hardly anything to stop the astronomical rise of premiums and hand the keys directly to private companies themselves, who have already shown how horribly they behave when untamed.

Really interesting how insurance are always painted as the good guys. Very frustrating!

I think the HSA's and tax credits are a great idea if the market costs do significantly drop. Selling across state lines would definitely help lower those costs IF (big, big if) somewhere in the 250+ page bill stops them from piling up in the most laxly regulated state like you said. If that is in the bill, or is later added, do you feel like improvement in the market could be seen for the middle and lower class? Either way, the rich are fine it seems.

 

[SurfingDoctor]

I'm sure the repeal of Medicaid coverage expansion under the ACA that dramatically reduced uninsured children will be a popular provision and greatly help children's health.

 

[libertyyne]

Being in an open market where you can choose your employers plan or pick a cheaper one anywhere in the states, I don't really see how the costs could rise. To me, it sets up a competition between your employer and insurance companies to begin competing on costs. Or is that just way off?

How I understood it is that only able bodied individuals without preexisting conditions will be kicked off. But they would also receive tax credits for competing in the open market, along with being in a market that has (hopefully) lowered costs due to competition. No one with debilitating illnesses would be kicked off. Is that correct?

Definitely agree that the high risk pool will be way underfunded. Sad to see that. Hopefully that's up for change.

Your employer already shops in the open market and finds the best plan it can find for the price also negotiating group discounts. Prior to the ACA people were free to go to the open market and buy plans. Almost no one did because employer provided plans are almost always cheaper. That coupled with the fact that you are now losing money the employer was paying on your behalf towards the plan to get those juicy tax breaks. It's like having a 401k plan where your employer provided a 50% match, by going outside your employer you loose that match. Your trust in open markets is misplaced in this instance as prior to ACA we had this set up yet costs never magically came down.
The plan will kick all people off Medicaid expansion, even with exisiting conditions. They can buy plans at the Community rate under the plan. But 1200 -3000 is not enough to buy a coverage plan on the open market so people on Medicaid wont be able to shell out 5k+ per year to buy a plan therefore going without. If you make 15k a year you ain't spending 10k to buy health insurance even if you get a 3 k tax credit.

 

[username456789]

Your employer already shops in the open market and finds the best plan it can find for the price also negotiating group discounts. Prior to the ACA people were free to go to the open market and buy plans. Almost no one did because employer provided plans as almost always cheaper. That coupled with the fact that you are now loosing money the employer was paying on your behalf towards the plan to get those juicy tax breaks. It's like having a 401k plan where your employer provided a 50% match, by going outside your employer you loose that match. Your trust in open markets is misplaced in this instance as prior to ACA we had this set up yet costs never magically came down.
The plan will kick all people off Medicaid expansion, even with exisiting conditions. They can buy plans at the Communists ity rate under the plan. But 1200 -3000 is not enough to buy a coverage plan on the open market so people on Medicaid wont be able to shell out 5k+ per year to buy a plan therefore going without. If you make 15k a year you ain't spending 10k to buy health insurance even if you get a 3 k tax credit.

I don't have much to add right now except please learn the difference between "lose" and "loose." You are making that error way too often.

 

[libertyyne]

I don't have much to add right now except please learn the difference between "lose" and "loose." You are making that error way too often.

Thanks, Fixed. My phone autocorrects. Does it matter tho, considering this is the internet.

 

[YoungDoc25]

Your employer already shops in the open market and finds the best plan it can find for the price also negotiating group discounts. Prior to the ACA people were free to go to the open market and buy plans. Almost no one did because employer provided plans are almost always cheaper. That coupled with the fact that you are now losing money the employer was paying on your behalf towards the plan to get those juicy tax breaks. It's like having a 401k plan where your employer provided a 50% match, by going outside your employer you loose that match. Your trust in open markets is misplaced in this instance as prior to ACA we had this set up yet costs never magically came down.
The plan will kick all people off Medicaid expansion, even with exisiting conditions. They can buy plans at the Community rate under the plan. But 1200 -3000 is not enough to buy a coverage plan on the open market so people on Medicaid wont be able to shell out 5k+ per year to buy a plan therefore going without. If you make 15k a year you ain't spending 10k to buy health insurance even if you get a 3 k tax credit.

I agree hardly anyone went to the open market, but that was because prices were down. I know my premiums, along with most everyone else, have gone up since ACA. Prices were definitely lower then with an open market, even if you stayed with your employer. Now your employer not only has your state to shop around in, but all over the country as well. I agree though that the loss of employer help in paying it isn't a positive. Them paying less towards my health insurance does allow me an opportunity to negotiate a higher salary though. That, paired with giving me a 1200-3000 tax credit, could easily offset the difference when in a market where I can find the cheapest plan.

The Act does keep you if you have preexisting conditions, as long as you've had your plan continuously over the last 18 months. Pretty fair IMO. If you're paying 10k in insurance for yourself, you're getting screwed.

 

[general admission]

I agree hardly anyone went to the open market, but that was because prices were down. I know my premiums, along with most everyone else, have gone up since ACA. Prices were definitely lower then with an open market, even if you stayed with your employer. Now your employer not only has your state to shop around in, but all over the country as well. I agree though that the loss of employer help in paying it isn't a positive. Them paying less towards my health insurance does allow me an opportunity to negotiate a higher salary though. That, paired with giving me a 1200-3000 tax credit, could easily offset the difference when in a market where I can find the cheapest plan.

The Act does keep you if you have preexisting conditions, as long as you've had your plan continuously over the last 18 months. Pretty fair IMO. If you're paying 10k in insurance for yourself, you're getting screwed.

Premiums were going up before the ACA at a much faster rate than they are now.

 

[YoungDoc25]

I'm sure the repeal of Medicaid coverage expansion under the ACA that dramatically reduced uninsured children will be a popular provision and greatly help children's health.

Great point. Hadn't thought of them, and apparently no one writing the bill had either.

 

[SurfingDoctor]

Great point. Hadn't thought of them, and apparently no one writing the bill had either.

Children can't vote... thus they don't typically count. That's been my experience.

 

[YoungDoc25]

Premiums were going up before the ACA at a much faster rate than they are now.

Depends on what data you look at, but thats also an interesting topic. If you take out the federal subsidies citizens receive that have lowered premiums, do you think the rise in cost would be fairly similar? Difference would be that the government debt grows instead of you spending more. Lose/lose situation. I don't/didn't hate the ACA, but too many people try to act like it was/is gold standard in healthcare.

 

[libertyyne]

I agree hardly anyone went to the open market, but that was because prices were down. I know my premiums, along with most everyone else, have gone up since ACA. Prices were definitely lower then with an open market, even if you stayed with your employer. Now your employer not only has your state to shop around in, but all over the country as well. I agree though that the loss of employer help in paying it isn't a positive. Them paying less towards my health insurance does allow me an opportunity to negotiate a higher salary though. That, paired with giving me a 1200-3000 tax credit, could easily offset the difference when in a market where I can find the cheapest plan.

The Act does keep you if you have preexisting conditions, as long as you've had your plan continuously over the last 18 months. Pretty fair IMO. If you're paying 10k in insurance for yourself, you're getting screwed.

The problem is you are discounting local health system monopolies and their ability to dictate prices. Out of state insurers have very little leverage over local health systems, so either you can buy a plan that no local healthcare entity will accept or the price will be exorbitant. This magical opening of the state borders will not drive down costs, it already existed in the ACA , no states took advantage of that. 1200 in tax credits to a low income earner is not going to make a huge difference since they are probably not paying much federal income tax to begin with. Good Luck negotiating a higher salary, not likely to happen for people working minimum wage.

 

[YoungDoc25]

Children can't vote... thus they don't typically count. That's been my experience.

Without completely draining Medicaid funds, do you think there is an affordable way to give children adequate healthcare? I think the new projection was that it would run out in 2028. Sad to hear.

 

[SurfingDoctor]

Without completely draining Medicaid funds, do you think there is an affordable way to give children adequate healthcare? I think the new projection was that it would run out in 2028. Sad to hear.

No. I think they only way to support children's health to insure all children have coverage is through societal contributions which everyone contributes (essentially, more or less, the system that is in place now).

 

[YoungDoc25]

The problem is you are discounting local health system monopolies and their ability to dictate prices. Out of state insurers have very little leverage over local health systems, so either you can buy a plan that no local healthcare entity will accept or the price will be exorbitant. This magical opening of the state borders will not drive down costs, it already existed in the ACA , no states took advantage of that. 1200 in tax credits to a low income earner is not going to make a huge difference since they are probably not paying much federal income tax to begin with. Good Luck negotiating a higher salary, not likely to happen for people working minimum wage.

Ah, I see your point. The problem there comes from insurance companies and their reimbursements though. Not necessarily the healthcare policy being implemented. Even more frustrating when you look at it that way.

The income I was talking about wasn't clear. I was thinking more along the lines of people wanting the minimum wage higher. There would be more reasoning behind that movement given the lessened help by employers to provide adequate healthcare.

 

[YoungDoc25]

No. I think they only way to support children's health to insure all children have coverage is through societal contributions which everyone contributes (essentially, more or less, the system that is in place now).

Under the system we have now, the predicted flatline of Medicaid was moved up 2 years to 2028 though.. Tough to turn a blind eye to when I know it's not sustainable for them. I guess the only sustainable option is to find ways to drastically cut healthcare costs?

 

[SurfingDoctor]

Under the system we have now, the predicted flatline of Medicaid was moved up 2 years to 2028 though.. Tough to turn a blind eye to when I know it's not sustainable for them. I guess the only sustainable option is to find ways to drastically cut healthcare costs?

Healthcare costs for children are already quite low. Most of the money goes into pharmaceutical prices, unnecessary outpatient tests and practices that overcharge covered individuals, and inpatient hospitals that are overpriced to the insured to cover those who can't cover the stay.

The purpose of the provider-insurer relationship is to have profit. Healthcare is just the environment in which they operate that profit.

 

[libertyyne]

Ah, I see your point. The problem there comes from insurance companies and their reimbursements though. Not necessarily the healthcare policy being implemented. Even more frustrating when you look at it that way.

The income I was talking about wasn't clear. I was thinking more along the lines of people wanting the minimum wage higher. There would be more reasoning behind that movement given the lessened help by employers to provide adequate healthcare.

My point was to show that insurance premiums and healthcare costs wont go down with this plan because it doesnt address those things.

The trump admin is against raising the minimum wage, so i doubt that raising the minimum wage will be on the agenda.

 

[YoungDoc25]

Healthcare costs for children are already quite low. Most of the money goes into pharmaceutical prices, unnecessary outpatient tests and practices that overcharge covered individuals, and inpatient hospitals that are overpriced to the insured to cover those who can't cover the stay.

Ah, didn't take into account. Especially pharmaceutical costs. I like the idea stated earlier for a single EMR system. I feel like that could cut into a lot of overall costs for all patients when it comes to unnecessary tests.

 

[SurfingDoctor]

Ah, didn't take into account. Especially pharmaceutical costs. I like the idea stated earlier for a single EMR system. I feel like that could cut into a lot of overall costs for all patients when it comes to unnecessary tests.

Again single EMR, while fine in principle, goes against free-market, monopoly issues. EMRs are also a business. Having practiced in the pre-EMR era, I have yet to see evidence that it actually improved healthcare.

You are welcome to read about healthcare costs in the US and the difficulty addressing them in a for-profit market here:
http://kff.org/health-costs/issue-brief/health-care-costs-a-primer/

 

[YoungDoc25]

My point was to show that insurance premiums and healthcare costs wont go down with this plan because it doesnt address those things.

The trump admin is against raising the minimum wage, so i doubt that raising the minimum wage will be on the agenda.

They actually do have the opportunity to go down. But the point you made is that the hospital/clinic you go to may not accept that cheaper insurance, limiting you to your badly priced local plan. That isn't a fault in the healthcare policy though. That's a flaw in having insurance companies not having universal reimbursements and/or trying to dictate what tests should or shouldn't be run on patients. Right now it's really an open market for physicians. They choose their patients based on their insurances' likelihood to reimburse them well for their service. The same market isn't found for patients, regardless of the healthcare policy in place.

 

[YoungDoc25]

Again single EMR, while fine in principle, goes against free-market, monopoly issues. EMRs are also a business. Having practiced in the pre-EMR era, I have yet to see evidence that it actually improved healthcare.

You are welcome to read about healthcare costs in the US and the difficulty addressing them here:
http://kff.org/health-costs/issue-brief/health-care-costs-a-primer/

Very enlightening. I appreciate your insight!

 

[libertyyne]

They actually do have the opportunity to go down. But the point you made is that the hospital/clinic you go to may not accept that cheaper insurance, limiting you to your badly priced local plan. That isn't a fault in the healthcare policy though. That's a flaw in having insurance companies not having universal reimbursements and/or trying to dictate what tests should or shouldn't be run on patients. Right now it's really an open market for physicians. They choose their patients based on their insurances' likelihood to reimburse them well for their service. The same market isn't found for patients, regardless of the healthcare policy in place.

The insurance premiums are based on costs associated with care. Those costs are not going down for a variety of reasons. Information asymmetry, supply induced demand, emergent need, are a few reasons why free markets dont work well in healthcare. The plan does nothing to drive down actual healthcare costs, blaming healthcare entities or insurance companies makes no difference considering the plan does nothing to fix them.

 

[YoungDoc25]

The insurance premiums are based on costs associated with care. Those costs are not going down for a variety of reasons. Information asymmetry, supply induced demand, emergent need, are a few reasons why free markets dont work well in healthcare. The plan does nothing to drive down actual healthcare costs, blaming healthcare entities or insurance companies makes no difference considering the plan does nothing to fix them.

I agree that those do impact the costs greatly. 100% agree. But the plan does open the doors for a competitive market where the chance to lower costs is there. It's no different than any sort of shopping you and I do daily, so denying that is pointless. The difference is that insurance companies may not reimburse on the same terms, causing healthcare businesses to refuse to accept them as payers. Fixing the problems you stated should be on the to-do list. But the issue of insurance companies winning and the payer and healthcare provider losing money isn't something that should be ignored either. No healthcare policy can truly succeed with that in place.

 

[cbrons]

As I look at residency programs, its amazing the difference between insurance coverage, even between university programs. There are some residency programs that I simply cannot afford to go to simply because the cost of covering my wife and kids would be so astronomical we could barely pay rent.
Not sure if that has a thing to do with this topic, but it's whats pissing me off today.

 

[libertyyne]

I agree that those do impact the costs greatly. 100% agree. But the plan does open the doors for a competitive market where the chance to lower costs is there. It's no different than any sort of shopping you and I do daily, so denying that is pointless. The difference is that insurance companies may not reimburse on the same terms, causing healthcare businesses to refuse to accept them as payers. Fixing the problems you stated should be on the to-do list. But the issue of insurance companies winning and the payer and healthcare provider losing money isn't something that should be ignored either. No healthcare policy can truly succeed with that in place.

Your assumption that it is just like buying anything on the free market is incorrect. Consumers have little to know idea what tests they will need or do need, When you are having an MI you cant shop around for the best price, and having more proceduralists in a geographic region contributing to higher then expected utilization of that procedure. And no one has any idea what quality looks like, do you know what the difference in infection rates post appendectomy is for your local hospitals? It is no where as simple as you are making it out to be. It is not buying a car. The plan does nothing to fix healthcare spending which in turn will do nothing to reduce insurance premiums or growth of insurance premiums.

 

[YoungDoc25]

Your assumption that it is just like buying anything on the free market is incorrect. Consumers have little to know idea what tests they will need or do need, When you are having an MI you cant shop around for the best price, and having more proceduralists in a geographic region contributing to higher then expected utilization of that procedure. And no one has any idea what quality looks like, do you know what the difference in infection rates post appendectomy is for your local hospitals? It is no where as simple as you are making it out to be. It is not buying a car. The plan does nothing to fix healthcare spending which in turn will do nothing to reduce insurance premiums or growth of insurance premiums.

You're completely misunderstanding what I'm shopping for. I'm shopping for insurance, not hospitals. Any citizen can compare prices on similar coverages and decide for themselves which is better. We do it daily. So yes, it is that easy. That's what this plan does. My issue is in agreement with what you also stated earlier. Even if that insurance plan is cheaper than the one in your area/state, your medical provider may not accept it which forces you to choose the pricier insurance, preventing you from saving money. The reason it's rejected is because their reimbursement rates most likely suck. That is my issue.

For what it's worth, ask your local insurance companies if they know the answers to those questions. They dictate what is going to be reimbursed when you go to the doctor for those problems, so it should be fitting if they knew all of those answers. They won't though. And there lies the problem of an outsider dictating your care.

 

[libertyyne]

You're completely misunderstanding what I'm shopping for. I'm shopping for insurance, not hospitals. Any citizen can compare prices on similar coverages and decide for themselves which is better. We do it daily. So yes, it is that easy. That's what this plan does. My issue is in agreement with what you also stated earlier. Even if that insurance plan is cheaper than the one in your area/state, your medical provider may not accept it which forces you to choose the pricier insurance, preventing you from saving money. The reason it's rejected is because their reimbursement rates most likely suck. That is my issue.

For what it's worth, ask your local insurance companies if they know the answers to those questions. They dictate what is going to be reimbursed when you go to the doctor for those problems, so it should be fitting if they knew all of those answers. They won't though. And there lies the problem of an outsider dictating your care.

Coverage tiers were standardized under the ACA, this will no longer be the case. That being said here is a summary on why shopping for non standard health plans is a nightmare and consumers dont fare well. https://www.mnsure.org/assets/MR-CUConsumerSelect_tcm34-183778.pdf .( this was published prior to the ACA)

Consumers do not know what the negotiated discounts or cost for services will be at local facilities even if the local facility accepts your insurance. Plus when obtaining services you dont know the quality of the service or if you went across town with your insurance it would be cheaper and of higher quality. You dont know if the procedure/test that is being ordered is actually needed or the real value that it provides.

Information asymmetry is a bitch and john q public is not going to suddenly be an MD to be able to evaluate what services are being utilized appropriately and what is over-utilization and the relative quality. This leads to continued cost growth which leads to increasing premiums. Healthcare costs will not be curbed by this plan and less people will be insured. We as a nation voted and opted to go this route, doesnt mean this route will solve the underlying issues.

 

[YoungDoc25]

Coverage tiers were standardized under the ACA, this will no longer be the case. That being said here is a summary on why shopping for non standard health plans is a nightmare and consumers dont fare well. https://www.mnsure.org/assets/MR-CUConsumerSelect_tcm34-183778.pdf .( this was published prior to the ACA)

Consumers do not know what the negotiated discounts or cost for services will be at local facilities even if the local facility accepts your insurance. Plus when obtaining services you dont know the quality of the service or if you went across town with your insurance it would be cheaper and of higher quality. You dont know if the procedure/test that is being ordered is actually needed or the real value that it provides.

Information asymmetry is a bitch and john q public is not going to suddenly be an MD to be able to evaluate what services are being utilized appropriately and what is over-utilization and the relative quality. This leads to continued cost growth which leads to increasing premiums. Healthcare costs will not be curbed by this plan and less people will be insured. We as a nation voted and opted to go this route, doesnt mean this route will solve the underlying issues.

Eh, we're still not on the same page. I'm not going to beat a dead horse.

 

[Stagg737]

Again single EMR, while fine in principle, goes against free-market, monopoly issues. EMRs are also a business. Having practiced in the pre-EMR era, I have yet to see evidence that it actually improved healthcare.

You are welcome to read about healthcare costs in the US and the difficulty addressing them in a for-profit market here:
http://kff.org/health-costs/issue-brief/health-care-costs-a-primer/

This is true, but if you required all companies to have a common "cover page" that provides a basic medical and family history, etc. (like the common app for college applicants) and is compatible across EMR programs, then you've got at least a basic form providing the essential information across all systems. I can't imagine it would be that hard to create a form which companies could integrate into their systems and auto-populate, and it would accomplish the goal of making a patient's past medical records (or at least the major/important points) easily accessible by any physician or provider they see while allowing for EMR to remain a private enterprise.

 

[VA Hopeful Dr]

Premiums were going up before the ACA at a much faster rate than they are now.

Because with the now more common sky high deductibles, insured patients are foregoing more care than they used to.