What did the passing of "Obama care" mean for us?

[Dirkwww]

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I know that its media hay day was a few weeks ago, but i was wandering what are the pros and cons for "Obama care" being passed in terms of psychologists. How does it affect us in the future whether it is private practice, VA, or any other type of setting? I have been asked a lot recently and i'm not really sure its total impact on us.

Thanks in advance.

 

[Therapist4Chnge]

As it stands today, once it is in full swing:
1. If you are not part of an ACO, you will most likely struggle, regardless of your area of work.
2. If you are a specialist, your reimbursements will continue to be slashed, and only the top %'tiles who can do a cash practice will be okay, but that is still a crapshoot.
3. If you are a generalist and/or do mostly/all therapy...you are screwed.

There are a ton of websites out there that explain things in more detail, though it may be harde to get a clear picture of being a psychologist bc we are barely even mentioned (blame a lack of leadership & $$ on The Hill back when all of this was getting negotiated.)

 

[dumbledoresgirl]

As it stands today, once it is in full swing:
1. If you are not part of an ACO, you will most likely struggle, regardless of your area of work.
2. If you are a specialist, your reimbursements will continue to be slashed, and only the top %'tiles who can do a cash practice will be okay, but that is still a crapshoot.
3. If you are a generalist and/or do mostly/all therapy...you are screwed.

There are a ton of websites out there that explain things in more detail, though it may be harde to get a clear picture of being a psychologist bc we are barely even mentioned (blame a lack of leadership & $$ on The Hill back when all of this was getting negotiated.)

http://www.nationalregister.org/trr_spring11_deleon.html

This site explains the role of ACOs...although it's painting a slightly rosier picture than what reality is going to be like for psychologists.

 

[Doctor Eliza]

Are you sure you want to start this all out war here?

There is a major benefit to psychologists as consumers of healthcare for themselves. Many psychologists work in private practice settings or as independent contractors where no insurance is provided. This puts them in a situation where they need to obtain insurance privately. Insurance companies will label you "uninsurable" for fairly mild things (e.g., well-controlled diabetes but thaking "too many meds," well-controlled depression but taking something other than a traditional AD, currently being in psychotherapy for an adjustment disorder---all 3 real examples from people in my practice). Changes under the Obama administration have allowed for the establishment of high risk pools to allow people like these to obtain insurance.

If you doubt that this is needed for psychologists, let me tell you what happened when my state psychological association tried to arrange for a group plan for members. After having both interested and uninterested members submit personal health data, all major insurance companies declared our group "too sick" and were unwilling to work with us on creating a group plan.

Also, the term "Obamacare" can be considered inflammatory. It is often used by people who dislike this legislation. ACA is the official term.

Best,
Dr. E

 

[erg923]

I just signed the paper work for our medical insurance with my new full-time employer. I am still in the VA on internship, but it ends next week and then I will be employed by a University.

The plan I got for us is worth over $15,000/year. My university pays 70% of it. Thus, to offset this, someone in PP would need to make over 10,000 more than someone in a salaried job at an larger institution. NOT a very viable feat to accomplish in those first few years of practice. Not to mention what Dr. E brings up about being easily DQed.

 

[dumbledoresgirl]

Are you sure you want to start this all out war here?

There is a major benefit to psychologists as consumers of healthcare for themselves. Many psychologists work in private practice settings or as independent contractors where no insurance is provided. This puts them in a situation where they need to obtain insurance privately. Insurance companies will label you "uninsurable" for fairly mild things (e.g., well-controlled diabetes but thaking "too many meds," well-controlled depression but taking something other than a traditional AD, currently being in psychotherapy for an adjustment disorder---all 3 real examples from people in my practice). Changes under the Obama administration have allowed for the establishment of high risk pools to allow people like these to obtain insurance.

If you doubt that this is needed for psychologists, let me tell you what happened when my state psychological association tried to arrange for a group plan for members. After having both interested and uninterested members submit personal health data, all major insurance companies declared our group "too sick" and were unwilling to work with us on creating a group plan.

Also, the term "Obamacare" can be considered inflammatory. It is often used by people who dislike this legislation. ACA is the official term.

Best,
Dr. E

So are psychologists' reimbursements not going to be slashed? I understand there is a huge benefit to those seeking services (i.e., not being rejected by insurance companies for preexisting conditions), but if the cuts to reimbursement are going to be significant then I don't see how that is an advantage for psychologists. I will make a disclaimer here--I am NOT AT ALL knowledgeable about the issue and am trying to understand it just as much as the OP, so if I am misunderstanding something please let me know!

 

[AcronymAllergy]

Yeah, I think the fringe benefit overhead at my AMC site is between 30-40% of base salary (according to a faculty member). That's a lot of money to have to make up for if you're in PP, and I believe many of the independent/non-employer health plans can be somewhat skimpy by comparison (at least from what I've heard).

 

[JeyRo]

So are psychologists' reimbursements not going to be slashed? I understand there is a huge benefit to those seeking services (i.e., not being rejected by insurance companies for preexisting conditions), but if the cuts to reimbursement are going to be significant then I don't see how that is an advantage for psychologists. I will make a disclaimer here--I am NOT AT ALL knowledgeable about the issue and am trying to understand it just as much as the OP, so if I am misunderstanding something please let me know!

What good is a psychologist being able to obtain "insurance" coverage if you can't put food on the table and make your office rent (e.g., due to slashed reimbursements)? What good is it if insurance costs go up year upon year every year for everyone (no "bending of the cost curve," sorry).

Somewhat OT - my wife has asthma. There was a point many years ago where she was actually able to obtain insurance coverage despite the fact that she had this well-documented preexisting condition - although they covered everything except her asthma (since it's a preexisting condition, and therefore not insurable; economically an extremely reasonable position to take).

Then California passed a law (IIRC) that said that insurance companies couldn't deny people coverage for their preexisting condition. In response, any and all insurance companies proceeded to simply just deny my wife any coverage at all. So, now the fix is Obamacare - more government to fix the problems caused by more government.

I think everyone's thinking is completely screwy about medical economics in this country - "we should force insurance companies to pay for preexisting conditions" - well, here's a thought for you. Can you insure someone for a house fire after the house has burned down? NO. That's not insurance. Same thing here.

Sorry, rant over. Probably has a better place in the Wolf's Den. Feel free to rap my knuckles and move this post over there.

 

[dumbledoresgirl]

What good is a psychologist being able to obtain "insurance" coverage if you can't put food on the table and make your office rent (e.g., due to slashed reimbursements)? What good is it if insurance costs go up year upon year every year for everyone (no "bending of the cost curve," sorry).

Somewhat OT - my wife has asthma. There was a point many years ago where she was actually able to obtain insurance coverage despite the fact that she had this well-documented preexisting condition - although they covered everything except her asthma (since it's a preexisting condition, and therefore not insurable; economically an extremely reasonable position to take).

Then California passed a law (IIRC) that said that insurance companies couldn't deny people coverage for their preexisting condition. In response, any and all insurance companies proceeded to simply just deny my wife any coverage at all. So, now the fix is Obamacare - more government to fix the problems caused by more government.

I think everyone's thinking is completely screwy about medical economics in this country - "we should force insurance companies to pay for preexisting conditions" - well, here's a thought for you. Can you insure someone for a house fire after the house has burned down? NO. That's not insurance. Same thing here.

Sorry, rant over. Probably has a better place in the Wolf's Den. Feel free to rap my knuckles and move this post over there.

Points well taken.

 

[JeyRo]

Points well taken.

Thanks. A critical article on ACOs (more on point to some of the earlier posts in this thread):

http://www.forbes.com/sites/aroy/20...is-destroying-accountable-care-organizations/

 

[roubs]

Oh God, Obamacare means we won't be able to put food on the table or pay rent.

Can someone point to actual evidence that our reimbursements will be slashed? They seem to be constantly slashed with the insurance companies in charge. Again if there is a mechanism for it (that doesn't come from a source that primarily hates the Obama part of Obamacare), I'd like to learn about it.

31 million more Americans with insurance will do something significant to the supply/demand ratio for our services.

And for JeyRo, there is a more recent article about how the changes have been implemented and haven't caused the system to implode and haven't sent doctors to the soup kitchen line:

http://www.forbes.com/sites/bruceja...able-medicare-effort-surpasses-goals-critics/

It's interesting that your article included a statement that "omg 65 rules, the kitchen sink, this is awful" -- in the 2012 version it appears to have been implemented with 33 quality measures. I wonder if they listened to those complaining letters?

 

[Therapist4Chnge]

So are psychologists' reimbursements not going to be slashed? I understand there is a huge benefit to those seeking services (i.e., not being rejected by insurance companies for preexisting conditions), but if the cuts to reimbursement are going to be significant then I don't see how that is an advantage for psychologists. I will make a disclaimer here--I am NOT AT ALL knowledgeable about the issue and am trying to understand it just as much as the OP, so if I am misunderstanding something please let me know!

As psychologists, we may stand to benefit from being paid a higher % of our billing (billed x actual % of collected $'s), but it will be at the cost of accepting a lower rate, higher volume, and more paperwork/interference related to patient-provider relationship.

We should always be concerned when terms like "cost savings" and "greater efficiency" are inserted into a discussion involving benefit/cost changes. Not surprisingly, those terms and similar have been thrown around quite a bit in support of the implementation of ACOs, which are all about high-volume productivity. While the term "gatekeeping" is highly debated, the structure and function of implementing an ACO system acts as a secondary gatekeeper to access to providers (and providers' ability to see/acquire patients).

There is probably more info in the Sociopolitical Forum (a sub-forum of The Wolf's Den).

 

[Therapist4Chnge]

Oh God, Obamacare means we won't be able to put food on the table or pay rent.

That is a distinct and problematic outcome.

Can someone point to actual evidence that our reimbursements will be slashed? They seem to be constantly slashed with the insurance companies in charge. Again if there is a mechanism for it (that doesn't come from a source that primarily hates the Obama part of Obamacare), I'd like to learn about it.

Private insurance companies typically base their rates off of the Medicare rate (set by the gov't...interpreted by CMS), so when the gov't decides to slash rates, private insurance follows. If you dig into the currently proposed structure of Obamacare you will find that, in general, generalist providers like PCPs and GPs may actually see a slight increase in reimbursements, while specialists will see their reimbursement continue to shrink. The problem with projecting out the direct impact on psychology is that we did not have a seat at the table when all of this was being set up, so it is still somewhat up in the air how much/little interaction and influence we will have with a typical ACO. We are very much playing catch-up, and we most likely will be beholden to ACOs for our patients. Being that a primary goal of an ACO is to minimize cost and maximize services, one of the easiest ways to keep costs down is to slash reimbursements. I don't have a crystal ball, but when HMOs were being pushed...they were using the same kind of logic that supporters of ACOs are using (lower costs, raise efficiency, etc), and we all know how well that turned out for providers.

 

[Doctor Eliza]

I take issue with the comparison of obtaining insurance with a preexisting condition to getting homeowners insurance after the house burns down. We are not just talking about people here who have chosen to be uninsured until an issue crops up (like your hypothetical homeowners). We are talking about people who have paid for and maintained insurance throughout their lives who have a change in employment (perhaps going from an employment setting to PP) and can no longer qualify for insurance.

People underestimate how much this issue can effect them personally.

Dr. E

 

[becomethelight]

ACA will primarily affect psychologists that receive reimbursement for services authorized by Medicare and Medicaid - generally speaking, services for low income, disabled, or elderly individuals, pregnant women and children. VA psychologists do not get reimbursed by these systems, so it won't affect them. Psychologists in private practice that are paneled providers for a MCO probably won't be affected too much, at least not at first.

What will be affected by ACA is the publicly funded mental health system. It depends on how that is structured in the state you live in, so it is really hard to know how this will affect psychologists in practices that do accept clients receiving public assistance. ACA will likely be a boon for psychologists though because it expands the Medicare/Medicaid benefits package to include mental health benefits (something that states were not mandated to provide prior to this). Mental health care will be available to more people as a result, and behavioral health care will become more integrated with somatic health care, also providing more potential job opportunities for psychologists. This is a very good thing for our field.

Don't listen to everything on hear on TV and educate yourself.

 

[roubs]

That is a distinct and problematic outcome.



Private insurance companies typically base their rates off of the Medicare rate (set by the gov't...interpreted by CMS), so when the gov't decides to slash rates, private insurance follows. If you dig into the currently proposed structure of Obamacare you will find that, in general, generalist providers like PCPs and GPs may actually see a slight increase in reimbursements, while specialists will see their reimbursement continue to shrink. The problem with projecting out the direct impact on psychology is that we did not have a seat at the table when all of this was being set up, so it is still somewhat up in the air how much/little interaction and influence we will have with a typical ACO. We are very much playing catch-up, and we most likely will be beholden to ACOs for our patients. Being that a primary goal of an ACO is to minimize cost and maximize services, one of the easiest ways to keep costs down is to slash reimbursements. I don't have a crystal ball, but when HMOs were being pushed...they were using the same kind of logic that supporters of ACOs are using (lower costs, raise efficiency, etc), and we all know how well that turned out for providers.

Having read some of the proposed structure, it seems in line with what you are saying which is why I don't understand the level of certainty in the statements "your reimbursement will be slashed / generalists will be screwed". I see a history of prognosticating awful consequences from various parts of the ACA which seem to turn out less revolutionary or awful when actually put into place. Some psychologists can't be financially successful now due to reasons having nothing to do with Obamacare so it seems alarmist to push 'food on the table' based arguing.

 

[roubs]

While many of us do homework to find out the current and potential problems w/the ACA I think many begin from an attitude exemplified by this woman:

SANDY LEVINE, Florida: I don't care for his health plan.

JUDY WOODRUFF: What is it about the health plan that bothers you?

[Pause]

SANDY LEVINE: I'm not quite sure, to be honest with you. There's just something about it that I don't care for.

 

[wigflip]

While many of us do homework to find out the current and potential problems w/the ACA I think many begin from an attitude exemplified by this woman:

Clearly the real problem is that the plan was championed by a Kenyan born socialist. 🙄

 

[Pragma]

Clearly the real problem is that the plan was championed by a Kenyan born socialist. 🙄

With that snappy middle name...

 

[wigflip]

While many of us do homework to find out the current and potential problems w/the ACA

I heard a nurse and health advocate providing a progressive critique of the ACA on Pacifica a few weeks back. Unfortunately, I was running errands, so I was in and out of the car and didn't grasp the details, but if I understood correctly, she was saying that there was fine print which somehow undermined the "no preexisting conditions" clause. Can anyone speak to this?

 

[JeyRo]

I take issue with the comparison of obtaining insurance with a preexisting condition to getting homeowners insurance after the house burns down. We are not just talking about people here who have chosen to be uninsured until an issue crops up (like your hypothetical homeowners). We are talking about people who have paid for and maintained insurance throughout their lives who have a change in employment (perhaps going from an employment setting to PP) and can no longer qualify for insurance.

People underestimate how much this issue can effect them personally.

Dr. E

It boils down to the fact that if your house has already burned down, you might be able to get some government program to pay for it after the fact, but that's not "insurance." Same thing about a preexisting condition. It's not an insurable event. Same thing with routine dental visits, routine doctor visits, routine colonoscopies for all men over age 50 (or whatever), those aren't insurable events, yet we insist on being "insured" for these things (THESE THINGS AREN'T INSURABLE!).

If you don't get the similarity then you're not getting my point - but this is why healthcare costs continue to spiral upward (and even more rapidly under Obamacare) and reimbursements and quality will continue to spiral downwards.

Again, my wife was able to independently obtain coverage a long time ago from insurance companies, just not for her asthma (again, because like a house that's already burned down, her asthma isn't insurable). But then when that California law was passed (again, as far as my memory goes) that required insurance companies to not deny coverage to beneficiaries for their preexisting condition, then she was suddenly unable to obtain independent coverage from anyone.

 

[Pragma]

It boils down to the fact that if your house has already burned down, you might be able to get some government program to pay for it after the fact, but that's not "insurance." Same thing about a preexisting condition. It's not an insurable event. Same thing with routine dental visits, routine doctor visits, routine colonoscopies for all men over age 50 (or whatever), those aren't insurable events, yet we insist on being "insured" for these things (THESE THINGS AREN'T INSURABLE!).

If you don't get the similarity then you're not getting my point - but this is why healthcare costs continue to spiral upward (and even more rapidly under Obamacare) and reimbursements and quality will continue to spiral downwards.

Again, my wife was able to independently obtain coverage a long time ago from insurance companies, just not for her asthma (again, because like a house that's already burned down, her asthma isn't insurable). But then when that California law was passed (again, as far as my memory goes) that required insurance companies to not deny coverage to beneficiaries for their preexisting condition, then she was suddenly unable to obtain independent coverage from anyone.

Seems like an interesting loophole - instead of excluding one condition, they just deny you entirely? Doesn't seem to be the spirit of the law, although I am not familiar with CA law.

 

[JeyRo]

Seems like an interesting loophole - instead of excluding one condition, they just deny you entirely? Doesn't seem to be the spirit of the law, although I am not familiar with CA law.

I'm sure it wasn't the spirit of the law, but it's an expected consequence. It relates to why insurance companies lobbied so heavily for the Obamacare mandate.

 

[JeyRo]

While many of us do homework to find out the current and potential problems w/the ACA I think many begin from an attitude exemplified by this woman:

I have to find the cartoon but I saw a funny one. Some dude with a sign that says, "Repeal and Replace Obamacare." A person asks the guy with the sign, "What would you replace it with?" He says, "I don't know... something conservative?"

 

[FadedC]

You make an interesting point about insurance. My issue with insurance though, is that medical insurance really is currently necessary for more then just "insurance". There is such a disparity between prices charged to insurance companies for medical services, and prices charged to uninsured individuals, that insurance becomes a necesity for medical care even for those who might otherwise have enough money to comfortably pay for a disaster.

Routine visits are another matter of course, and they are often much more affordable without insurance. I think the push to include those is more for long term benefit. A few $200 checkups might prevent a $30,000 surgery down the road.

It boils down to the fact that if your house has already burned down, you might be able to get some government program to pay for it after the fact, but that's not "insurance." Same thing about a preexisting condition. It's not an insurable event. Same thing with routine dental visits, routine doctor visits, routine colonoscopies for all men over age 50 (or whatever), those aren't insurable events, yet we insist on being "insured" for these things (THESE THINGS AREN'T INSURABLE!).

If you don't get the similarity then you're not getting my point - but this is why healthcare costs continue to spiral upward (and even more rapidly under Obamacare) and reimbursements and quality will continue to spiral downwards.

Again, my wife was able to independently obtain coverage a long time ago from insurance companies, just not for her asthma (again, because like a house that's already burned down, her asthma isn't insurable). But then when that California law was passed (again, as far as my memory goes) that required insurance companies to not deny coverage to beneficiaries for their preexisting condition, then she was suddenly unable to obtain independent coverage from anyone.

 

[Doctor Eliza]

Seems like an interesting loophole - instead of excluding one condition, they just deny you entirely? Doesn't seem to be the spirit of the law, although I am not familiar with CA law.

Thankfully, although insurance comapnies still do this, the High Risk pools established under the Obama administration can help provide care for people that inmsurance companies won't touch.

JeyRo, I guess I don't understand what you think insurance companies should cover? You think everyone should pay out of pocket for routine and preventative care too? Also their illnesses? Are you just taking issue with the terminology? Should we have a program called something other than "insurance" to address preventative care? Even the insurance companies don't seem to be arguing against preventative care! Please clarify.

Dr. E

 

[JeyRo]

Thankfully, although insurance comapnies still do this, the High Risk pools established under the Obama administration can help provide care for people that inmsurance companies won't touch.

JeyRo, I guess I don't understand what you think insurance companies should cover? You think everyone should pay out of pocket for routine and preventative care too? Also their illnesses? Are you just taking issue with the terminology? Should we have a program called something other than "insurance" to address preventative care? Even the insurance companies don't seem to be arguing against preventative care! Please clarify.

Dr. E

Oh, I think people are stupid if they don't have medical insurance, if you get an unexpected, catastrophic illness (e.g., beyond just a cold or a flu) you really shouldn't be trying to pay for it out of pocket unless you're wealthy.

Keep in mind what the actual definition of insurance is (and I think Wikipedia provides as good a definition as any - it's how I understand the word anyways):

"Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss."

Prices for medical services used to be far, far more competitive before the government got it's grubby hands on things and began forcing insurance companies to pay for noninsurable events (and also before Medicare). Most people did pay out of pocket for routine care and it worked pretty well.

(Waiting for this thread to get moved to the Wolf's Den).....

 

[wigflip]

For all you folks who loathe gov-mint and its nefarious meddling...get off the city streets. My taxes helped pay for that.

 

[Pragma]

For all you folks who loathe gov-mint and its nefarious meddling...get off the city streets. My taxes helped pay for that.

Yep. All those pre-emptive strikes too.

Politics is funny that way. People want government to protect/spend money on whatever set of interests they find important, and then are inconsistent about how they approach other issues.

Both parties are a joke.

 

[Therapist4Chnge]

Thankfully, although insurance comapnies still do this, the High Risk pools established under the Obama administration can help provide care for people that inmsurance companies won't touch.

This is a part of Obamacare that I think was a good idea, but the HUGE concessions he made to get coverage for the high risk ppl & pre-existing exclusion clause waived I don't think will be worth the effort. I think offering a 'safety net' coverage is needed for all citizens, but I don't like how his plan shaped up. It isn't a Red or Blue issue...as the insurance companies paid both off quite well, it is a fairness issue for tax payers. The burden Obamacare will create for future generations will make SS look like peanuts. A truly free market for insurance would allow for fair competition, but the gov't would be required to get out of the insurance business...or at least play fair (akin to subsidizing the USPS and competing against FedEx & UPS).

JeyRo, I guess I don't understand what you think insurance companies should cover? You think everyone should pay out of pocket for routine and preventative care too? Also their illnesses? Are you just taking issue with the terminology? Should we have a program called something other than "insurance" to address preventative care? Even the insurance companies don't seem to be arguing against preventative care! Please clarify.

It would make more economic sense to pay out of pocket for routine and preventative care, as it could allow for fairer pricing and less profit for insurance companies (no funny math to muck up a transaction between patient & provider). However, many people can't afford that right now AND if even if they could, that assumes they will be able to budget for it...which is unrealistic given the spending habits of most people (per economist/expert report).

Insurance companies would rather save $1 today than spend it because there is a chance that someone in their plan may cost $5 down the road. They have little incentive to pay for someone else's cost today because that person may be on a different insurance plan by the time the (insert expensive Dx/procedure here) actually happens.

For all you folks who loathe gov-mint and its nefarious meddling...get off the city streets. My taxes helped pay for that.

Did you also build all of the successful (small & large) businesses that line those city streets? According to Obama you did, but I disagree with that assertion.

 

[JeyRo]

For all you folks who loathe gov-mint and its nefarious meddling...get off the city streets. My taxes helped pay for that.

They're everyone's streets - I paid for them too (despite my loathing of government).

 

[becomethelight]

Prices for medical services used to be far, far more competitive before the government got it's grubby hands on things and began forcing insurance companies to pay for noninsurable events (and also before Medicare). Most people did pay out of pocket for routine care and it worked pretty well.

JeyRo, when is this magical time you speak of? How were medical services ever priced in such a way that the elderly (retired and/or low income - people with literally the highest medical costs) could afford them?

 

[Therapist4Chnge]

They're everyone's streets - I paid for them too (despite my loathing of government).

And for some AR-15 bullets, senators' pensions, ex' presidents' secret service, farm subsidies, pet projects with bloated budgets, failing school systems in far away states, etc. 🙁

 

[erg923]

JeyRo, when is this magical time you speak of? How were medical services ever priced in such a way that the elderly (retired and/or low income - people with literally the highest medical costs) could afford them?

50s and 60s. I dont think my grandparents had insurance when my father was growing up. Cost were much, much lower then.

 

[Therapist4Chnge]

JeyRo, when is this magical time you speak of? How were medical services ever priced in such a way that the elderly (retired and/or low income - people with literally the highest medical costs) could afford them?

Traditional indemnity plans (mostly gone since HMOs and PPOs took over) often covered the majority of all medical expenses. Routine/Preventative care may or may not be covered, but the actual cost to the member was far more reasonable than the Funny Math today. The actual reimbursement rates to an out-pt. office are quite modest for most preventative care, but the billing typically does not reflect that.

 

[JeyRo]

JeyRo, when is this magical time you speak of? How were medical services ever priced in such a way that the elderly (retired and/or low income - people with literally the highest medical costs) could afford them?

You're not denying that prices of medical products and services have been in a state of gradual and increasing hyperinflation since roughly the 70s.....? Economics explains why, and Medicare has largely been the driver of this. Overall, far more people were able to afford routine medical services out of pocket prior to the government's enormous entrance into the market in 1964 (when Medicare was founded).

 

[becomethelight]

Of course costs were lower then, but that doesn't mean that a larger proportion of the population could afford it. Prior to Medicare, many elderly individuals either went without healthcare or their families were broken with medical costs if an elderly family member became ill. To put things in perspective, the average life expectancy in 1960 was 66.6 for men and 73.1 for women. In 2010 it was 76.2 for men and 81.1 for women. Granted this is in due to many reasons (better preventive care, early intervention, etc.) but one of the reasons is that more seniors can afford better health care.

 

[JeyRo]

Of course costs were lower then, but that doesn't mean that a larger proportion of the population could afford it.

I don't know how you can seriously make that statement given growth of the costs of medical care and services in the US since the 1960s have far outstripped even the US government's watered-down estimate of inflation (the CPI).

 

[cara susanna]

The majority of healthcare costs do appear to be in administration (read: insurance).

 

[becomethelight]

You're right. It's hard to know if someone can afford something, as opposed to spending money on that thing.

It's important to keep in mind the skewed distribution of health care expenditures. Half of the population spends little to nothing on health care. The high utilizer end of the distribution, the top 5% let's say, accounts for around half of the expenditures. Medicare led to substantial saving in out of pocket costs to those individuals in the top end of the distribution. Assistance programs like Medicare/Medicaid are designed to spread the costs out over the entire distribution to realize savings.

 

[roubs]

I hear they rationed radiology pretty hard back in the 50s, I can't find a single record of people being allowed to get a scan!

 

[Sanman]

The majority of healthcare costs do appear to be in administration (read: insurance).

Well, streamlining payment would certainly allow us to lower healthcare costs. Now, that can be done as Jeyro says, by paying for routine medical services out of pocket. It could also be done by streamlining the process. How much of the cost of an office visit to any medical provider pays for the billing person/service that processes payments and fights denials by insurance companies? The truth is that this cuts two ways, you can either cut insurance out of anything but catastrophic care, but that may mean being kicked out onto the street after you are no longer emergent if you don't have the money. I imagine most of the mentally ill and elderly that can't afford the care they need will not do well in that system. The other is total government oversight, where excessive profits can be removed from the system. Of course, the lobbies of major industries like pharmaceuticals and insurance companies will not allow themselves to lose such profits.