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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsObamacare: The Rest of the Story
http://www.nytimes.com/2013/10/14/opinion/keller-obamacare-the-rest-of-the-story.html?_r=0What you may not know is that the Affordable Care Act is also beginning, with little fanfare, to accomplish its second great goal: to promote reforms to our overpriced, underperforming health care system. Irony of ironies, the people who ought to be most vigorously applauding this success story are Republicans, because it is being done not by government decree but almost entirely with market incentives.
Using mainly the marketplace clout of Medicare and some seed money, the new law has spurred innovation and efficiency. And while those new insurance exchanges that are now lurching into business will touch roughly 1 in 10 Americans (the rest of us are already covered by private employer plans or by government programs like Medicare), these systemic reforms potentially touch every patient, every taxpayer.
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Since the Affordable Care Act was signed three years ago, more than 370 innovative medical practices, called accountable care organizations, have sprung up across the country, with 150 more in the works. At these centers, Medicare or private insurers reward doctors financially when their patients require fewer hospital stays, emergency room visits and surgeries exactly the opposite of what doctors have traditionally been paid to do. The more money the organization saves, the more money its participating providers share. And the best way to save costs (which is, happily, also the best way to keep patients alive) is to catch problems before they explode into emergencies.
Hoyt
(54,770 posts)Whether it will work or not, is the question. There are also incentives for building community care centers, and the competition among insurers will lead to change.
While single payer, public option, etc., would have been nice from the git-go, I've come to the conclusion we may be better off letting the system evolve at the expense of insurance companies who have the money to invest in the systems. networks, and what have you, and the risk inherent in a major change.
zipplewrath
(16,646 posts)The underlying theory behind ACO's is similar to that of the HMO. The HMO's were going to manage health care and therefor keep people healthy (and therefor cheap). They were going to front load with vaccines and regular checkups and preventative medicine. Unfortunately, it didn't really pan out. People get sick, even when we do our best to try to prevent it. So you pay the cost of trying to prevent it, AND you pay the costs of treating/curing it when it happens anyway. The insurance companies quickly figured this out and became less interested in alot of preventative care. In fact, what the companies figured out is that the cheapest method is to let people die, so you don't have to pay for their health care anymore. The only people that are truly profitable for insurance companies are folks that don't get sick.
It's the fundamental problem, with insurance in the health care industry at all. In the end, it's not really insurance. It's an extended payment plan. Everyone ends up needing health care. The few exceptions that don't won't begin to make up for all of the rest that do. Insurance is profitable for things that may or may not happen. Insurance for things that WILL happen are much harder to turning profits. You can see this in large corporations that are "self insured". There's no point in buying insurance because the cost for large populations is effectively known in advance.
So in the end we can attempt to make health care delivery more efficient, but until you get the "profit" out of health care, free market forces are going to drive up the cost of health care. We, as a society, have a shared interest in a health population. As such it makes sense for us to share in that cost, and to manage those costs to the best interests of all of us.
Scuba
(53,475 posts)ACO's are about healthcare providers improving quality to gain additional revenues. Very different, especially considering that many providers, inluding most hospitals, are not-for-profit.
But I agree we need to get profit motives out of healthcare
zipplewrath
(16,646 posts)I'm not sure about that whole "nonprofit" assertion. We have 3 hospitals here, 2 are part of for profit chains. Alot of nonprofits were bought up. However, that aside, at the end of the day, they have "for profit" employees and they use "for profit" equipment. And they have to cover their costs just like everyone else.
"ACO's are about healthcare providers improving quality to gain additional revenues."
What I am suggesting is there aren't that many "additional revenues" to be had by improving quality. There are some efficiencies to be had for sure, but in the end the gains are eaten up by the rate of inflation of the costs. We have to get control of the rate of inflation of the costs, and you can't do that until you control the industry.
Health care isn't like alot of other industries. People will get sick and they will have to be treated. This isn't a cost you can avoid. Until you get direct contol of those costs, they will continue to inflate at unsustainable rates.
Scuba
(53,475 posts)And yes, there are additional revenues to be had by improving quality. By definition an ACO is an organization that ties reimbursement to quality.
http://en.wikipedia.org/wiki/Accountable_care_organization
zipplewrath
(16,646 posts)I agree there are additional revenues to be had by improving quality. I'm just suggesting that those are relatively "one time" savings and that cost inflation is continuous and unending. At best ACO's will be able to slow the rate of cost inflation, not stop it. And currently the rate is unsustainable. If it was cut in half, it would still be too high.
LiberalEsto
(22,845 posts)My last regular ob-gyn checkup was free.
Our daughter was able to go back on my husband's company healthcare policy for a couple of years, thanks to the ACA provision allowing young adults to stay on their parents' policies until age 26.
The ACA has already saved us money.
Blue Idaho
(4,987 posts)I am able to keep my current insurance but Obamacare is still making a difference in my out of pocket expenses for wellness exams and testing. While I view the ACA as being more about insuring the previously uninsurable - it is impacting the cost of my insurance (in a good way) as well as my health care expenses.
Zorra
(27,670 posts)or at the very least enslave them in total subjection to the will of the people.