Where the ACA Should Go Next?

On Tue, Sep 9, 2014 at 1:47 PM, Dan <cdansplace2@aol.com> emailed:

Rortybomb, New Piece on Where the ACA Should Go Next Rorty touts the 2009 House Bill which calls for a Public Option and described here To improve ‘Obamacare,’ reconsider the original House bill

Maggie Mahar replies:

Originally I favored a public option, but in fact, at the time, no one really spelled out who would run the public option–or how it would be run.

One of the best things about the ACA is that lets both HHS and CMS make end-runs around Congress. I would never want a public option that was run by Congress.

Here is the comment I just posted in reply to the post “Where the ACA Should Go Next”

I would need to know far more about the public option—and how it would be different from Medicare– before voting for it.

Medicare is extraordinarily wasteful– 1/3 of Medicare dollars are squandered on unnecessary treatments that provide no benefit to the patient. Why? Because Congress is Medicare’s board of directors, and lobbyists representing various specialist’ groups, hospitals, device-makers and drug-makers control Congress.

Meanwhile, Medicare does not cover much needed care, ie. vision checks are just one example. This is why the vast majority of Medicare beneficiaries must buy separate private insurance (MediGap or Medicare Advantage) to supplement what medicare doesn’t cover.

Finally, I favor narrow networks. They keep costs down. The doctors and hospitals that are not included in the networks are those that refuse to negotiate  prices.  By excluding them we remind doctors and hospitals that we can no longer afford letting providers charge whatever they wish. No other developed nation allows doctors and hospitals to simply set prices.

As for the notion that a network might not include the specialist a patient needs to treat a particular disease, that’s simply not true. Under the ACA if a patient suffered from a  rare disease and no doctor in the network was qualified to treat it, the patient can appeal at two levels and under the ACA, must get a speedy response.

Also keep this in mind: all of the medical research on cost and quality reveals that more expensive care is no better and often it is worse. Doctors and hospitals that are money-driven are likely to over-treat, putting their patients at risk without benefit.

Finally, I would favor a public option only if it were very different from Medicare. Ideally it would be run by an independent board and its decisions would not have to  be approved by Congress. Instead, that board  would use medical evidence to decide what to cover–and what not to cover.

Best, Maggie Mahar Health Beat Blog