Health reform is certain to change the landscape of medicine, business and insurance. Most of the electorate has not contemplated future consequences, which is certainly understandable due the extreme complexity of the new law and subsequent inevitable and yet unknown changes to the new law certain to be enacted by future Congresses.
The ultimate end game (for those who wrote and will enforce the law) is a single payer plan where the federal government is in control and delivers a win/win for the other major stakeholders involved – big corporations, unions, medical providers/pharma and the largest medical insurance companies . The wins will take place over time – incrementally – but the eventuality brings single payer.
The stakeholders are complicit to big government single payer to help their own bottom line. Business will be rid of the financial burden and uncertainty of self-funded employee medical insurance. Unions will realize increased membership rolls from nurses, physicians and medical staff joining over time. Medical providers/pharma will realize an increase in demand immediately and over time with a full reservoir of payment in endless supply. The largest insurers will continue to operate – however, they will provide Administrative Services Only (ASO) – as they now do for Medicare, TriCare (US Military) and for large corporate self-funded insurance plans – and without any financial risk or uncertainty of the amounts of future medical claims.
How will we get to single payer? Simple. Insureds will demand lower rates while the supply of insurance will shrink to the minimum until there are no more carriers. Insureds will clamor for alternatives as insurers raise rates almost immediately and continuously into the future due to mandated loss ratios, an influx of claims due to coverage of pre-existing conditions and increased number of claims due to increased insurance rolls – all due to the new law. Small medical insurance carriers will fold due to slim operating margins caused by mandated loss ratios and regulated rate increases – all due to the new law. Small carriers are those that operate in one or two states (i.e. the majority of insurance carriers; aka all but Aetna, CIGNA, United Healthcare, WellPoint/Anthem Blue Cross). Insureds will demand lower rates which will inevitably only be offered by the Uncle Sam following the acceptance of a public option. Uncle Sam will be one of the few left standing. The others left standing – Aetna, CIGNA, United Healthcare and WellPoint – will agree to provide ASO and let the government take the financial risk in its entirety – complete with all medical insurance premiums and accompanying reserves.
Washington has devised a very clever scheme (in the London insurance markets, plans of insurance are known as schemes). Following last year’s election, it would follow that the electorate was on board. However, after this coming November, it will be interesting to see how much of the scheme survives, how much changes and how much goes away. The electorate, at least from what the current polls show, may wind up with the final say by sending new charges and new votes to DC. 2012 may even become more interesting.
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One can only hope that this Healthcare Deform Bill will lead to single payer. Those operating in the reality based world need only look at the cost and outcome of the so-called "socialized medicine" countries to see that the flea market does not produce better healthcare, only better profits.
Ron, if we do get to single-payer, the result will be a system of providers that operate much like public (nee government) schools and private/religious (non-government) schools do today in the K-12 education space. All tax payers will pay into the system and have access public provided care. Those that choose to pay for care over and above what is offered by the government, will pay for that care from their own pocket (including a market for private insurance). Prices for the non-government system will be well out of reach of the average American. Those doctors and hospitals that seek a higher return for their services will migrate to the private model and be completely shut off from access to the government system. Those docs and hospitals that choose to stay in the government system will not be motivated by vast sums of money – unless they convince the government bureaucrats that they deserve more or, more likely, they organize and collectively bargain for their vast sums of money and accompanying membership dues.
Prices are already well out of reach, so I see no issue there, and there is no evidence to back up your claim. Again, all you need do is look at single-payer systems in action world-wide. We suck in comparison. Sorry. But you can argue points of view, but facts are facts. And by the way, until the war on education was launched by Reagan in 1980, we managed to economically, scientifically, and militarily become a super power through free public education. You remember, from 1945 until 1980. And, I might add, there was the top marginal tax rate of %90+
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See my post on how insurance is priced. If the cost of doctors, hospitals and pharma go down, the cost of insurance goes down. Insurance is merely priced according to claims paid – which are payments to docs, hospitals and pharma. The cost of docs, hospitals and pharma is what is really out of reach. There is evidence to back up my claim. Read Maggie Mahar, "Money Driven Medicine"http://www.amazon.com/Money-Driven-Medicine-Reaso... Ms. Mahar is a fellow at The Century Foundation and a supporter of single-payer. Personally, I like capitalism better than socialism and don't wish to start with health care, regardless of whatever other countries might find it acceptable to their culture. My point regarding education was not an indictment on public education and I am surprised you are defensive about it. My analogy will prove true as we go down the road with Mr. Obama's health care reform and already is as many doctors are presently opting out of medicare in response to the new health care act. Further, and I am certain that you are aware, public education v. private education is not a zero sum game. During the period of 1945 through 1980, private education existed, as well. You may recall the genesis of the United States rise to super power status was the Manhattan Project – conducted at the private University of Chicago. And imagine how much more of a super power we might be if the marginal tax rate was far less than 90%!