Saturday, August 24, 2013

My proposed system vs. the Accountable Care Act/Obamacare

It has been almost four years since I last posted to this blog.  I’ve been busy on other priorities but also waiting to see how the Affordable Care Act/Obamacare would play out.  A few thoughts on a few aspects of the ACA:
1. Under the ACA, insurance companies will no longer be able to exclude coverage of pre-existing conditions.  Too much administrative effort and cost is spent on underwriting for pre-existing conditions, and this will no longer happen.  This is one positive change.
2. Under the ACA, everyone must purchase insurance or pay a penalty.  At first glance, this seems oppressive.  However, it is only fair–if pre-existing conditions are immediately covered, then the cost of covering them must be spread as widely as possible.
3. Under the ACA, employers are required to provide insurance for employees who work more than a certain number of hours per week, which is leading many employers to increase the number of part-time positions and decrease the number of full-time positions.  This does not bode well for an economy in which many are still unemployed or underemployed.  In my proposed non-governmental single payer system, insurance centers on the individual rather than on the employer, but employers would contribute something for each employee rather than for separate health insurance and workers compensation insurance.
4. Under the ACA, premiums for the oldest pre-Medicare age individuals cannot exceed three times the premium for the youngest adult.  This may raise premiums for the youngest and lower them for the oldest.  In my proposed system, individual contributions would be based on income, not age.
5. Under the ACA, young people may remain on their parents’ insurance until age 26.  This assumes they will have achieved steady employment and employer-based insurance by age 26, which is often not the case.  In my proposed system, there would not be arbitrary age cutoffs.
6. Under the ACA, there are premium subsidies for individuals and families with income below certain thresholds.  In my proposed system, individual and family contributions would be based on income, which would be administratively simpler.
7. My main criticism of the ACA is that, rather than achieving administrative simplification, it is administratively far more complex than my proposed system and even more complex than what we have now, with state health insurance exchanges as an added layer of bureaucracy.  As a result, I anticipate even less of the health care dollar going toward health care and more toward administration.  
In short, I believe that by enabling more people to have health insurance, the ACA is merely putting more people into an inherently broken system, whose failings I have described in my earlier posts.  If the cost of health care in the USA is to be lowered, we need a radical overhaul as I have proposed, rather than more of the same.

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