Three More Perspectives on Health Insurance

Cost control, the free market, and Medicaid.

It seems to be Healthcare Day at The Billfold, so here are three more perspectives on the health of our health insurance:

First, Slate’s discussion of the ACA vs the ACHA:

Congress’ Current Health Care Debate Ignores America’s Biggest Health Care Problem

Initiatives from the Affordable Care Act, including Accountable Care Organizations and Medicare’s bundled payment program, began shifting some health services from fee-for-service to fee-for-value, evaluating quality relative to cost. These included penalizing health systems for high readmission rates and linking physician payments to better patient health outcomes. Recent evidence suggests that these programs may be linked with fewer readmissions, a good proxy for better outcomes, and reduced health care spending respectively.

The Senate health care bill, on the other hand, has no theory of cost control. It simply cuts funding for health care without addressing the root cause of rising costs. Even the last-minute horse trading over health savings accounts and opioid funding has largely focused on who pays for health care, rather than howwe receive it. GOP proposals over the past year have largely placed the burden on health insurance companies to drive down the overall costs of care, calling for high deductibles and co-pays that shift costs directly to patients to make them “smarter buyers” of health services.

Second, what happens when we “shift costs directly to patients.” As one doctor writes, people who have unexpected medical costs forced upon them (sometimes without their knowledge or consent, if they are found unconscious and placed in an ambulance) have told him they would have preferred to die:

Opinion | Don’t Leave Health Care to a Free Market

Most dismaying for me as a physician is that after all of my attempts to apply my compassion and training to save their lives, all three of these patients told me some variant of: “Thanks for what you’re doing, but I would rather that you hadn’t.” Even the man with the brain bleed, who certainly would have died without our immediate intervention, expressed dismay. In the neurology intensive care unit, with a bolt through his skull to measure the pressure around his brain, he told me that while he did not have health insurance, he did have life insurance. He said he would rather have died and his family gotten that money than have lived and burdened them with the several-hundred-thousand-dollar bill, and likely bankruptcy, he was now stuck with.

Lastly, the NYT explains why Medicaid is important:

One Woman’s Slide From Middle Class to Medicaid

A dozen or so years into retirement, Rita Sherman had plenty going for her financially.

Recently widowed, she had a net worth of roughly $600,000 as of 1998. Her health was excellent, and she dutifully purchased a long-term care insurance policy that would cover three years of nursing home costs should she ever need help. Watching over it all was her daughter, a medical social worker, and her son-in-law, a financial planner.

By the time she died at the age of 94 last year, however, all of the money was gone after a diagnosis of dementia and five and a half years in a nursing home. Like so many people who never see it coming, she’d gone from being financially comfortable to qualifying for Medicaid.

Yes, Medicaid—not Medicare, which is usually what we think of when we think of healthcare assistance for the elderly.

While many people don’t realize it until well into old age, it is Medicaid, not Medicare, that pays for most nursing home and community or home-based care for older adults who run out of money.

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