[HN Gopher] Obamacare Created Big Medicine
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Obamacare Created Big Medicine
Author : connor11528
Score : 23 points
Date : 2023-04-07 19:40 UTC (3 hours ago)
(HTM) web link (mattstoller.substack.com)
(TXT) w3m dump (mattstoller.substack.com)
| jonny_eh wrote:
| > I want to offer that one key part of our health care problem is
| a simple conflict of interest, which is letting payers and
| providers be owned by the same entities.
|
| Combining payer (insurer) and provider (hospital/clinic) appeared
| great for patients. It aligns the interest of keeping the patient
| healthy (so they keep paying premiums), and costs are kept low
| (no pointless/dangerous diagnostics or interventions). As a
| customer of Kaiser Permanente, I couldn't be happier. Feels
| totally natural that I pay for someone to keep me healthy, and
| they do.
|
| But having read the article, I'm wondering if Kaiser Permanente
| is structured different from UHG/Optum, creating different
| incentives, and leading to the problems discussed. Or maybe
| they're just less greedy than UHG?
| skybrian wrote:
| If vertical integrations were prohibited, wouldn't that mean
| Kaiser has to break up?
| renewedrebecca wrote:
| B.S. this was happening way before the affordable care act was
| passed.
| PopAlongKid wrote:
| Further, like any massive new legislative program, there are
| plenty of improvements that can and should be made over time,
| no one can get everything right the first time. But we all know
| why every opportunity to make even slight improvements to ACA
| has been deliberately rejected.
| sonotathrowaway wrote:
| Matt Stoller would never let a fact get in the way of hating
| the Libs.
| DangitBobby wrote:
| I'm pretty much "the Libs". I view the ACA as guaranteeing
| private health insurance companies a future instead of
| granting them the death penalty like the country needs. Even
| so, I read through the entire article without once thinking
| "wow, this really is critical of Libs." What in particular
| would you characterize as "hating the Libs"?
| wsatb wrote:
| > I view the ACA as guaranteeing private health insurance
| companies a future instead of granting them the death
| penalty like the country needs.
|
| It was a step in the right direction at the time. We've
| done nothing to improve upon it since then because one side
| has spent the last decade trying to destroy it and the
| other seems mostly ok with our system as it stands.
| DangitBobby wrote:
| I don't know if it was a step in the right direction. It
| helped people in a very real way, my family included. But
| that was maybe the only shot we will have for the
| foreseeable future to unfuck our healthcare system. Who
| knows when the political will to really shake things up
| in healthcare will come back.
| yabbutts wrote:
| [dead]
| weare138 wrote:
| Exactly. I'm from Gen-X and the author's assertion is patently
| false and conveniently ignores everything that happened prior
| to the Obama admin. Besides it was Republicans that deregulated
| the medical industry among others and removed limitations on
| how much market share any single company can control. This is
| what led to the mass market consolidation and mega-
| conglomerates we have today.
| derbOac wrote:
| Yes I had a similar reaction. I've been involved in healthcare
| long before the ACA, and my family before that, and I thought
| it was absurd to tie any of these trends to Obamacare. Pretty
| much everything decried in the piece was on track long before
| the ACA, in the sense that even if something occurred after the
| ACA, it was predictable from trends prior to the ACA.
|
| I'm also tired of all the focus on insurance and payment, and
| not on the monopolies (monopsonies?) in health care provision.
| We can focus on payment all we want but if we don't open up
| healthcare services to real competition and innovation prices
| will continue to go through the roof with declining returns.
|
| I give some credit to the piece for somehow touching on that
| issue, but it's superficial and again tied to insurance and
| payors.
|
| It's infuriating being on the inside of all of this and seeing
| the way it usually is discussed in policy forums. It's like
| everyone wants everything to remain the same but be cheaper,
| and that's not going to happen.
| DangitBobby wrote:
| What does it take to open it up? You can't get to competitive
| pricing without transparent pricing, which you can't have
| with our opaque payment system. No one can tell you how much
| something is gonna cost, even after services are rendered,
| until much later usually with a bill in the mail.
|
| With how dysfunctional healthcare is, you'd think if real
| competition were possible we'd already be seeing disruption
| in this space. That's not happening! The most obvious culprit
| is the private payer, so that's a natural place to look.
| maxerickson wrote:
| A lot of the problems come from Medicare acting like a
| central planner that doesn't regulate prices for people
| outside of their system.
|
| Like my local hospital is blessed, it runs an ER in an area
| with few hospitals, so Medicare pays it at a higher rate
| _for all care_. But Medicare also won 't make an agreement
| to pay for care if someone tries to open up a competing
| hospital (and investors know this, so they won't bother
| trying to compete), and they don't tell the hospital that
| they have blessed that it's not okay to charge ridiculous
| prices to other customers.
| DangitBobby wrote:
| It sort of puts the blame on one part of the ACA, but even if
| you find that distasteful or not compelling, the rest of the
| article is very interesting and informative.
| Blackstrat wrote:
| That Obamacare accelerated the trends may be true. However, I
| can't think of too many government reforms that actually improved
| healthcare generally. For instance, W's prescription drug program
| increased drug costs for a lot of seniors. Previously, a relative
| of mine received her most expensive drugs free of charge through
| programs administered by the drug companies themselves.
| Afterwards, many of these programs went away, transferring the
| cost back to the consumer and ultimately the taxpayer.
| DangitBobby wrote:
| > The two firms leading the charge here were UnitedHealth Group
| (UGH) and CVS
|
| Bit of cheeky a Freudian slip here
| robotresearcher wrote:
| > The dominant trend of US social life over the last fifteen
| years is a stagnating, and then declining, life span. There are
| many reasons for this trend, such as violence, diet, suicide,
| drug addiction, and auto accidents.
|
| Americans are less than half as likely to have a fatal car
| accident today than they were in 1970. Violent crime is way down
| too.
|
| How do I read the substantial claims in this article when these
| simple false claims are tossed out in passing?
| lapcat wrote:
| Jimmy Carter doomed universal health care in the 70s. He promised
| it when he ran for president in 1976, but then his administration
| dithered and delayed, worried about the costs, proposing
| incrementalism instead. Ultimately, Senator Ted Kennedy, author
| of his own universal health care bill, got so tired of the
| delays, backtracking, and broken promises that he ran a primary
| challenge against Carter in 1980, which failed but may have
| doomed Carter's chances in the general election.
|
| Carter ran as an outsider, and his problem as President is that
| he was an outsider, alienating his own party, making him largely
| ineffectively, and leaving him with no base of support anywhere.
|
| Democrats could have passed universal health care when they had a
| filibuster-proof super-majority near the beginning of the Obama
| administration, but Obama himself was kind of an outsider and
| quite a political novice, having served less than one term as
| Senator. It's a joke to call it "Obamacare", because Harry Reid
| and Nancy Pelosi did practically all of the negotiating and heavy
| lifting, while Obama himself was mostly MIA during the debate.
| (Not to mention, the Obama administration completely botched the
| ACA rollout.) And the Democrats bent over backwards to water down
| the proposals to get Republican votes, but they ended up getting
| precisely zero Republican votes anyway, despite the fact that
| their bill was basically Romneycare.
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