American Intelligence Test: Healthcare Reform and the Healthcare Marketplace: You Will Have Access To Any Plan You Want to Choose?

The American Healthcare Act (AHA) is envisioned as a system poised to under-go another transformation in the near future. The Republicans are looking to make good on their multi-year campaigns’ pledges to repeal Obamacare (aka, ACA). In addition, the GOP’s proposal includes the evolved ‘replacement’ healthcare policies that have emerged as political survival requirements since returning the system to the pre-Obamacare state would create some problems that might haunt the Party just like elements of Obamacare have haunted the Democrats.

One premise underpinning the new proposed Healthcare policy is a reliance on the free marketplace to produce the most efficient and affordable healthcare system. This is an excellent concept since the free marketplace will insure that costs will be low and quality will be high. Of course the free marketplace does this when the requirements of a free marketplace are meet. If those requirements are not part of the plan then the outcome varies according to how the reality differs from the ideal.

The CBO issued its assessment which did not conform to the idea of ‘healthcare for everyone’ a campaign promise and current proclamation of the Administration.

So to make sense of the promise, the AHA proposal and how much they agree; you ought to be able to pass a pertinent test. Of course, you may get an AHA! moment.

Question A:   Is healthcare insurance different than other insurance (home, auto, mortgage, life, …) from an economic perspective?

(1). Yes

(2). No

Question B:   If more people buy healthcare insurance does the cost of medical treatment get reduced?

(1). Yes

(2). No

Question C:   Does a health insurance free marketplace produce lower cost healthcare and higher quality medical treatment?

(1). Yes

(2). No

Question D:   Is ‘access to affordable healthcare’ and ‘affordable healthcare’ the same thing?

(1). Yes

(2). No

Question E:    Which of the following factors drive up the cost of H: Healthcare, I: Insurance?
Select answers for each H: and I: separately.

(1). Inflation

(2). Insurance company profits

(3). Restrictions/prohibitions on allowing cross-state insurance competition

(4). Government mandated plan coverage requirements

(5). Taxes

(6). Medical Malpractice lawsuits and insurance

(7). Aging population

(8). Uninsured individuals

(9). Congress

(10). Preexisting conditions

(11). Medical advances

(12). Pharmaceutical companies

Question F:    If more insurance companies offer more insurance plans to create a larger variety of different plans to choose from in the market place will that reduce A: the cost of insurance, B: the cost of healthcare?

Answer separately for A: and for B:

(1). Yes

(2). No

Question G:   Hospitals’ Emergency Room services are mandated to provide for the public welfare. Does the cost of Emergency Room services for uninsured citizens affect healthcare insurance costs?

(1). Yes

(2). No

Question H:   If consumers pick healthcare insurance plans that exclude coverage of items that do not apply to them, what happens to premium cost for OWN: their plans, OTHER: others’ plans?

Select all that apply to each.

Answer separately for OWN: and OTHER:

(1). Premium costs decrease

(2). Premium costs increase

(3). Premium costs increase for medical coverage that includes treatments that you require

(4). Premium costs decrease for medical coverage that don’t includes treatments that you require

Question I:      Are there cost consequences because of individuals who do not have healthcare insurance for those individuals who do?

(1). Yes

(2). No

Question J:    Is there a role for the federal government in providing affordable healthcare to the public?

(1). Yes

(2). No

Question K:   Which of the following statements would promote an equitable and affordable America’s healthcare system?

(1). You must pay for your own healthcare insurance or pay for your own treatments.

(2). Basic healthcare that covers non-disease, non-elective related medical events should be available to all citizens.

(3). States’ governments should cover costs of basic healthcare.

(4). Federal government should cover costs of basic healthcare.

(5). Tax-credits should support low-income purchases of healthcare insurance.

(6). Healthcare should be a one-payer system.

(7). Healthcare should be a free marketplace insurance company-payer system.

(8). Patients should buy their own coverage needs with minimum to no federal or state support.

(9). Medicare coverage should be capped to an ‘expected’ lifetime fixed amount based on available funding.

(10). Competitive insurance and competitive healthcare will reduce medical treatment costs and improve quality.

(11). America’s healthcare system should promote cost-effective, quality medical treatments based on successful competition across patients, medical professionals, medical facilities, pharmaceutical companies, equipment manufacturers, insurance companies, and government entities; where cost-control is financially rewarded.

(12). Death rates by decade-bounded age groups will improve over current levels at lower costs than presently delivered.

(13). None of the above

ANSWERS TO TEST QUESTIONS:

Answer - A:  No

Rationale - A:      Insurance is a financial business arrangement that provides customers with funds that cover fiscal risks that individuals would be unable to reasonably afford on their own. This risk can be addressed and funds obtained by distributing the risk over a large group that contributes small payments that collectively covers (coverage) those in the group that experience the risk event. This is the basis of all insurance: spreading the risk over a population of clients.

Answer - B:  No

Rationale - B:      The number of people buying insurance doesn’t alter the cost of the treatment that it is intended to cover. It should affect the premium price that customers pay, but that isn’t required nor guaranteed. To lower the cost of insurance there are several other conditions required before your costs would be effected. Some of these conditions are:

(i)    There must be a way for the customers to determine that they can get identical coverage for a lower cost. This can be exceptionally difficult if there are no identical plans in the marketplace.

(ii)   Insurance companies need to have comparable customer-pools to create an insurance plan cost-structure that would allow them to lower prices relative to some competitive risk; otherwise they can just retain (or even raise) prices and increase profits.

(iii)  If the increased clients’ medical conditions/risks are statistically different from their current client-pool’s medical conditions/risks than premium costs could allow for lower, retained or higher prices depending upon the magnitude and direction of the new risk situation.

(iv) Professionals that provide the actual medical treatments and the costs of those treatments are not necessarily impacted by insurance companies’ offered coverage since they can just require any non-covered costs to be paid by the patient.

(v)  Equipment manufacturers are more incented to just selling more of their devices to more customers than to seeking lower-cost devices if there is no competitive risk of lost revenues and profits; and lower cost devices can be opportunities to just increase profitability not lower prices.

Answer - C:  No

Rationale - C:      Under the right conditions, if there are competitive factors that drive insurance companies, medical professionals, pharmaceutical and manufacturing companies to lower costs, improve quality or both then healthcare costs may be driven more by other factors. The current healthcare debate and legislative efforts to address healthcare affordability is indicative of other factors influencing costs than competition.  Recent incidents have shown that device manufacturers and pharmaceutical companies can raise their prices and profits independent of the insurance marketplace.

A free insurance marketplace has some historic evidence that healthcare doesn’t require them to lower the nation’s costs or improve quality in order for them to increase their profits. So again, just operating in a free marketplace system doesn’t mean that you get lower costs and quality without other economic factors being in place and operating.

Answer - D:  No

Rationale - D:      “Access” is a conditional term that must have meaningful importance otherwise it would be irrelevant or redundant. Today, everyone has ‘access’ to healthcare insurance since it can be purchased under the ACA (Obamacare). Before the ACA, ‘access’ existed to other insurance plans unless you had a pre-existing condition that precluded you from qualifying for a plan. Under the GOP AHA proposed plan you will have access to plans, but the important conditional is ‘affordable’ not ‘access’. You have to be able to pay for what you want and this will be constrained by what the plan offers/covers and what it costs.

The name you give something isn’t important until that name informs you about the details that are provided by and because of that name. “Access” doesn’t mean you have the thing, just that you can get to the thing by fulfilling additional requirements, like paying for it.

Answer - E:  H: 6, 7         I: 6, 7, 8, 10

Rationale - E:      Before you disagree, I must point out that everything on the list can cause costs to go up; but they are not all specific to healthcare and/or insurance. So the answers relate to the factor being directly salient to healthcare or insurance costs.

Item 6 should be a no-brainer, but if you can’t figure it out then it is a cost that only applies to medical treatment and by causal impact to healthcare insurance. Item 7 is easily derived from the fact that healthcare costs rise with age, and since the nation’s population is on average getting slightly older and living longer the costs of treatment and its supportive insurance industry rise with it.
Items 8 and 10 don’t affect the cost of the treatments that are associated with their medical conditions. If they aren’t insured the treatment still costs what it costs, it they don’t require it the costs don’t change either. For a precondition, the issue of costs is strictly an insurance cost issue because you either can’t get it or can’t afford it. The cost not being shared across a larger pool is the problem, and if included in a pool with non-precondition clients their costs rise to reduce yours; hence an insurance problem only.

Items 3, 4 and 9 are factors that can change the legal requirements of either or both the healthcare or insurance industries but they need not result in an increase or decrease in the healthcare or the insurance costs. Changing to a cross-state competitive offering environment may make costs increase if the conditions associated with operating in multiple state markets actually more expensive, and it may reduce costs. It will depend upon the terms and conditions that will have to be accommodated. The participation of government could likewise have positive or negative impacts on costs of either or both areas. If we consider Congress’ involvement there is a high probability that the costs of both healthcare and insurance will rise, since they have been involved for decades and the costs for both have continued to rise.

Items 11 and 12 are factors that in and of themselves are not factors that only operate in a unidirectional manner. Each can raise costs or lower costs because they change the existing environment. New treatments or medicines may be better and cheaper, or better and more expensive. They may be new to cover conditions that did not have medical solutions previously which can increase medical costs but avoid costs from not having an effective solution.

The remaining items 1, 2 and 5 are economic factors that can result from healthcare and insurance costs and operations not the causers of healthcare or insurance costs.

Answer - F:  A: No,  B: No

Rationale - F:      The cost of an insurance plan isn’t lower because it covers less, it’s just priced to provide a profit for what it does cover. More plans mean smaller pools on any given plan which means a higher degree of risk that must be accounted for in the price and profit determination. This higher risk should tend to increase the costs to insure the profits. After all, if the risk turns out to be covered at a lower incurred cost to the insurance company they just make more profit which isn’t a problem for them. For plans that cover more items but over a smaller pool of clients then the cost of those plans must go up along with the need to provide an acceptable profit. For the cases where a client chooses a plan at a lower cost that doesn’t cover a treatment that they turn out to require then the client has to pick up the cost of treatment themselves. In these cases, is the cost of insurance in fact lower?

Healthcare costs are more difficult to assess in terms of how more plans might impact them, but there is no reason that more plans would reduce the cost of a treatment. However, there are decent arguments for more plans to cause increasing costs of treatments. Where fewer individuals are insured for particular treatments the costs of providing those treatments must be borne by few individuals who have plans that do. When plans don’t cover a treatment individuals in those plans may elect to forego the treatment since they would have to pay (and may not be able to); this could result in more severe outcomes that increase other costs in the healthcare system.

Answer - G:  Yes

Rationale - G:     It’s well established that emergency care is incorporated into the rates charged by medical facilities to individuals who are covered by insurance plans. This makes the costs of those plans higher.

Answer - H:  OWN: 1 and 3 ; OTHER: 2 and 4

Rationale - H:      For your plan, the premium costs decrease (1) unless you require a treatment that isn’t part of what the OTHERs’ plans exclude. This is a you don’t pay for them and they don’t pay for you. The net is in general a statistical cost model that weighs the cost of your treatments’ risks and costs, and the size of your pool; similarly, an equivalent model deals with their treatments’ risks and costs and the size of their plans’ individual pools.

This is part of Question F’s situation. Whether your premiums go up or down will depend upon more than just what you think your needs are.

Answer - I:  Yes

Rationale - I:        Healthcare providers determine the cost for their services based on what they are required to do for patients, both insured and uninsured. The costs for the treatments can thus include some (or even all) the uninsured who receive their service for less than the ‘cost to provide’ with or without profit.

Answer - J:  Yes

Rationale - J:       This is one of those questions that spans a continuum of what you mean by having a role; however, that continuum cannot include a ‘not in any way, none, No’ state. It may be a very small role or a very large one, but the shear existence of a society means that its government will be involved somewhere along that continuum. The degree to which the federal government is involved will depend upon what the society wants and expects, and what legislative measures they have taken to define the role that the federal government will play.

Answer - K:  13

Rationale - K:      The nation’s healthcare system is far too complex for any of these answers or any combination of these answers to create an affordable or equitable system. The issues that need to be addressed are strangely not the answers to the problem, but a thorough and detailed assessment of what the nation’s healthcare problems, issues and needs are; and similarly, what the goals for the nation’s policies are and how meeting those goals are quantified.