B-Large Posted March 21, 2012 Share Posted March 21, 2012 Explain to me the difference between Paul Ryan's proposal that seniors should receive vouchers to purchase private Heath insurance (in lieu of the current single-payor), and the ACA where Americans will be given vouchers and premium support to purchase private health insurance? Each mandated to purchase a product from a company.... Why dont we just fine tune ACA, and expand it to all Americans? As I was on the treadmill watching the News, I thought they are basically the same exact thing.... Subsidies to purchase insurance on State by State exchanges.... I respect Paul Ryan for putting forth proposals, while I don't always agree with all oh his ideas, he is setting stage for the budget discussions.... But to suggest vouchering Medicare and repealing the ACA seems illogical... And I have concerns about insurance companies having the responsibility of covering the sickest, costliest segment of our population... Why would they ever want that, unless they are able to get juicy premiums from the Government to cover the fogies.... Hmmmm..... Thoughts. Link to comment Share on other sites More sharing options...
OCinBuffalo Posted March 21, 2012 Share Posted March 21, 2012 Explain to me the difference between Paul Ryan's proposal that seniors should receive vouchers to purchase private Heath insurance (in lieu of the current single-payor), and the ACA where Americans will be given vouchers and premium support to purchase private health insurance? Each mandated to purchase a product from a company.... Why dont we just fine tune ACA, and expand it to all Americans? As I was on the treadmill watching the News, I thought they are basically the same exact thing.... Subsidies to purchase insurance on State by State exchanges.... I respect Paul Ryan for putting forth proposals, while I don't always agree with all oh his ideas, he is setting stage for the budget discussions.... But to suggest vouchering Medicare and repealing the ACA seems illogical... And I have concerns about insurance companies having the responsibility of covering the sickest, costliest segment of our population... Why would they ever want that, unless they are able to get juicy premiums from the Government to cover the fogies.... Hmmmm..... Thoughts. Apples and oranges politically. Nobody has an emotional or nostalgic or psychological or historical commitment to Obamacare. On the other hand "Don't touch my Medicare...." ...as Grandma goes over the cliff. Moving away from single payer is always a step in the right direction, regardless of the program, but none of this is the answer and here's why: Providers are told their revenue by payers, with Medicare leading the way, and said reimbursement is calculated the most absurd way possible. In what other business does the customer set the price? Worse, this has nothing in common with how the business of providing care actually works. It's based on ludicrous abstraction, created by amateurs trying to do my job, and FAILing. Which payer...is irrelevant. Observing the current status of the patient/resident, and comparing that to their dx/care plan is patently stupid. Setting uniform pricing by dx/procedure, when the care process has 0 chance of being standard is also patently stupid. Adjusting for COL, and "complexity" is laughable = further distorting a distortion. Why? Because we have literally an infinite # of ways to arrive at that patient status, and it's only relevant for today, or for the time it takes to make the observation! And, we could have performed that procedure a boatload of ways involving a huge variance of costs and quality. Therefore, these are never truly measurable pieces of data. To base entire reimbursement tools/schedules on this....merely compounds the error exponentially. And, how are revenue adjustments made? Based on performance, or based on yet more top-down distorted abstraction? Or worse, politically infused, macro distorted abstraction? We aren't making jets, or processing insurance claims, so why are we using their BPM/workflow/BI methods by focusing on their easily defined output? Yeah, for our purposes focusing on the patient outcome...is wrong . Sorry. The patient outcome is nearly impossible to define. The unit of work to which cost is PROPERLY associated in this instance is: the service, not the patient, because services defined with proper granularity are the ONLY consistent vehicles to which we assign cost with an acceptable degree of accuracy. The patient's status, or the fact that a procedure was done, complex or not, literally tells us nothing about the quality/cost of the service provided. If somebody came in with 5 bedsores, and now they have 1, but dipschit surveyor shows up, and ding! deficiency, that tells us nothing about the good work, cost efficient or not, that was done to treat the other 4. OTOH, if the lady next door has one, because of bad care, we won't know what that cost either, and we also don't know how the F we got here, because we aren't tracking what we did in any manner that could be called consistent, we are only looking at the patient. SO, how does health care calculate cost? It doesn't. Not properly anyway. Yet, calculating cost is how prices are set everywhere else in the world. Instead we do it assbackward. We are provided revenue, and then costs are adjusted to that. Nobody cares about cost, because regardless of what the cost is, you, the nurses, docs, unions, insurance companies, everybody, already knows the price that will be paid. And, then we are somehow dumbfounded by costs continuing to rise? How the F do we propose to contain costs....if we don't have the first friggin clue what the REAL (not financial allocation) cost of doing business is? Until we do, nothing will be solved, we will get to see even more "Sue the nursing home" lawyer commercials, and frankly vouchers or not, will have little effect without a financial incentive. We can only achieve that incentive if we know what things cost. Link to comment Share on other sites More sharing options...
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