Healthcare Exchange More than Commonly Thought
As I explained in a video blog a couple of years ago, Tiverton resident, one-payer healthcare advocate, and just-about-overt socialist Nick Tsiongas is an instructive figure to watch in Rhode Island politics, and the op-ed that ran in yesterday’s Providence Journal is a fine example.
I’m thinking that many of us have underestimated the intended reach of the state-level healthcare exchanges that will be implemented as part of ObamaCare:
Any reform with a chance of success would require that we move as much of the money as possible into one place and coordinate its use with a state health plan. The power of the plan and the purse would let us use carrots and effective sticks to change this crazy system.
Such an opportunity exists: It’s the exchange, a marketplace set up by the state under the Affordable Care Act where people and businesses could buy health insurance. We have the chance to build an exchange where all Rhode Islanders can buy public or private insurance.
If your view of the healthcare exchange has been as a sort of benign, non-binding Web site on which to compare possible plans in a straightforward manner, you (like me) forgot that everything that government does is not about serving the public, but about government power. In Tsiongas’s telling, the exchange is an opportunity to filter all of our healthcare dollars through a single point, at which the government can impose requirements that force users of health services to conform with best practices as defined by Nick Tsiongas and friends.
By opening the exchange to all our residents and linking it to an explicit state health plan, we can finally empower ourselves to get off the cost treadmill, maintain quality and start treating this ailing system.
He doesn’t go into how, exactly, the exchange will be “linked” to “an explicit state health plan.” On one end (no doubt his ideal), all companies allowed to sell healthcare plans would have to do so through the exchange, and the exchange would require them all to conform with government-defined benefits, creating a de facto single plan over which bureaucrats, ideologues, and special interests have government access.
On the mild end, a state plan would compete with other plans which may or may not have to be on the exchange or meet additional requirements than they currently face. If that’s the case, then it’s hard to see how a state plan could be so attractive as to draw people away from other options unless it exacerbates cost problems by subsidizing member benefits through additional revenue confiscated from taxpayers.
Either way, the exchanges cannot be written off as a mild distraction for unnecessary government functionaries if the likes of Tsiongas have such strong intentions for them.
Wow, Tsiongas has it SO WRONG here. The reason we have 30 MRI machines is because the system as it stands, public AND private, provide incentives for people to use them with no need to worry about the cost.
I have a ‘Cadillac’ plan, a $3,000 MRI costs me $10. Naturally, I’m going to be prescribed one at the drop of a hat.
Someone on public assistance/Medicare is going to get the same treatment. Someone with a $1,000 deductible is going to run that out and then switch to consuming as much as possible.
I’ve explained it before, but if I were king providers would still be private, but there would be universal coverage that paid for 90% of costs, not fixed-dollar amounts. You want an MRI? It’s going to cost you $300. Can’t pay right away? We’ll make a payment plan or loan to you and hand it over to a collections agency if you default. Nobody would be getting needless MRIs if they were $300, but people would be seeing primary care doctors for $16 a pop.
Also, participation in this plan, where providers could freely set their own costs and refuse morally-repugnant services would only be contingent on adhering to a uniform medical record system and open publishing of efficacy rates and cost schedules. No ‘government takeover’ here.
How to pay for the 90%? Well, just tax for it, but keep it on a year-to-year basis and keep it separate from the federal budget. Basically, what you already pay for Medicare would provide most of this, especially once the market-driven nature of it brings costs down to 8% of GDP (compared to our 18% spending now).
Justin, I think the state plan being referred to is a state health system plan, not a state sponsored insurance plan.