Tuesday, November 19, 2013

Prices and the Affordable Care Act.

The biggest problem with the Affordable Care Act, and Medicare and any single payer system is consumers are shielded from price. When prices are too low, people over-consume. The Obama administration realizes this. From the Washington Post on Healthcare.gov:

The problem there was politics, not code. In the first version of HealthCare.gov, there was no way to window shop. You needed to register an account in order to see the plans. The rationale was sensible enough: The White House wanted to ensure people saw the real price they'd be paying. That meant verifying their identity, their income, their age, their citizenship, and everything else that goes into calculating subsidies.
This proved a technological nightmare. Imagine if before browsing a book in Barnes & Noble you had to find a clerk and have them take down and verify your credit card, your phone number, and the address you want the book sent to once you've bought it. The staff would quickly be overloaded. No one would ever get into the store. And it would be a massive waste of time because many of the people clogging the line were just there to browse anyway.
 When the Post says the White House wanted people to see the real price they would be paying, it is saying the White House didn't want people to see the real cost of their health insurance. It didn't want old and sick to see how much it really costs to insure them, because they may choose not to buy. Where they less concerned the young and healthy people wouldn't notice they were being forced to overpay to subsidize the old and sick, or did they succumb to their own hype and believe somehow exchanges would result in lower prices for the young and healthy as well? Or was it a numbers game: many more getting subsidies, than paying for over-priced insurance and the politicians were willing to make that trade-off?

It is ironic the ACA is in deep trouble due to it's willful desire to shield consumers from price and that desire resulted in a technological, are we still calling it Glitch?

The idea consumers should be shielded from price is the biggest objection many, including myself, have had to this legislation from the very beginning. The ACA relied on insurance as a financing mechanism for health care, the original sin, removing the consumer from seeing the price of his consumption, and doubled down by removing the consumer from seeing the price of his insurance. It took a bad system, and made it worse.

Single payer won't make it better. It will make it even worse. "Free" healthcare will result in more over consumption. The only way the government will be able to ration healthcare is by bureaucratic mechanisms which includes deciding what treatments people can and can not have and when they can have it. It will be health care for the loudest. Scream you need your neighbor to pay for your birth control and birth control becomes free. Scream you need your neighbor to pay for your ED and ED becomes free. This has already happened with Medicare and ACA, there's no reason to think this trend would moderate with single payer.


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