“I don’t think there should be a profit motive in health care. I think all the health care dollars should go to care.”
—Elsa Stone, a North Haven, Connecticut, pediatrician
Well, what do you know. The universe is starting to make sense.
From Thursday’s USA Today:
HARTFORD, Conn. – In the past decade, most states have turned Medicaid over to private insurance plans, hoping they could control costs and improve care. Nearly half of the 60 million people in the government program for the poor are in managed-care plans run by insurance giants such as UnitedHealthcare and Aetna.
Connecticut, the “insurance capital of the world,” is bucking the trend.
Beginning Sunday, Connecticut will jettison its private health plans from Medicaid, the state-federal health insurance program. Instead of paying the companies a set monthly fee to cover the health costs of more than 400,000 children and parents, the state will assume financial responsibility.
Glad you asked:
State officials say the companies, including Hartford-based Aetna, did not fulfill their promise of lower costs and better care.
Take that all of you private-insurance lovers out there.
Notably, our neighbor to the West, Oklahoma, one of the reddest states in the Milky Way, doesn’t trust the private insurers either, and hasn’t for a while:
Oklahoma moved away from private plans in 2005, and officials there say they have no regrets. “While achieving very encouraging marks in both member satisfaction and quality, the cost per member has grown at a very low average annual rate of 1.2% over the last five years,” says Mike Fogarty, Oklahoma’s Medicaid director.
a 2009 state-commissioned report showing Connecticut was overpaying insurers by nearly $50 million a year–about 6% of total expenses.
Other state reports found the plans were spending too little on health services and published networks of doctors that were misleading because many doctors refused to accept Medicaid patients when “secret shoppers” called for appointments.
And, thus, the story touches, albeit indirectly, on a major problem with the very conservative Affordable Care Act:
Many doctors are happy to see the state’s experiment with managed-care plans end. Many had been frustrated with having to follow different rules for different plans. They also complained about payment delays and problems referring patients to some specialists.
You see, because too much worry is exhausted on who gets paid, the folks in the middle—doctors and patients—tend to suffer. The ACA, while guaranteeing everyone health insurance, still keeps in place that profit-minded system. In fact, Paul Ryan’s budget plan—fully embraced by the Republican Party—would essentially do for older folks, who would have a hard time getting health care, what the ACA does for younger folks, who can’t afford or aren’t able to get health care.
Yes, it’s true.
An important but little noticed point made in the recent controversial Politifact article, “Lie of the Year 2011,” explains:
Under the current Medicare system, the government pays the health care bills for Americans over age 65. Under the Ryan plan, future beneficiaries would be given a credit and invited to shop for an approved plan on a Medicare health insurance exchange…Ryan’s plan requires private insurers to accept all applicants and to charge the same rate for people who are the same age…
“Ryan basically proposed the Affordable Care Act for future seniors,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology, who advised both President Obama and Republican Mitt Romney on health care. “I don’t understand how you can like it for future seniors but not like it for today’s needy uninsured. That doesn’t make any sense.”
Of course, it also doesn’t make sense how most people in the country can like Medicare for seniors and not like Medicare for everyone, but Republicans have done such a darn good job of demonizing everything that comes in contact with government that it is somewhat understandable why there is such cognitive dissonance out there.
Fortunately, some states, most recently Connecticut, are coming to their senses about how health care is delivered in this country, and it’s not through motivating private insurers with profits. And that, despite all the Republican criticism of it, is what is wrong with the Affordable Care Act. It is an improvement over the dog-eat-dog insurance system we have now, but the dogs are still out there.