[quote=SK in CV]
But in general I agree with you. The law was in part poorly written, and in part ill conceived. There was a lot more that could have been done. But I expect that ultimately it will reduce the rise total health care costs, expand the availability of coverage and be a step in the right direction to fix what was a many faceted irreparable model for health care financing. It wasn’t just health care providers making too much profit, or insurance companies making too much profit, or DME manufacturers or drug companies making too much money that caused the system to break. And no single thing will fix it.[/quote]
The underlying systemic issue is what is causing our prior model to break. We’re not a heartless nation saying just let people die, so we EMTALA. EMTALA results in 80% of ER visits being uninsured. The ER is one of the LEAST cost effective points for treating people.
The facilities all then restructure their chargemaster to recoop their cost through insurance by factoring it in to the cost. So your ER is 5X what it really should be, because the bill is reimbursing the hospital for the fact that 4 out of 5 basically aren’t paying.
Your regular doctor is much the same. But instead of no-pays, they have Usual, Customary and Reasonable charges. And they have to work on collecting any amount over the various UCR which brings us back to the emergency room analogy.
IMO, the biggest savings of ACA will be driven by taking a large subset of the 40+ million uninsured and moving them from expensive, too little too late treatment in the ER, to less expensive, more preventative treatment up stream.
