More on working towards a deal

Harold Pollack has an interesting give and take with Avik Roy about Avik’s health reform plan. There have been legitimate criticisms about the details or lack of them and how the gaps would likely have to be filled in, and that is how it goes and why it is so hard to pass any sort of health reform proposal. Many folks thought that I went too easy on Avik’s plan, but they missed my main point. It is not the details of his plan that were the most important, but his frame of acknowledging that the overall structure of the ACA is here to stay, and that continued policy nihilism is a bad strategy. It is inevitable that the ACA will be changed and tweaked over time, and it is better to start the process sooner, rather than later.

These sorts of details noted in the various pieces won’t be “snuck through” a revision of the ACA. The country is paying far more attention to health insurance and health policy than ever before. These issues will be banged out in the open, and both political sides have a stake.

One key issue that needs to be resolved:

  • what is an acceptable out of pocket spending amount from both a policy and cultural perspective?

As Adriana Macintyre noted today on on twitter, deductibles over $1,000 have often been considered to be relatively high, and the presence of deductibles above this level has been trending up for some time.

ScreenHunter_01 Sep. 10 10.47

However, many ACA exchange plans have deductibles much larger than that. There is a lot more “skin in the game” than many think. Is that good? Bad? Acceptable? What is the maximum that should be allowed?

These are the types of questions that will have to be banged out in the next step on health reform.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to More on working towards a deal

  1. Bob Hertz says:

    The problem is that deductibles are applied to virtually all forms of care.
    A person hit by a car and brought in for emergency surgery will still face a deductible of $1000 or much more.
    A person who wants genetic testing or chelation therapy faces the same deductible.

    The solution is to do (as much as we can) what France has done for years. Deductibles would not apply to emergency care or life-saving treatments.

    Personally I would be content with Medicare Part A being available to anyone. (and no games about “being in the hospital for observation.”)

    Then, in my ideal world, the government would have no particular role in your choices for ambulatory/discretionary care.

    (other than to require full binding price disclosure before the outpatient procedure takes place.

    No binding estimate would mean you owe nothing. That will create transparency as “quick as hell.”

  2. Pingback: Cost v value as policy focus | freeforall

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