Part 17: The Current Version of The BCRA Will Not Significantly Reduce Premiums

At the current rates, it is estimated that by 2019, the federal government will spend more on healthcare than on Social Security entitlements. This would add an additional $1 trillion annually, to the deficit. One key way to prevent this is that the new healthcare legislation to seek to return personal health responsibility to individuals. 

The U.S. per capita cost of healthcare is six-times higher than of the country with the next highest cost, yet the United States does not deliver the expected quality of care.  Multiple layers of bureaucratic processes and waste, over-regulation, and legal issues are to be blamed; these are fixable. 

What is lacking in the current healthcare system and in the proposed BCRA:

The current U.S. healthcare system is the most expensive in the world but not the best. Despite that, the cost of healthcare continues to escalate in America. It is not necessarily the drugs and excessive investigations carried out on patients that escalate healthcare costs but the profit-driven motives of underwriters and hospitals (e.g., annual profits for the insurers through the “ACA cover alone” exceeds, $15 billion, annually), pilferage, and waste. 

The current version of the healthcare Bill (BCRA) lacks, (A) definitive steps to reduce premiums and deductibles, and (B) providing wider access to the populous, and sustainability. Pushing and tinkering the BCRA just to get it ratified for debate/ hearing in the Senate is likely to cause major problems later. There are several key areas that Senators need to modify in this Healthcare Bill to make it not only appealing to Senators of Democratic party but more importantly for the benefit of the public.  Previous parts of this series of healthcare policy articles, author illustrated other gaps in the BCRA. 

Real changes to the health care system is necessary;

A paradigm shift of prioritizing disease prevention, maintaining health together with universal access to care (Medicare for the Young) would generate tremendous cost savings and bring prosperity, happiness, enhanced productivity, and decreased losses through opportunity costs. Such ill would also attract bipartisan support from both, the House and the Senate. However, if done properly, BCRA can be a win: win situation for all Americans.

Restrictions in care utilization are counterproductive to achieving the overall goal of keeping people healthy nor in the long-term, reducing costs. Thus, a paths other than ‘restricting access to healthcare’ should be taken to reduce costs. Healthcare is an essential service. 

By creating options, opportunities for consumers, and enhancing competition for customers, process will be subject to consumers-driven market-forces, driving down the premiums. It will allow self-regulation of hospital and emergency-room visits, referral patterns, and the costs, albeit that may take some time to materialize. 

Making healthcare affordable:

BCRA is a once-in-a-lifetime opportunity to strengthen the U.S. healthcare system to achieve an affordable and sustainable system for generations to come. However, to do so requires a fundamental shift to prioritizing disease prevention and keeping people healthy; this is a major shift from the current model of spending money for an acute, hospital-based system. 

The BCRA should also provide access to everyone, and all individuals should be allowed to purchase what they want (the level of cover) and what they and their families can afford. A paradigm shift of striving for a focused, chronic-disease–management program needs to be a major part of the BCRA, with an emphasis on keeping people healthy.   

Why people will be hesitant to sign-up for the new healthcare coverage:

When the healthcare insurance is not affordable (i.e., high premiums and/deductibles), it is inevitable that people will be hesitant to purchase insurance cover.  When the ACA came live, signing-up was a nightmare for many.  In addition to being too complicated, the healthcare.gov website was down more days than it was up and running.  It was hard to get through to a customer services person (ACA) to get assistance; even if managed to get through the toll-free telephone number provided, most of the time they were clueless and unable to assist. 

For respondents’ point of view, majority of times personal information had to be entered multiple times into the government website; only in few cases intended beneficiaries were able to sign-up during their first attempt.  Moreover, the information entered were not retained, thus every time the system kick-them out, these have to be reentered; wasting hours before they could finally manage to sign.  Many other gave up after multiple failed attempts, thus, opted to be without Obamacare insurance. 

Out of the 22-million people who signed up for ACA, more than half of them did so to avoid Obamacare tax penalty.  Consequently, when the tax penalty for not having the health insurance cover is removed (by the current administration) in 2017, over 10-million people is estimated to choose not to purchase the new health insurance. This group consider it is cheaper not to have insurance, in the absence of a penalty.  

This issue is further complicated because, half of those who signed up for Obamacare healthcare insurance do not submit annual tax returns, and thus, there is no way to impose the ACA-mandated tax penalty for this large group of people.  

Conclusions:  

The new healthcare plan must have tangibly improved benefits in quality, accessibility, and equity, at an affordable cost for participants and the government. It would be a waste to continue the current practice of expensive care that benefits a smaller percentage of the population. Doing so would not improve the broader clinical outcomes, quality of life, or life expectancy of Americans. What is needed is cost-effective, affordable, equitable coverage and a dependable healthcare delivery system that leads to better outcomes at a lower cost. 

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Professor Sunil J. Wimalawansa, MD, PhD, MBA, DSc, is a physician-scientist, social entrepreneur, process consultant, and educator. He is a philanthropist with experience in strategic long-term planning, cost-effective investments and interventions for preventing non-communicable diseases, globally. 

The author has no conflicts of interest and has received no funding for this work [https://wimalawansa.org; LinkedIn-Wimalawansa]. The author can be reached via [email protected]

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