By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    UV damage to eyes
    Warning Signs of Long-Term UV Damage to Your Eyes
    December 9, 2021
    degree for healthcare job
    The Ultimate Healthcare Recruiting and Staffing Guidebook
    March 21, 2022
    medicare part d benefits
    Everything that You Need to Know About Medicare Part D
    August 15, 2022
    Latest News
    Clean Your Mattress Properly to Avoid Common Health Issues
    March 29, 2023
    5 Benefits Of HIPAA-Compliant Answering Services
    March 28, 2023
    3 Ways To Deal With Health Issues In Cities With High Pollution
    March 22, 2023
    What Tools Should Your Caregiver Have?
    March 22, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Image
    Disruptions on the Yellow Brick Road II
    June 5, 2015
    What Can We Learn From European Hospice Care and Life Insurance Policies?
    October 5, 2018
    Here’s Why Plastic Surgery Shouldn’t Be Taboo Anymore
    September 28, 2020
    Latest News
    What Are Bioidentical Hormones Made With?
    March 23, 2023
    Cover Medical Costs of Child Dog Bites with Legal Specialists
    March 23, 2023
    3 Ways to Improve the U.S. Healthcare System By 2030
    March 14, 2023
    6 Steps To Ensure Speed And Efficiency Of Clinical Studies
    March 14, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Is a Government Takeover of Health Care Underway?
Share
Sign In
Notification Show More
Latest News
healthy travel tips when visiting Australia
7 Essential Tips to Stay Safe and Healthy Visiting Australia
News
health risks of dirty mattress
Clean Your Mattress Properly to Avoid Common Health Issues
Health
eligble for NDIS?
Are You Eligible For NDIS? How To Apply
News
upgrade to your nursing career
4 Pertinent Ways to Upgrade Your Nursing Career
Nursing
career in nursing
8 Keys to A Fulfilling & Successful Career in Nursing
Career
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Is a Government Takeover of Health Care Underway?
Health ReformPolicy & Law

Is a Government Takeover of Health Care Underway?

DavidEWilliams
Last updated: 2011/08/01 at 5:03 PM
DavidEWilliams
Share
5 Min Read
SHARE

The normally sage CEO of the Kaiser Family Foundation, Drew Altman isn’t as persuasive in his latest Pulling it Together column (Are We Headed for a Government Takeover of Health Care?). His essential argument is that since the government’s share of health care spending is projected to rise only modestly –from 45 percent to 49 percent– from 2010 to 2020, that no such takeover is occurring. As he puts it,”our health care system has been, and will remain, a mixed public-private one.”

The normally sage CEO of the Kaiser Family Foundation, Drew Altman isn’t as persuasive in his latest Pulling it Together column (Are We Headed for a Government Takeover of Health Care?). His essential argument is that since the government’s share of health care spending is projected to rise only modestly –from 45 percent to 49 percent– from 2010 to 2020, that no such takeover is occurring. As he puts it,”our health care system has been, and will remain, a mixed public-private one.”

In my view, this mixed system of financing is one reason the US health care system is in a tough spot. Since the government is the single biggest customer for most provider organizations, that’s where providers place the bulk of their attention. Add on all the regulatory requirements and opportunities for harsh civil and criminal punishments the government imposes, and the focus becomes even more central. It’s hard, even for a big national or regional commercial health plan, such as Aetna or a Blue Cross, to get a provider’s attention for an innovative quality program or payment model. It’s also true that health plans tend to follow government (especially Medicare) coverage decisions, whether because Medicare is perceived as doing the right thing or because it’s just the easiest way to go. Commercial health plans’ reimbursement rates are also influenced by Medicare and Medicaid, either because they use those rates as the basis for their own or because key provider organizations tell commercial plans the amount needed to make up for their losses on government programs.

The Patient Protection and Affordable Care Act (PPACA) does certain things to make innovation from commercial health plans even less likely. In particular minimum medical loss ratio (MLR) rules limit the profit potential of innovations that hold down medical costs.

More Read

everest healthcare

The Everest Foundation’s Mission to Support Inclusive Healthcare

Colleges Prove the Huge Benefits of AI in Healthcare Education
Using EHR systems in healthcare for Cost-Effective Services
Benefits of Emerging Technology in Healthcare in 2023
Why Is a Referenced Based Pricing Tool Necessary?

So while I would not say that PPACA represents a “government takeover of health care,” it is fair to say that government already weighs heavily on the sector and that PPACA takes that a step further.

The dynamic I describe would probably still hold even if government spending were cut to half of its current level, something that seems very unlikely. (Notably the latest debt ceiling deal avoids a hard look at the root causes of Medicare spending). Even with such a dramatic change Medicare would still be the biggest customer of most hospitals. Government rules would still dictate compliance priorities. And health plans would continue to follow the government’s lead.

So what, practically speaking,  is to be done? I see a couple of opportunities, both of which are likely to take a while to play out given the dysfunctional dynamic in today’s Washington and anger and confusion among the public:

  • Encourage the entry of new health plans by eliminating the MLR requirement for them and waiving regulations such as mandated benefits. There are some intrepid players such as Averde Health that are ready to try new ideas. But setting up safe harbors for innovation and providing some advantages against established rivals will bring a lot more new, exciting ideas out of the woodwork. The MLR requirement itself actually discourages new entrants, because it’s hard for health plans to reach the required level until they have a lot of members
  • Stop pretending/hoping that commercial plans are ever going to add much net value to a system dominated by government payers, and outlaw them altogether, moving to a single-payer system. Then focus on allowing providers to innovate in the face of restrictive budgets. I know this one seems particularly farfetched based on the current mood of the country, but I think there’s a good chance we are headed in that direction over the next 20  years

 


TAGGED: healthcare policy, healthcare reform, PPACA, us government

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
DavidEWilliams August 1, 2011
Share this Article
Facebook Twitter Copy Link Print
Share
Previous Article Microsoft Data Center Video Tour–Where HealthVault and Other Cloud Services Are Stored And Deployed
Next Article HHS: Insurance Required to Offer Birth Control, Contraceptive Planning

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

healthy travel tips when visiting Australia
7 Essential Tips to Stay Safe and Healthy Visiting Australia
News March 29, 2023
health risks of dirty mattress
Clean Your Mattress Properly to Avoid Common Health Issues
Health March 29, 2023
eligble for NDIS?
Are You Eligible For NDIS? How To Apply
News March 29, 2023
upgrade to your nursing career
4 Pertinent Ways to Upgrade Your Nursing Career
Nursing March 29, 2023

You Might also Like

Bioidentical Hormones
Medical Education

What Are Bioidentical Hormones Made With?

March 23, 2023
child dog bite lawyer
News

Cover Medical Costs of Child Dog Bites with Legal Specialists

March 23, 2023
US healthcare system
Global Healthcare

3 Ways to Improve the U.S. Healthcare System By 2030

March 14, 2023
Clinical Studies
Global Healthcare

6 Steps To Ensure Speed And Efficiency Of Clinical Studies

March 14, 2023
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Removed from reading list

Undo
Welcome Back!

Sign in to your account

Lost your password?