Saturday, September 28, 2013

The Tools of ACA for Lowering Costs

ABC News ran an article on the Affordable Care Act that made little mention of the effect of various "free" services on costs. Upon pointing this out, another reader commented that those services "will lower costs because treatable illnesses will be caught early before they are very expensive to treat and irreparable damage has been done."

The assumption in "treatable illnesses" lowering costs is that only those with illnesses are getting that "free" treatment.

First, there is nothing free about the "free" visits. Just because people are not paying does not mean there is no cost. Added to that, with people not paying, they are even more likely to drive up that cost.

Second, instead of focusing on those who need medical care, ACA both assumes that everyone needs prevention, and that things can be prevented. Not every illness determined to be "treatable" is preventable.

This is not to say ACA won't find ways of lowering costs.

Those found to be out of adherence with preventive guidelines may be denied care for non-compliance with prior "wellness" "best practices." This is called "accountable care."

Those found to have a "non-treatable" illnesses can likely kiss experimental treatment and medical innovation goodbye as well. Without a basis for "comparative effectiveness," care can be denied on the basis of no justification for the cost.

Therefore, whether one has a medical condition deemed treatable or not, ACA has ways of denying care.

In a free market system, yes, there are those who can afford expensive treatments and those who cannot. The rest of that story is in a free market system, medical innovation that was originally funded by the early adopters, eventually becomes affordable as entrepreneurs are motivated to find ways to expand their market to more people looking for lower prices.

In a system of guaranteed coverage where price does not matter, the only step for entrepreneurs between the early adopters and everyone else is a person (or board) with the power to approve or disapprove treatments deemed worthy of "effectiveness" that lower costs.

That kind of power vastly increases the risks of corruption.

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