I have a new rule. If someone complains about something wrong with Obamacare, I officially don’t care unless they suggest how to fix the problem (other than repealing Obamacare). Problems with the web site? Fix them. Employers reducing the number of full time employees? Change the rule. As long as people are just trying to find anything wrong with the ACA (no matter how trivial) in order to justify getting rid of it, then they do not deserve to be taken seriously.
Seriously.
11 Comments
What is the root problem we are trying to fix? Lets start from defining it and discuss our way up.
My fix is to ask the person if he/she is a Republican. If “Yes”, I ask what is wrong with this Republican Plan?
Hassan. That’s actually relatively easy. The US healthcare system spends far more for demonstrably worse results. Our people are less healthy and we pay more for it. We are not getting value for our health care dollars. Furthermore a personal issue I have is that I find dealing with the healthcare system in the US to be annoying and frustrating, especially compared to the healthcare systems I have experienced in other countries (and I have lived in four other countries). The healthcare system is largely driven by making as much money as possible (for the doctors, hospitals, and insurance companies) not for keeping people healthy.
We are not getting the results we want or need, and we know that other countries are doing better. The result is hurting our economy, both by siphoning a large percentage of our GDP into a wasteful and inefficient healthcare system, and also because our people are not healthy.
There are plenty of systems that work better, including both single payer systems and private systems. I personally would prefer a single payer system (like our Medicare and especially like the system in New Zealand) because it is simpler, but I could also be happy with a regulated private system like Romneycare/Obamacare (which is successful in Japan and Switzerland).
While single payer might work well for a very small counrty like NZ, estimated at about 4.4 million or about 1/2 the size of NYC or LA, I don’t think it would work as well here.
I agree that people ought to stop complaining and start identifying what’s brokern and start brainstorming solutions. First on my list is the mandatories of what is required by law to be in there. Now I understand why they put it in there, but I have a very hard time having to be made to have maternity and abortion coverage seeing that I’m fixed aas is my wife and we arn’t planning on trying to reverse that. I understand they said everyone so that everyone else’s premiums would be lower, but I still don’t like it.
The other is getting all the healthy people to sign up and pay for what they don’t want and may never need, again to keep others premiums lower. There don’t seem to be penalties for smokers, overwieght, lack of fitness, etc. In order for socialized medicine, which this is except that currently we still have private insurer’s, to be fair then personal choices, ie smoking, overweight and poor fitness need to be addressed or I will be made to pay for someone elses lack of priorities or common sense. If people want to smoke, drink, drug, eat fatty foods, sit on the couch thats their choice, but now those making better choices will have to pay for their freedom to choose. So where will the incentive to change come from if not pain in the wallet. Example, I quit smoking 30 years ago because I didn’t want higher life insurance premiums.
While I think their are many benefits to the ACA including not being dropped or being banned part of me still see’s this as an entitlement program without any incentive to improve. I know people with good insuranceplans that still only go to the emergency room when their sick and never see their doctor regularly, how do we get to them?
So many questions and topics. All in all it seems like a step in the right direction, but IMO needs alot of work to make it good for all of us.
To me what is surprising is the cost of healthcare itself. What can be done to reduce the cost of healthcare? The medical system (hospitals/doctors etc) are doing business (which they have right to do). Why there is no competition there to reduce cost? Secondly insurance companies are also in for money, but they do not provide any service? They are just gambling and making profit.
If people who have money are being forced to pay for people who do not have money, at least make it easy on them by reducing cost and getting rid of profit factor for insurance companies.
I think two big things adding to the cost of healthcare are the cost of higher education and med school and the unbelievable ability of pharmaceutical companies to charge high prices for drugs.
PatriotSGT, so long as you have insurance, you’re going to pay for other peoples’ poor choices, whether you’re picking up part of someone’s chemo bills for smoking-induced lung cancer or an air cast for a kid jumping off their roof into a pool, the whole thing is subsidizing other folks’ medical bills regardless of the ACA. There is a point that poorer people are less likely to have healthcare (slightly less so now) and more likely to be unhealthy though, so I see that angle. As to healthy people needing to pay, well, it’s sort of like home insurance, you don’t get it because you know you’ll need it, you get it because you’ll want it there if you do. If one of those super healthy people all of a sudden gets hit by a car or something, that money comes from somewhere.
I also like Hassan’s last point. Is there some way to keep insurance companies honest and try to cap their profits somehow? I don’t think I’ve seen an insurance-as-a-non-profit idea other than single-payer.
Good points Hassan and Thatguy. On the insurance I do get it, same way with car and home insurance. Those companies spread the risk/reward to cover all. But, with car insurance there is a high risk pool funded by state govt’s to cover the young if they’re not on someone else’s insurance. Also if they’ve done some stupid stuff like rack up speeding tickets or DWIs they are kicked off regular plans and sent to the high risk State plans at an astronomical price. Same with flood insurance nowadays, if you want to have a beach house you pay, but in some areas only Federal flood insurance is available again at a higher cost, your choice you pay. There could be some system for people whose health lifestyle choices send give them consequences or require them to pay more.
On the Pharmaceutical companies I agree. They spend a lot of money on advertising and promoting and giving perks and kickbacks to Docs, hospitals and companies that manage both. Personally if I never see another Viagra type commercial I’d be very happy. Having to explain to an 7 yr old girl what erectile dysfunction is because she was watching the history channel with her father should not be a conversation we need to have.
> “While single payer might work well for a very small counrty like NZ, estimated at about 4.4 million or about 1/2 the size of NYC or LA, I don’t think it would work as well here.”
Are you forgetting that Medicare is single payers and is very popular and effective (it dramatically reduced the number of senior citizens who were dying from lack of health care).
One of the problems with any discussion of health care costs is that people tend to focus on fixing one aspect while ignoring the interconnections between problems.
As for why health care costs so much, it’s several things. First, American doctors make more on average than doctors in other countries (http://www.motherjones.com/kevin-drum/2013/02/charts-day-doctor-pay-america-and-other-countries). Next, American doctors pay more for medical malpractice insurance; other countries have lower liability costs because of caps, better disability safety nets, and centralized control (http://www.aaos.org/news/aaosnow/sep11/managing4.asp). Closely related to this is the practice of defensive medicine, which includes running unnecessary tests; compounding this problem is the incentive structure of tests, in which doctors have no reason to NOT order the test. Compounding this problem is the fact that many private physician practices have begun to bring testing facilities in-house…because they are cash cows. We add additional for-profit structures all over the place; specifically, we have a for-profit billing industry whose sole service involves charging and collecting payments for other services. Lastly–and most importantly–to support this supposed “free market” approach, all of these actors go out of their way to hide costs. You will never go into a doctor’s office and see a menu showing how much each item costs, how much insurance pays, how much will get written off through insurance adjustments, etc.
To make matter worse, we have taxpayer-subsidized insurance tied to employers. This is the part that is really screwed up. If you are fortunate to have a job, the U.S. taxpayers help pay for you to get insurance through your employer, as your premiums are deducted pre-tax. If you are poor and don’t have a job, you don’t get the same taxpayer subsidies. Furthermore, your premiums will be higher, as employer plans benefit from economies of scale and bulk purchasing. Lastly, you need to be a lawyer to understand all the loopholes that are built into these plans.
The ACA is a band-aid for parts of this problem, but it doesn’t go far enough. There are so many more things that need to happen: Ban employer-provided plans, and replace them with state-wide single payer systems. Provide an adequate social safety net for disability services to reduce the need to sue for malpractice. Institute medical review boards that also incorporate non-physicians for malpractice claims. Introduce firewalls between physicians who order tests and the groups that perform the tests to reduce the incentives for unnecessary tests.
And, lastly, introduce more intellectual diversity into the Supreme Court. The judicial history of the last half-century has been unabashedly pro-big business and has routinely struck down any attempt to regulate corporate control. In my opinion, the only reason the ACA survived was because it preserved the health care boondoggle structure of private enterprise. Had it actually moved more toward a single payer, Medicare-for-all type of system, I believe it would have been killed.
Hey, while I’m shooting for the moon here, let’s also toss in the hidden cost of education. That’s part of the reason why doctors believe (somewhat rightfully so) that they deserve higher compensation: They have to pay off hundreds of thousands of student loan debt that their counterparts in, say, Europe don’t have to.
I remember when I was growing up (not in this country), we would have to write essays in English and native language. So if title of essay would be “My Aim in Life”, everyone would write (not necessary mean it) about how they feel for humanity and they have soft corner and they want to serve poor etc. Hence to achieve that goal, they want to become doctor. That is definitely not the case here in US.
I have a confession to make, I do not have medical insurance. Not because I cannot afford, but my extreme hatred of insurance companies. I will enroll in ACA last day before penalty kicks in.
I have a doctor that I visit just once a year on average (only when I need to). The doctor is of same ethnic background as I am, but he does not know me personally. Last year I went to him, he spent 1 hour in person with me (nurse spent 20 minutes). Usually doctor only gives 5 minutes, but this guy spent whole 1 hour with me (no exaggeration). He asked me if I had insurance, then he ordered only tests that I needed. He charged me 75$ only (yes that is correct, that his standard fee I believe). The tests cost me about 250$ from labcorp or something like that.
This year I went to him, his business has grown, and he has most of the tests in house. He spent may be 30-40 minutes this time (did not need more time). They wanted to certain tests, and I agreed to pay for it. But after tests, they wanted some more to be on safe side, and they did those for free. Because they already told me total cost before, and I agreed, so any test they did after, they did not charge me.
Sounds like a good doctor!