Even if HRC became POTUS and there were no GOP attacks is/was Obamacare really sustainable?

[Mijin]

@puddleglum

Mortality is not a good measure of a health system since so much is genetic. For example, black americans and asian americans both use the same healthcare system but there is an 11 year difference in life expectancy.

I agree mortality rates can be misleading. I just brought it up here because I thought the stat brought up by Omar Little is probably more misleading.
But yes we need a range of measures to try to gauge the efficacy of a healthcare system.

Also, I don’t think you mean “genetic”. If Asian Americans have a comparatively low life expectancy, I wouldn’t jump to the conclusion that that is evidence of a genetic difference, since in many cases their parents’ country of origin may have a higher life expectancy than the US.

[iamthewalrus_3]

@rbroome

And they were actively encouraged to disapprove. If there are large groups of people actively badmouthing anything, say taxes, then large numbers of people will start to disapprove.

I mean, I’m sure that has something to do with it, but it’s generally not very hard to convince people that they don’t want to pay a tax penalty.

Without re-litigating the whole of the ACA, I will say that I think there are legitimate grievances that plenty of people could have with the way that the ACA allocates costs in the individual market. I personally detest the Republican noise machine, but I still don’t like the ways the individual market was set up.

I’m strongly pro-Medicaid expansion, FWIW.

[Wesley_Clark]

@Omar_Little

What are the specific reasons that the US healthcare cost per person is 2-3x more than other nations? It appears that the US spend is heavily skewed toward older members of the population. The incidence of deaths from heart disease per 1,000 in the US is no where near the highest country. My only guess is that Americans do more to try and preserve life at the end as opposed to letting life pass on. Family members want doctors to continue to perform lifesaving measures even if the prognosis isn’t good. These types of measures result in much higher medical costs.

I read a health economist once say there were 3 meta categories behind our higher spending.

1. Administration is terrible. There is a lot of duplication of efforts, a lot of money goes to administration rather than care, a lot of labor hours are used on administration rather than providing care, etc. According to this article, even in 1999 the US was spending 3x as much on administration as Canada,

After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States, as compared with 16.7 percent of health care expenditures in Canada.

2. We do not use public or private market forces. Private market forces are things like transparent pricing or letting consumers shop around. Public market forces are the government negotiating prices or setting prices.

3. Our fee for service system incentivizes expensive care. If you injure your knee and go to a hospital, both the doctor and hospital have an incentive to provide the most expensive care possible. They may want multiple scans followed by major surgery when science says that several months of physical therapy is just as effective as surgery.

So the reasons our care cost so much tend to come back to those 3 areas.

Also American health care wasn’t always head and shoulders more expensive than anyone else. Back in 1980 (that is about as far back as I can find), US spending was on par with Germany or France.

https://live.dev-mercatus.com/sites/default/files/Chart%202%20small_1.png

However from 1980 to today, health spending in the US has gone from 9% of GDP up to 18% of GDP, which is an additional 9% of GDP. Most other wealthy nations have only seen health costs go up 3-4% of GDP, not 9% like in the US. The US went from 9% to 18% of GDP from 1980-today. France and Germany went from 9% to 12% during the same time period.