# Future of Health Care in America **URL:** \ **Category:** Great Debates\ **Created:** [June 28, 2012, 5:34pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604 "2012-06-28T17:34:31Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Qin\_Shi\_Huangdi](https://avatars.discourse-cdn.com/v4/letter/q/f04885/32.png) [@Qin\_Shi\_Huangdi](https://boards.straightdope.com/u/Qin_Shi_Huangdi)\ **Post date:** [June 28, 2012, 5:34pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/1 "2012-06-28T17:34:31Z")
Now that Obama’s Health Care law has been ruled constitutional how will health care policy in America develop over the coming years? It seems unlikely that the law will be repealed unless there was a conservative supermajority in Congress and a Republican in the White House. How close will the US come to achieving universal coverage once all the parts of the law are in place. ---
**Author:** ![Ruminator](https://avatars.discourse-cdn.com/v4/letter/r/b9bd4f/32.png) [@Ruminator](https://boards.straightdope.com/u/Ruminator)\ **Post date:** [June 28, 2012, 5:48pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/2 "2012-06-28T17:48:54Z")
> [@Qin\_Shi\_Huangdi](#): > > How close will the US come to achieving universal coverage once all the parts of the law are in place. The US will inch towards something that government officials (and maybe even the citizens) will label as “universal coverage” but since the USA finances are not healthy enough to afford it, it will be of a limited form. It won’t be the kind of extensive coverage that Scandinavian countries had in the heyday before their trends toward privatization. This will eventually lead to parallel “supplemental” health coverage that the middle and upper classes buy separately to truly handle their requirements. E.g. the government “universal coverage” doesn’t cover a new surgical procedure but the “supplemental coverage” does. Agan, the “universal” is “universal” in name only. That’s the way it has to be because a slippery fiction around that terminology is the only way the USA can actually afford it. This disparity between those USA citizens who buy private insurance and those without will lead to another phase of discontent. The cycle for political remedy renews itself. ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [June 29, 2012, 5:57am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/3 "2012-06-29T05:57:43Z")
> [@Ruminator](#): > > The US will inch towards something that government officials (and maybe even the citizens) will label as “universal coverage” but since the USA finances are not healthy enough to afford it, it will be of a limited form. It won’t be the kind of extensive coverage that Scandinavian countries had in the heyday before their trends toward privatization. > > This will eventually lead to parallel “supplemental” health coverage that the middle and upper classes buy separately to truly handle their requirements. E.g. the government “universal coverage” doesn’t cover a new surgical procedure but the “supplemental coverage” does. Agan, the “universal” is “universal” in name only. That’s the way it has to be because a slippery fiction around that terminology is the only way the USA can actually afford it. > > This disparity between those USA citizens who buy private insurance and those without will lead to another phase of discontent. The cycle for political remedy renews itself. We could never afford Scandinavian health care, they pay 0.5 times as much as we do and they only cover 1 out of every 1 person. We cover 7 out of every 10, which is either 7 or 10 times better depending on whether you use creationist or intelligent design mathematics. ---
**Author:** ![oreally](https://avatars.discourse-cdn.com/v4/letter/o/7ab992/32.png) [@oreally](https://boards.straightdope.com/u/oreally)\ **Post date:** [June 29, 2012, 6:08am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/4 "2012-06-29T06:08:52Z")
We citizens will overall get taxed much more heavily to pay for “free” care for others. Yay. ---
**Author:** ![mister\_nyx](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@mister\_nyx](https://boards.straightdope.com/u/mister_nyx)\ **Post date:** [June 29, 2012, 6:13am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/5 "2012-06-29T06:13:48Z")
> [@Ruminator](#): > > The US will inch towards something that government officials (and maybe even the citizens) will label as “universal coverage” but since the USA finances are not healthy enough to afford it, it will be of a limited form. It won’t be the kind of extensive coverage that Scandinavian countries had in the heyday before their trends toward privatization. > > This will eventually lead to parallel “supplemental” health coverage that the middle and upper classes buy separately to truly handle their requirements. E.g. the government “universal coverage” doesn’t cover a new surgical procedure but the “supplemental coverage” does. Agan, the “universal” is “universal” in name only. That’s the way it has to be because a slippery fiction around that terminology is the only way the USA can actually afford it. > > This disparity between those USA citizens who buy private insurance and those without will lead to another phase of discontent. The cycle for political remedy renews itself. Explain why you think that universal health care will raise the cost of health care, given that it’s vastly cheaper per capita in all the places that have it. [QUOTE=oreally] We citizens will overall get taxed much more heavily to pay for “free” care for others. Yay. [/QUOTE] I’d extend the same challenge to you if I weren’t already aware you couldn’t possibly stand up to it. ---
**Author:** ![oreally](https://avatars.discourse-cdn.com/v4/letter/o/7ab992/32.png) [@oreally](https://boards.straightdope.com/u/oreally)\ **Post date:** [June 29, 2012, 6:23am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/6 "2012-06-29T06:23:34Z")
> [@mister\_nyx](#): > > I’d extend the same challenge to you if I weren’t already aware you couldn’t possibly stand up to it. ah the favorite refuge of the weak argument: personal attacks. Stay classy. Explain how you think this will be cheaper - wait never mind, I’d ask if I “weren’t” (or wasn’t) already aware blah blah blah ---
**Author:** ![mister\_nyx](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@mister\_nyx](https://boards.straightdope.com/u/mister_nyx)\ **Post date:** [June 29, 2012, 6:30am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/7 "2012-06-29T06:30:34Z")
> [@oreally](#): > > ah the favorite refuge of the weak argument: personal attacks. Stay classy. > > Explain how you think this will be cheaper - wait never mind, I’d ask if I “weren’t” (or wasn’t) already aware blah blah blah And you’ve confirmed that I was right to believe you couldn’t handle making an argument. Thanks! ---
**Author:** ![oreally](https://avatars.discourse-cdn.com/v4/letter/o/7ab992/32.png) [@oreally](https://boards.straightdope.com/u/oreally)\ **Post date:** [June 29, 2012, 7:19am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/8 "2012-06-29T07:19:43Z")
> [@mister\_nyx](#): > > And you’ve confirmed that I was right to believe you couldn’t handle making an argument. Thanks! And you’ve confirmed that I was right to believe you couldn’t handle making an argument either Mr Pot. Thanks! whee this is fun :rolleyes: ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [June 29, 2012, 7:50am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/9 "2012-06-29T07:50:54Z")
> [@Ruminator](#): > > The US will inch towards something that government officials (and maybe even the citizens) will label as “universal coverage” but since the USA finances are not healthy enough to afford it, it will be of a limited form. It won’t be the kind of extensive coverage that Scandinavian countries had in the heyday before their trends toward privatization. > > This will eventually lead to parallel “supplemental” health coverage that the middle and upper classes buy separately to truly handle their requirements. E.g. the government “universal coverage” doesn’t cover a new surgical procedure but the “supplemental coverage” does. Agan, the “universal” is “universal” in name only. That’s the way it has to be because a slippery fiction around that terminology is the only way the USA can actually afford it. Wait, what? You say the US won’t have something like the Scandinavian countries (and I agree), but then your second paragraph seems to assume we will, or at least something like Canada’s. And you’re not the only one I’ve seen do this, so maybe there’s something I’m not understanding. “Obamacare” doesn’t provide governmental universal coverage at all, does it? Everyone still needs private insurance - that’s the whole point of the individual mandate, isn’t it? We have to buy private insurance or pay the $95 penalty tax (theoretically, since they’re not enforcing it). Doubly the whole point since Medicaid guidelines may not be expanded after all, depending on what state you live in. There will be insurance exchanges set up by each state, but they’re not government insurance, they’re state managed listings of private insurance policies that you can choose from and search through based on your income and the coverage you want. It’s the striking down of Medicaid expansion that troubles me the most. I understand why the ruling, but I know a whole lot of people who can’t afford - or aren’t willing to stop buying video games in order to afford - a monthly premium, but make too much or are too single or too male or too illegal to qualify for Medicaid under current guidelines. There is going to be a huge pool of uninsureds in some states if they don’t figure out a way to fix that, and yes, those uninsureds are going to keep on driving up costs for the rest of us. I don’t see a whole lot changing, actually. It’s going to continue to be too expensive or perceived as too expensive for a lot of people to get insurance and they’ll continue to try and use ERs for primary care. ERs will continue to provide lifesaving and stabilizing care, but turn away those who need a refill on their birth control pills or a knee replacement. Hospitals in low income areas are going to continue to bleed money providing services they never get paid for, and that will actually get worse as those marginally better off now get insurance and go to better hospitals for better care. Doctors and nurses in shitty neighborhoods will continue to be sub-par because few people are altruistic enough to work there for long if they can find better working conditions. Students whose parents have family policies, people with pre-existing conditions who have money for insurance and people with massive health care expenses and formerly lifetime maximum policies are about the only ones I really see benefiting from the Act as it stands now. And that’s a lot of people, and I’m happy for them that their lives are getting easier. But there are still a whole lot of us who would have benefited much more from a true UHC system, or at least the Medicaid expansion. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [June 29, 2012, 8:20am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/10 "2012-06-29T08:20:59Z")
Fwiw, the former head of Medicare already sees significant change: > [@](#): > > But Berwick says the clock cannot be turned back on moves that are under way everywhere to improve the co-ordination and quality of care as the Act requires, he says. Doctors and hospitals are exploring different relationships. Accountable care organisations (ACOs) are springing up to provide the entire network of care many people need – specialist, primary care doctor and home health care as well, instead of just the separate parts – and these are being offered not just to Medicare patients but to the privately insured as well. > > “So I don’t think we will ever go back,” said Berwick. > **[US healthcare reform cannot be undone, says former Medicare boss](https://www.theguardian.com/world/2012/jun/15/us-healthcare-reform-undone)** > > Don Berwick says supreme court cannot turn back the clock on reforms that have already become standard across the US Interesting that he sees reform as taking rigidity out of the system, and he sees new approaches being explored. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [June 29, 2012, 8:23am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/11 "2012-06-29T08:23:25Z")
> [@WhyNot](#): > > It’s the striking down of Medicaid expansion that troubles me the most. I understand why the ruling, but I know a whole lot of people who can’t afford - or aren’t willing to stop buying video games in order to afford - a monthly premium, but make too much or are too single or too male or too illegal to qualify for Medicaid under current guidelines. There is going to be a huge pool of uninsureds in some states if they don’t figure out a way to fix that, and yes, those uninsureds are going to keep on driving up costs for the rest of us. Have any states said for sure that they won’t take part in the Medicaid expansion? (I realize it’s only been 18 hours since they’ve known for sure that they could opt out, but maybe some announced their intentions in advance.) ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [June 29, 2012, 8:34am UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/12 "2012-06-29T08:34:56Z")
> [@Lord\_Feldon](#): > > Have any states said for sure that they won’t take part in the Medicaid expansion? (I realize it’s only been 18 hours since they’ve known for sure that they could opt out, but maybe some announced their intentions in advance.) NPR interviewees said Florida was likely to be a no-go, and mentioned two or three other states by name which I can’t recall at the moment. Nebraska’s been fighting tooth and nail against it, as has Mississippi. There are more. Here is one summary of some state officials’ comments on the issue (seems like some were pre-ruling and some post-ruling): [What Will The States Do On Medicaid? - KFF Health News](http://www.kaiserhealthnews.org/Stories/2012/June/28/what-will-states-do-on-medicaid.aspx) ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [June 29, 2012, 1:56pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/13 "2012-06-29T13:56:18Z")
> [@WhyNot](#): > > NPR interviewees said Florida was likely to be a no-go, and mentioned two or three other states by name which I can’t recall at the moment. Nebraska’s been fighting tooth and nail against it, as has Mississippi. There are more. Here is one summary of some state officials’ comments on the issue (seems like some were pre-ruling and some post-ruling): [What Will The States Do On Medicaid? - KFF Health News](http://www.kaiserhealthnews.org/Stories/2012/June/28/what-will-states-do-on-medicaid.aspx) Eh, I don’t think resistance to the Medicaid expansion will last very long. The Feds are picking up 90-100% of the bill. That’s a lot of money to leave on the table. And its not like poor people will stop getting sick just because the governors won’t let medicaid cover them. They’ll get sick, show up at hospitals, and the states will end up paying for far more then the 10% of the cost it would’ve cost them to cover them under the expansion. A few governors will showboat for a few years, but by the time the ACA gets rolling, the medicaid will be inplace in every state. ---
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [June 29, 2012, 2:09pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/14 "2012-06-29T14:09:35Z")
**mister nyx** and **oreally** , both of you need to cut it out. If you have personal problems with each other, take them to The BBQ Pit. Otherwise, stop the sniping. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [June 29, 2012, 3:34pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/15 "2012-06-29T15:34:26Z")
> [@fumster](#): > > We could never afford Scandinavian health care, they pay 0.5 times as much as we do and they only cover 1 out of every 1 person. We cover 7 out of every 10, which is either 7 or 10 times better depending on whether you use creationist or intelligent design mathematics. Cogent analysis! Some years ago I read a N.Y. Times article stating that hospital infection rates declined significantly in an experiment in Europe when doctors and nurses changed into freshly-laundered gowns multiple times per day. The interesting sentence was something like “Of course this option is unavailable in U.S. hospitals due to high costs.” ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [June 29, 2012, 4:56pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/16 "2012-06-29T16:56:36Z")
> [@oreally](#): > > We citizens will overall get taxed much more heavily to pay for “free” care for others. Yay. “Others”? Non-citizens? ---
**Author:** ![Kevbo](https://avatars.discourse-cdn.com/v4/letter/k/e47774/32.png) [@Kevbo](https://boards.straightdope.com/u/Kevbo)\ **Post date:** [June 29, 2012, 6:17pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/17 "2012-06-29T18:17:22Z")
> [@Ruminator](#): > > The US will inch towards something that government officials (and maybe even the citizens) will label as “universal coverage” but since the USA finances are not healthy enough to afford it, it will be of a limited form. ad to another phase of discontent. The cycle for political remedy renews itself. We could put all the Health Insurance companies out of business, expand medicare to cover all, and fund it by charging a tax that would amount to 50-75% of what people/employers/government is now paying the insurance companies. Tax increase, yes, net savings, also yes. Health of USA finances improved, check, UHC afforded, check. The only thing needed to make it happen would be to stand the health insurance industry lobby in front of a trench and have at them with a machine gun. ---
**Author:** ![Lightnin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lightnin/32/180_2.png) [@Lightnin](https://boards.straightdope.com/u/Lightnin)\ **Post date:** [June 29, 2012, 6:45pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/18 "2012-06-29T18:45:31Z")
> [@foolsguinea](#): > > “Others”? Non-citizens? Well, to be fair, that’s what generally happens to non-citizens in countries which have universal healthcare- they receive the necessary medical care, and the cost is eaten by the citizens. Considering this is such a negligible amount of money compared to covering the entire citizenry, it’s not such a big deal- and it’s a hell of a lot better than just letting sick tourists die in the streets. Of course, we already provide free emergency healthcare to people who don’t have insurance and can’t pay, so I’m not sure just what the heck **oreally’s** point was supposed to be. Personally, I don’t mind if I end up paying for someone else’s unpaid-for care, as long as I don’t have to worry about going bankrupt from appendicitis. I honestly don’t understand why people like **oreally** are so resistant to trying to fix our system. One can only assume that they haven’t yet had any major illnesses and/or have excellent health insurance. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [June 29, 2012, 6:52pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/19 "2012-06-29T18:52:12Z")
> [@oreally](#): > > We citizens will overall get taxed much more heavily to pay for “free” care for others. Yay. ?? You already pay for health care for the uninsured. Or are you under the assumption that someone with appendicitis and no insurance is left to die in the street? ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [June 29, 2012, 7:53pm UTC](https://boards.straightdope.com/t/future-of-health-care-in-america/626604/20 "2012-06-29T19:53:25Z")
> [@oreally](#): > > We citizens will overall get taxed much more heavily … Yep. You figured it out. In some countries the rich chip in to help provide health care to their fellow, but poorer, human beings. In America, we just want to keep them alive long enough to harvest their organs for the benefit of Job Creators. > [@oreally](#): > > … to pay for “free” care for others. Yay. The scare quotes on “free” make me think you almost launched into the _Free isn’t really Free_ explanation third-graders need to give second-graders on Internet comment boards. Thanks for omitting that. What, you decided we’re already at the third-grade level here at the Dope? 😃 [Next page](https://boards.straightdope.com/t/future-of-health-care-in-america/626604.md?page=2)