Problem with healthcare and why Obamacare in principle was a good idea.

Great Debates
1

This is my opinion and I want toe xpress it and see what others have to contradict it with.

The private sector will exploit and make as much money as they want. Right now we have private health insurance companies which compete with each other by LOWERING coverage with the argument of “lower prices for insurance”. What ends up happening is a bunch of people are on insurance plans that don’t cover basic shit, like getting a root canal instead of ur tooth removed.
Obamacare, a public option was suppose to have the Government step in and establish their own healthcare, and standardize coverages. To do so they had to force obamacare on people, so they were technically forced to sign up for it. This meant more people were using the public option so there was more funding from those who aren’t suffering greatly from medical issues to subsidize the costs of those who are.
The idea was the government would step in, start negotiating prices with Hospitals and pharmaceuticals. Because as everyone on this forums should know. The private sector’s main goal is to make money. They don’t want to negotiate prices with treatment options because they will benefit from having prices on care high, so they can increase their insurance costs on these basic coverage.

I don’t see any way you can convince people to want to stop making as much money as possible. So this idea that republicans somehow will help people with their medical expensiveness is absolutely false. It’s self destructive for the economy since most the working class will be forced to go into debt to pay for medical expenses, and as a result have less money in their pockets to put back into the economy. Ultimately increasing the wealth inequality gap, and further adding weight onto the backs of the Americans who pay for the rich’s welfare.

2

Sounds like a bad plan. If a guy liked that plan, would he have been able to keep it?

3

This post reads like it was written in 2008.

Obamacare was supposed to have a public option. The bill that passed Congress lacked a public option. But people call it “Obamacare” anyway.

4

This post was written in 2017.

Whatever you call it. The government trying to increase competition among the private sector (since we want to be so much about laizze fair) is the only way to possibly help the health insurance sector.
As things are going to be. Private sector health insurances will rack up prices while decreasing coverage. Maybe I misspell or mistype but I think my point is clear. If not let me know so I can elaborate.

5

I agree with a lot of your reasoning about how things stand, but I disagree with your conclusion that the ACA was a good idea, even as a fall back position.

It might be an odd simile, but the mess of the current medical system in the United States, reminds me of the antics of Microsoft, back in the late 1990’s. They had already set up the primary operating system for PC’s, as DOS. When they went to “fix” how much of a pain in the you know what DOS was to use, they came up with a layer to put over the top of it, called Windows 3.1. When that proved to be only slightly better, and more was desired, they came up with a replacement veneer, called Windows 95, and later, Windows 98 (actually advertised as a for-full-cost correction of the mistakes they made while rushing 95 to market). When even that was found to be annoying, they tried adding ANOTHER layer to that.

Ultimately, the problem was that the starting point for everything, DOS, was still what was ACTUALLY running the computers. The various Windows layers were just adding an extra bunch of software on top of that.

In the same way, the problem with the American medical system, is that the biggest problems are all caused at the FUNDAMENTAL LEVEL, and have been made worse by decades of “band-aid” fixes. Insurance itself, is one of those “band-aids.” The Insurance"band-aid," did start out helping patients, by paying part of the costs.

But the overall system is inter-reactive, as capitalism always is. Having insurance to pay things, meant among other things, that the natural capitalist pressure on caregivers to reduce costs, was nearly eliminated.

Then things got worse.

Insurance business profits , are all based on the company being able to as accurately as possible, predict how much they will have to likely pay out to customers, so as to set premium prices up that will pay all that, plus cost of doing business, plus profit margin. That meant that the insurance companies needed a MEDICAL expert, who could set standards of how doctors treat patients, in order to make costs predictable. They chose the American Medical Association to do that. The AMA established care guidelines, which were augmented any time a patient sued for malpractice. This is why when you see a doctor, there are always a specific series of tests that you will have to have done, whether the doctor thinks he knows the outcomes already or not.
The AMA also declared how much each procedure should COST TO PERFORM. That caused another “band-aid” to be added on to the multiple layers already in place. This again, was at the behest of the insurance companies, who needed to be able to predict final cost of care for each ailment. The problem was, that the AMA set costs at a fairly minimum level, and so most providers couldn’t charge what they wanted or needed to charge, in order to make a profit themselves; hence they had to increase the price of everything ELSE they provided. Hence high room charges, hence hundreds of dollars for aspirin, and so on.

Thus, the effect of the insurance companies efforts to lower THEIR costs, and raise THEIR profits, directly caused the overall cost of medical care to the PATIENTS to skyrocket.

It seems obvious to me, that continuing to insist on using an INSURANCE MODEL to base care around, will continue rather than defeat this spiral. Especially since the ACA forced insurance companies to offer MORE coverage than they wanted to, and therefore guaranteed that the insurance companies would have to raise rates, rather than lower them. Which they all did. And the idea of competition between insurance companies was further eroded, since they all knew that ALL of them had to offer the same coverage.

The ACA tried to put a band-aid on THAT, by offering Federal money to pay the bulk of the higher premiums, through Medicaid expansion. But the Republicans saw their chance and took it, to sabotage that overall plan, because Medicaid is administered by the States, and the Republican Party controlled many of the state legislatures and governorships. So they acted to prevent the expansion of Medicaid, thus making lots of people hate the ACA, because they suddenly had either huge tax increases (penalties) or even larger medical insurance costs.

What I would like to see, is an idea that rips all the various band-aid levels off, takes apart the defective structure, and replaces it with one designed from the bottom up, to deliver premium health care to everyone, at realistic costs. But the care has to be primary, not the cost levels.

6

People want to make money, but in the health care sector they’ve manipulated the market to stop competition which would drive down prices.

If government wanted to (and neither party wants to do this) they could reform the health care market to drive down prices.

All payer negotiations of insurance companies
Single payer
Outsourcing of care
Public sector negotiations of medical prices
Transparent prices
Comparative effectiveness mandates

etc. But neither party wants to take on a 3 trillion dollar a year industry and force them to start competing and driving down prices.

7

The critical concern is “does the guy actually understand what his plan doesn’t cover and the relative likelihood of his having the various problems it does and doesn’t cover?”

It’s one thing to say “consumers should be free to choose”. It’s another thing to say “businesses should be able to bamboozle customers with BS then overcharge and underdeliver. If they do manage to fool a customer, shame on the customer and hooray for the smart business.”

The less any given product is understandable by consumers, the greater the opportunity for the suppliers to compete not on best product for price, but on most confusing product for price.

Having insurance, whether for health, car, or residence that by law covers everything (or any other fixed list, but I personally prefer everything) ensures that competition happens only on the positive features of quality of service and product for price.

The nice part about that approach it also has the effect of bringing the total cost out in the open. A world full of hidden subsidies in every direction mutes that all important price signal we need to make smart decisions both in business and in politics. Competing for how best to slip the bill under the table to somebody else is a net loser for everyone. Even as it’s a net winner for some few smarty-pants.

We might find a market in this country for cars that have no safety features, but cost a bit less new. We’ve decided collectively we don’t want that option on the market.

Part of the reason we don’t want unsafe cars, and some of us don’t want illusory insurance that doesn’t cover the problems people statistically have, is that somehow society *still *ends up paying for the consequences.

When somebody gets the cancer that’s not covered by the cheapo health insurance, the customer doesn’t just go die for free. Instead Medicaid eventually picks up the tab. Why should that guy be able to socialize his costs? How about we do it more directly by simply having him get the proper cover and have the companies price it honestly.

Letting people free-ride by having useless insurance is the antithesis of the rightist “everyone pay their own way” ethos.

8

There’s several things that are either incorrect, or unsupported. You asked for feedback, so here is mine.

The private sector will not exploit and make as much money as they want. Non-profit entities exist in the private sector, whose goals are usually not to exploit and profit maximize. The phrasing “as they want” is also not true even if they are trying to maximize, they make as much money as they are able.

Private health insurance companies don’t simply compete on price. Some will, but some won’t - they will try to differentiate on service among other things. In addition, the consumers of these plans are often not individuals, they are companies buying group plans. For every company I’ve worked for, they have an incentive to care for their employees, not simply purchase the cheapest thing that is legal.

This is essentially forcing healthy people to pay for less healthy people, right? That seems bad to me.

You don’t see any way to convince people, or to convince Republicans and those you disagree with? Do you have any evidence that most of the working class will be forced to go into medical debt? The idea that this alleged debt and debt service would mean that there would be less money to put back into the economy is also not correct. Debt payments and debt servicing is put back into the economy. It’s not as if these dollars are put under a pillow or burned - it’s spent and the other end of that transaction is receiving a payment. Conflating wealth inequality with any of this seems like throwing unrelated items together.

All in all I’d say the ideas you’ve presented are unorganized, only loosely based on facts, and without a coherent message.

9

That’s a very long answer to a very short question, and yet I’m still not 100% sure of what it is. So, help me out, here: if someone likes having one of those policies, would you tell him he can keep it, or would you tell him he can’t?

10

My belief is that if he has a policy with a gaping hole in it, like it doesn’t cover cancer, then no he can’t keep it. He has to get one with cancer coverage. Why? Because if he isn’t paying for his cancer coverage, you and I are. Like it or not we already have socialized medicine for the big expensive problems.

Let’s make that explicit and get everybody to pay for the coverage they’re going to consume when they get sick. Not just for the coverage for the exceptionally good health they hope they’ll have.

11

You know Jonathon Chance, right?

12

Maybe UHC will come when there’s an accelerationist reaction to the GOP dismantling Obamacare with such glee. See? The centrist liberals were actually playing their own version of 36D Parcheesi.

That’s how insurance works. The people who don’t need it pay for the people who do.

13

Competition isn’t going to drive down prices. Health care isn’t a normal consumer market. By its nature, people by and large simply aren’t going to shop around for health care services/procedures. People sometimes shop around for a primary physician that they like. But when their doctor orders lab tests (for example), they’re going to go to the lab onsite or the one their physician is connected to. Nobody wants to get a note from their doctor saying they need X tests, and then call around to 6 different hospitals/labs to see who will give them the best deal.

14

Price shopping for pharmaceuticals is fairly easy online (although US domestic pharmacies mostly still hide their prices). As far as lab tests, I’ve gotten lab tests done in small independent labs that cost me a fraction of what it would’ve cost me to have them done in a hospital.

Granted, to my knowledge none of the other OECD nations that cover everyone with high quality health care for 8-12% of GDP require their patients to compare costs for medical goods and services. I could be wrong. But either way, our system is so screwed up that an incentive like that (combined with reimbursing the patient with lower premiums or lower deductibles) is something we could use.

15

Not really, no. Otherwise these companies would be able to select and force the best risks to be part of their pools. But no, typically other insurance markets will charge a premium commensurate with the risk they are taking on. In the case of health care, the costs are so high in certain circumstances that they couldn’t collect the premium necessary to cover the risk. Do you think that’s the way other insurance works?

If you’re a poor driver, when you go to get a policy you will be grouped with other similarly poor drivers and everyone will pay an elevated premium to cover the risk. With the ACA, it’s like the poor drivers aren’t able to pay the premium necessary to cover the risk, so the insurance company lobbies the government to force other low risk drivers into the pool to make up the difference.

16

As far as I understand Obamacare, it mandates buying insurance from a private insurer. That is the opposite of what you are describing.

You are describing something like a Beveridge or NI healthcare system, while Obamacare seems a move in the direction of a Bismarck style system.

17

Or me! Had the typical “American health problems”; Type 2 diabetes, high blood pressure, all things that can can be treated with relatively cheap, relatively old, pharmaceuticals. Fast forward to the beginning of November and I go to the emergency room 'cause I’m having trouble swallowing. Seventeen days later, seventeen, I’m discharged after spending most of my hospital visit in the MICU; anesthetized, intubated, on a respirator, with my new pal Myasthenia Gravis. I, easily, doubled or tripled (if not more) my lifetime heath care costs. I don’t want to think about what this would have cost me if I didn’t have insurance but I’m certain I would never be able to pay the bill.
I shudder to think about what the outcome would have been if it was 1917 instead of 2017. :frowning: <dead guy smiley

It isn’t “healthy” people paying for the “sick”, it’s pre-paying for services that you really, really, don’t ever want to actually need . . . but probably will.

CMC fnord!

18

Health care is not a growth business. Once everyone in the nation has health insurance, all you can do is break into other types of insurance. Once the market is saturated with all of the other kinds of insurance, there’s no where else to go (you can’t move to foreign markets, since those are all government-run) soo al you can do is try to get a larger slice of the pie in the domestic market, by lowering your costs and reducing your profit margin.

Insurance has one of the lowest profit margins, as an industry, in the US. You can look it up.

Your premise is false.

Health care is expensive in the US because employers hand it out like candy to employees, without doing a cost-benefit analysis. Employees simply want more moreness to consider working for the employer, and the employer wants the best employee that they can afford, and they get a tax reduction for offering money via health insurance - so it’s to their benefit to offer money to the employee in this fashion.

There’s no market force to push downwards in this particular system, while there is in the insurance industry itself.

If health care was migrated from being a perk of employment to being something that one purchases individually, the cost of health care, across the nation, would likely half over the course of the next decade (ignoring inflation).

On the other hand, this would probably negatively affect medical research, since most of the excess money that Americans spend on health care goes into the purchase of drugs (which cost double in the US what they cost elsewhere) and modern machinery (CAT scans, etc.) These provide medical supplies and pharmaceuticals companies with the money they need to work on next generation technologies. At the moment, the better equipment (CAT scans, etc.) don’t provide a sufficient advantage to offset the impact of American obesity, and so the US still has a reduced average lifespan compared to Europe. But eventually we will discover technologies that do earn their keep. But if the US stops paying for these useless, future tech solutions, then the market for them will collapse since no other country in the world is paying for them on the basis that the cost isn’t offset by return on years of life saved, and progress in medicine will slow down. It will take longer to discover technologies that would put a significant number of years of life back into the system.

Lowering health care costs in the US will also mean looking for ways to get the rest of the world to invest in medical future-tech, rather than simply running cost-effectiveness calculations and haggling for the lowest bid.

Allowing pharmaceutical companies to extend their patent on a drug equivalent to the time elapsed while going through mandatory safety testing would be one thing that could be done. But more than that will be necessary.

19

The cost of developing new drugs is … exaggerated.

Examine this pie-chart. Drug companies spend almost twice as much on Sales and Marketing as they spend on R & D. (And some of that “R & D” is paying doctors to do “research” by prescribing certain drugs.) Drug companies’ Profit also exceeds their R & D cost, as does ‘Other.’ (I don’t know how ‘Other’ breaks out but Leonard S. Schleifer, CEO of Regeneron Pharmaceuticals, earned over $47 million in 2015 and many other Pharma executives had eight-digit earnings.

20

This is why the patent system needs to be revised. It can take 20 years to run all of the tests to bring a molecule to market, by which time the patent will have expired.

To make any money, the companies either need to sell OTC medicines (like aspirin) and dump a bunch of money into convincing the general public that their version is somehow more amazing than anyone else’s, or they have to take two things that they’ve previously tested as safe, put them together, and sell that as something new and wonderful. All of which is a waste of resources.

The patent system is supposed to make it profitable for a company to invent new technologies. Without it, or without it functioning in a reasonable manner, it ends up leaving all of the people who chose a career in saving lives having to figure out how to squeeze extra dollars out of the general public using the same strategies as Coca-Cola.