[quote=“David49, post:31, topic:58553, full:true”]
Why didn’t this happen before the ACA, if it’s just a matter of “free markets?” Seriously, I am so confused by this argument.
[/quote]Is it your view that the markets were “free”, or more so before the ACA?
Are you willing to give up your CGM, or pay out of pocket for it, to have Universal Health Care?
I am willing, in a heartbeat, to pay out of pocket for it if it means other people get their cancer treatment. Also, FYI, Medicare is changing its policy and is now covering them.
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Maybe it is time to throw an amusing, well not so amusing for me anecdote about how “efficient” government can be. Since healthcare is so near and dear to all of ourselves and our loved ones health, perhaps a current story about my mortgage will be helpful at enlightening why single payer isn’t the best idea. I am currently self-employed, and trying to refinance my house. Since I haven’t been self-employed long enough, I needed to use my VA benefit to get approved for this loan. Should be a no-brainier since I was in the reserves for 11 consecutive years through a couple of wars.
Well, I was denied because one form in my electronic file was incorrect. Even though all of the evidence was also in that electronic file to approve me, they ignored that, found the reason to disqualify me, and denied me the benefit. They told me I needed to appeal their decision. So I appealed it, then I called and asked if they had acted on my appeal after 3 weeks. The federal employee laughed at me, and told me they would get to it in 6-9 months, if I was lucky. Then I called another office and asked if they could look at my file, and they told me that indeed I would probably qualify, they couldn’t actually say I would qualify because that just wouldn’t be right to say another employee had done something wrong, but in any event, their hands were tied and they couldn’t intervene because I was in an appeal status.
Following all of this, I have worked with two undersecretary’s offices and a veteran’s advocacy group to pressure the original office to make a decision. Guess how well this has worked. You guessed it, no approval 2.5 months after applying for a slam dunk decision.
And we want this system in charge of our healthcare…
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What state do you live in? When I was in Washington state I found all my interactions with government bureaucracy to be surprisingly pleasant. Not so in Texas. I found my interactions with my public schools, from K - post-grad, to be unfailingly positive.
Man that sounds awful.
That’s on par with every interaction I have ever had with the federal government. And there have been many for my job.
No doubt state and local governments can at times be reasonable. The federal government much less-so in my life’s experience
It is not fun, at least it is for something that isn’t life altering. If I don’t get the mortgage refinanced, I will still be able to live, just with a little less money in my pocket. My dealings with state government’s has been mixed, good in some states, less so in others. But, my dealings with the federal system have uniformly been like this. Eventually they get the decision right, but you often have to push pretty hard, and wait for enough time to elapse for it to get worked out. Both things which aren’t great in healthcare.
It’s pretty simple: I have lived in countries with “socialized” healthcare and received much greater healthcare for little to no cost than I have received in the US. I do trust government to deliver on certain services that private, “free” markets have proven to be ill-structured to deal with effectively and fairly. Will it be a perfect system with no waste, no cost, and no error? Of course not. Such a thing is not achievable.
However, I trust the idea of regulation and collective action more than I trust the supposed benefits deriving from a profit driven healthcare industry. I do not trust the people we just elected (Trump, GOP congress) to do anything other than favor the very wealthy and corporate profits. I believe that is the impetus for repealing the ACA, for their stated intention to deregulate pharmaceutical and insurance industries, and that they care more about power and profit than they do about the wellbeing of average Americans.
That is also based in experience. I have lived in places with socialized medicine and seen the benefits. I’ve lived in places with private, insurance-driven healthcare systems and seen the costs. My experience says the GOP is only interested in the welfare of the richest, most powerful people and corporations in this country. I have zero faith in US political parties to “do the right thing,” while I have great faith in government bureaucracies to do the right thing, albeit inefficiently and with mistakes. That’s what my experience says.
Perfectly fine for you to disagree with me, but do realize I’m not talking from some theoretical perspective. I’ve lived a good, long life with quite a bit of experience in different places and different systems. I am very educated, and have spent most of my adult life engaged in thinking (and acting) on these issues. I have a set of values that I hold dear, that are quite different, I suspect, from yours. It’s perfectly fine to disagree, but don’t dismiss.
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@Chris72, I know my dad is on Medicare and both my grandparents were and they seem to like it pretty well. So I suspect it really does depend on what federal service you’re getting.
What an awful, but unfortunately unsurprising experience:(
I really feel for you, and hope that you are able to make it through.
I also think that we should not confuse universal health care with government-managed health. Speaking for myself - I have a deep dislike of big government and do not believe that a governmental agency can run anything efficiently on its own, without strong counterbalances and market-driven initiative.
But the prinicple of health care for all does not require the government to run it. I am and always will be a proponent of universal health care, because it is the RIGHT thing. But I don’t believe that having the government run it is the right thing. These are two different things.
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Well if you can find a different mechanism I’d be all ears
Yes, absolutely. They were “more free,” in the sense of less regulated with fewer mandates, than after the passage of the ACA. The ACA added some very specific regulations to how private insurance could make decisions about who is covered, what services are delivered, and under what conditions a patient should be dropped.
To my mind, the ACA is “failing” (to control cost) for a very simple reason: at the same time Congress passed a bill requiring coverage of pre-existing conditions, coverage of dependents until the age of 25, birth control and preventive care, etc., they failed to require price-caps. They instituted two taxes to pay for government subsidies for the poor and middle-class to purchase on the market, but they did nothing to regulate the amount of profit the private insurance companies could make. Additionally, the fact that states were allowed to control Medicare expansion and implementation of insurance markets reduced the effectiveness of the program, thereby failing to reduce actual costs by enrolling more, younger, healthy Americans in insurance systems.
In other words, the ACA is failing because it is not regulated enough. In pre-ACA days, healthcare was even less regulated than it is now. No coverage of pre-existing conditions, lifetime benefit caps, kicking a 24 year old off of insurance, etc. Preventive care (vaccines, checkups, birth control) could be prohibitively expensive, because insurance plans just didn’t cover them. And despite the lack of (relative) regulation, premium, copay, and deductible costs before the ACA were still rising faster than inflation. The insurance companies have been taking advantage of American healthcare consumers for a lot longer than “Obamacare.”
At least that’s my view, and it’s why I believe the quality of healthcare and the number of people covered will decline while the cost will go up with a repeal of the ACA. Our current elected government has no desire to improve anything other than the profits of the big companies (including pharmaceutical and insurance companies). That’s my considered opinion, based in experience.
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Well who else could administer the universal healthcare in the USA besides the completely dysfunctional federal government … let’s see…
They’d have to have excellent record keeping, state of the art communication networks, minimal bureaucratic waste… nice buildings, etc etc
The Mormon church is the only alternative that comes to mind. Can we all get on board with that idea?
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@David49, I’m not sure insurance companies had such high profit margins prior to ACA, and I don’t think ACA is failing! It’s unpopular with some people, but it actually is doing its job in many ways.
The system would work better if a) certain states hadn’t declined to expand Medicaid. b) the financial penalty behind the mandate was too weak. There are too many sick people on the exchanges and too few well people; but I guarantee everyone would sign up for something if the penalty for not doing so was worse. Unpopular and hated though the mandate may be, it is basically the linchpin of the system. and c) perhaps the cost of premiums should be more for older people versus younger people.
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So if we can discriminate against people based on their income (already happening) and their age (your suggestion) how is that different than discriminating based on their health— which is the entire grand concept of this plan to put an end to such practices…
And charging older people who are likely no longer able to work and earn more money a higher rate for their insurance premiums… hmm that seems fair… in the end they’d just have higher rates but also higher subsidies and the people who actually work for a living and are reasonably productive would be forced to carry even more of the weight…
It is the linchpin for any kind of insurance of any kind whatsoever.
You cannot give fire insurance only to those people whose house is already up in smoke.
Let’s think, maybe we can come up with a really simple system that uses all the existing pieces that we know kinda work, and keeps us in a free-market system:
- What if we required everyone to be a part of the insurance pool, since that is the only way to create a low-risk pool, and since you can’t have people become insured when they run into trouble?
- What if we required that all insurance companies accept new members regardless of preexisting conditions?
- What if we let the existing insurance companies manage insurance as they have in the past?
- What if we created a free-market of insurance contracts, in every state, where people are free to pick any contract that is being offered? Since it is like a trading floor, we could even call it an “insurance exchange”?
- what if the only role the government had was that of regulator, like it does with the stock exchange?
This would probably be the best way to remain in a free-market system, with the smallest amount of government intervention, right?
But - oh wait - that is EXACTLY Obamacare!
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@Sam19, Medicare kicks in at 65, most people work until then nowadays.
Also age bracket limits can be bounded in a way that health won’t be. Once you know that, say, someone has cancer, you know the probability that they need expensive care that is 100 times more costly than someone else their age. An insurance company will then tend to charge that person 10 times what they would charge a healthy person of the same age, which is most likely to be unaffordable.
Whereas if you have a mixed pool of people and the 60-year-old pays twice what the 26-year-old does, you still get to pay for that 60-year-old who has cancer, but their costs are spread out over the population. Then when you combine that with information about income, it may be that a poor 60-year-old pays the same as the 26-year-old, even though they’re in a higher risk-tier. (By the way, the age-bracketing proposal is actually a Republican idea in one of their many proposals.)
Look, the insurance system is just a numbers game; you need enough healthy people to subsidize the care of sick people, with the understanding that stuff happens and all of us are subject to the vagaries of random chance. In the current market, the costs are out of whack because not enough healthy people signed up. That’s really the main problem. And how do you get them to sign up? Change the incentives.
Yes, the system will still be too expensive because there is waste going up and down the medical care supply chain and because end of life care in a hospital is enormously expensive. But cutting out those costs requires radically restructuring how hospitals deliver care (and when they do so), how we discover and pay for drugs, and how we incentivize doctors. That, to me, seems like an issue there is no hope of tackling in any potential repeal.
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Wellll… not exactly. If we took those 5 bullet points of reasonable ideas and expanded them into 30,000+ pages of incomprehensible garbage federal regulations as far reaching and irrelevant as defining when pawn shop owners need to issue IRS 1099 forms when they sell a gold coin…
Then we’d have Obamacare. I’d be more than happy to accept the handful of good things about it if it weren’t for the thousands of dysfunctional, overreaching, nonsensical aspects that do absolutely nothing but drive costs up and quality down.