Why so much fuss over Obamacare?

[Mxylplyx]

People in the US act as if government run healthcare is some kind of theoretical exercise that has not been proven effective in the real world. There's templates on how to create a national system all over the western world. We could just walk across the northern border and ask them. For some reason healthcare executives extorting a large percentage of our healthcare dollars through obscene profit margins and overcharging is much more palatable to Americans than even a fraction of those dollars being lost to government waste or inefficiency. I guess private enterprise raping the system all in the name of capitalism is the American way. I've never understood why that is. The ACA is certainly not perfect, as it had to be hacked to death from it's original design to make way for profiteers. My only hope is that once it becomes law, and healthcare becomes seen as a right instead of a privilege, and trust me IT WILL, there will be good faith efforts to make it better. Mark my words, we will eventually get to a universal health system like the rest of the civilized world. We might have to go bankrupt first before wising up, but it's coming.

 

[AViking]

live birth does not have a consistent definition and there are plenty of places where it isn't tracked all that well.

Infant mortality has a precise definition and the two places that I have used as an example (USA and Sweden) are pretty capable of counting these things on an even playing field. However this is from wikipedia and is probably what you are referring to:

The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. Many countries, including the United States, Sweden and Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[33] which are used throughout the European Union.[34] However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[35][36][37] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.

 

[Juddog]

People in the US act as if government run healthcare is some kind of theoretical exercise that has not been proven effective in the real world. There's templates on how to create a national system all over the western world. We could just walk across the northern border and ask them. For some reason healthcare executives extorting a large percentage of our healthcare dollars through obscene profit margins and overcharging is much more palatable to Americans than even a fraction of those dollars being lost to government waste or inefficiency. I guess private enterprise raping the system all in the name of capitalism is the American way. I've never understood why that is. The ACA is certainly not perfect, as it had to be hacked to death from it's original design to make way for profiteers. My only hope is that once it becomes law, and healthcare becomes seen as a right instead of a privilege, and trust me IT WILL, there will be good faith efforts to make it better. Mark my words, we will eventually get to a universal health system like the rest of the civilized world. We might have to go bankrupt first before wising up, but it's coming.

The people in America I know all say the Canadian system sucks because of the "horrible wait times", but the actual people in Canada I know personally all say it's great and haven't had issues with it. So you have to wait a half year for a knee replacement - big deal. It's not like you need a new knee more than twice a year, and the individual cost to employers and employees alike in the US for healthcare insurance is straight up ridiculous.

I'd rather wait a half year for a knee replacement (my left knee is shot and my health insurance doesn't cover it right now anyways), than deal with the current US healthcare system. Every time I've had to go to a hospital and wait in an emergency room for an actual emergency, it was crowded as hell and half the people didn't have actual emergencies.

 

[OGOC]

This is another part of our culture that is a problem. We are all led to believe that anything the government does is wasteful. Now in many ways this IS true, so don't misunderstand me, but the point doesn't end there. It goes "The government wastes our money and a free market capitalist society is better". Something like that. So we deregulate. We make everything free market and for massive profits.

What are we left with. Well the necessities like healthcare and education are becoming so expensive and are already unaffordable for many. We have a housing bubble. We have a bank crisis and are currently still in a giant recession and the worst economic period since the great depression.

But the U.S. doesn't have a free market, nor does it have capitalism. It has crony capitalism with a crony government with too much power using that power to pick winners and losers.

The housing bubble wouldn't have happened in a free market. Even if it somehow did, the losers would have been allowed to fail like they deserve.

Free markets don't have Federal Reserves manipulating interest rates low year after year which encourages risky investment and bubbles. They don't have Federal Reserves secretly loaning out trillions of dollars to prop up banks including foreign banks. They don't have Federal Reserves claiming to promote lending while paying banks to park their money. They don't have $700 billion dollar bailouts that are basically just a roundabout way to bailout and pay Goldman Sachs 100 cents on the dollar on their failed investments.

There's often a big disparity between employee healthcare and individual healthcare. Healthcare got linked to employment in large part because the government implemented wage controls. Government messes with the free market and winds up manipulating and distorting the market and then says we need more government manipulation to fix problems they caused.

Obamacare might be worth the bother if it actually was designed to lower costs. But it's not. Maybe at first it was, but it's not anymore. All it mainly does now is force everyone to become a guaranteed customer of the insurance industry.

There are some medical places in the U.S. that are trying to bring prices down by posting prices to increase competition and eliminating middlemen.
http://okc.biz/oklahoma/article-6019-there-is-a-way-to-lower-health-care-costs.html

Prior to Medicare, the cost of hospital care was affordable for all but the extremely poor.

What happened? Medicare happened. Physicians wanted nothing to do with this scheme in the early days of the program, so to sweeten the pot, the federal government offered to pay whatever the physicians wanted to charge.

As a result, the “someone else is paying for it” effect took over.

With only a portion of the financial burden of health-related expense borne by the patient, demand skyrocketed, and health insurance was born. Health insurance became necessary for everyone, due to the intervention of the federal government in the health care market. The result has been massive price increases.

The argument that “the free market has failed us in health care and that’s why we are where we are” is laughable.

What has happened, for instance, to the price of plastic surgery or Lasik surgery? The quality of care in these particular fields continues to improve, and the price continues to fall.

 

[woolfe9998]

Obamacare might be worth the bother if it actually was designed to lower costs. But it's not. Maybe at first it was, but it's not anymore. All it mainly does now is force everyone to become a guaranteed customer of the insurance industry.

No, what the ACA really does is get almost everyone insured. The mechanism is immaterial in the longrun. With everyone insured, we will never go back to having 40,000,000 uninsured. And if the high costs are not sustainable because the ACA doesn't do enough to lower them, at some point we will have no choice but to move toward a single payer system.

 

[rockyct]

No, what the ACA really does is get almost everyone insured. The mechanism is immaterial in the longrun. With everyone insured, we will never go back to having 40,000,000 uninsured. And if the high costs are not sustainable because the ACA doesn't do enough to lower them, at some point we will have no choice but to move toward a single payer system.

I think we basically have a feedback loop right now where the uninsured are driving up costs for hospitals which have to pass on the costs as a $40 dose of Tylenol to those who are insured. Ultimately premiums go up because of this so insurance becomes unaffordable for more people.

If we get something like 80-90% of our country insured, we can at least get out of that feedback loop. Part of the ACA is that 80-85% of a group's premiums has to go directly into medical care and health care improvement. If it doesn't, they have to issue rebate checks. It's not perfect but at least it tries to limit how much insurance companies can make off each person. Of course, since insurance companies will be getting more customers, their costs should be easier to spread out.

 

[woolfe9998]

I think we basically have a feedback loop right now where the uninsured are driving up costs for hospitals which have to pass on the costs as a $40 dose of Tylenol to those who are insured. Ultimately premiums go up because of this so insurance becomes unaffordable for more people.

If we get something like 80-90% of our country insured, we can at least get out of that feedback loop. Part of the ACA is that 80-85% of a group's premiums has to go directly into medical care and health care improvement. If it doesn't, they have to issue rebate checks. It's not perfect but at least it tries to limit how much insurance companies can make off each person. Of course, since insurance companies will be getting more customers, their costs should be easier to spread out.

I actually understand that perfectly well. Bringing everyone into the system will have a tendency to reduce costs. However, there are regulations on insurance which can have the counter-veiling effect of increasing them. I'm not sure how it all shakes out. We need about two years of data to make a decent assessment. However, my sense is that the net effect isn't going to large one way or another. I hope I'm wrong and that it works better, but I doubt it.

ACA would have been a lot stronger if it had included a public option that is efficient and relatively cheap like Medicare, to compete with private insurance on the exchanges. It would have been a middle ground between how it ended up and single payer, and it would likely have done more to lower costs.

 

[AViking]

You have a really simple economic indicator. Cost. If in 5 years we're spending less than 17% of GDP we're doing good. Then you can start looking at profit margins. You need to get premiums down to a reasonable level.

Odds are you will find that costs to the government go down, everyone gets insured, but insurance companies are still trying to fleece Americans with giant inflated healthcare costs. There's no reason we should pay high premiums so that health providers can make 500% what they would make in Canada or Europe. At that point you go single payer and tell the insurance companies to go fuck themselves.

 

[Gunslinger08]

You have a really simple economic indicator. Cost. If in 5 years we're spending less than 17% of GDP we're doing good. Then you can start looking at profit margins. You need to get premiums down to a reasonable level.

Odds are you will find that costs to the government go down, everyone gets insured, but insurance companies are still trying to fleece Americans with giant inflated healthcare costs. There's no reason we should pay high premiums so that health providers can make 500% what they would make in Canada or Europe. At that point you go single payer and tell the insurance companies to go fuck themselves.

It's my understanding that ACA essentially limits profits by instituting a max "profit" of 15-20% on your premiums. 80-85% of your premiums HAVE to be spent on medical care and you receive a rebate if they are not.

Really the problem isn't premiums. They are a symptom of incredibly high healthcare spending. The only thing that's going to bring that down is government mandated fixed prices, similar to Medicare; or rationing. I have a feeling that both of these things will eventually be implemented, along with a single payer system. Will this be better than what we have now? It depends on your station in life. If you can currently afford good insurance, the changes will be worse. You will receive fewer automatic diagnostic tests, wait longer for appointments and procedures, and potentially be denied medication/procedures if they aren't deemed necessary by a government board. If you can't currently afford good/any insurance, the changes will be better. You will get the medical care that you need to live a mostly normal life.

 

[woolfe9998]

It's my understanding that ACA essentially limits profits by instituting a max "profit" of 15-20% on your premiums. 80-85% of your premiums HAVE to be spent on medical care and you receive a rebate if they are not.

Point of clarification. The 80-85% must be spent directly on healthcare. The remaining 15-20% is for profit AND overhead, administrative costs, salaries, etc. In practice, it actually allows a profit margin smaller than 15-20%. It's probably closer to 5-10%.

 

[Gunslinger08]

Point of clarification. The 80-85% must be spent directly on healthcare. The remaining 15-20% is for profit AND overhead, administrative costs, salaries, etc. In practice, it actually allows a profit margin smaller than 15-20%. It's probably closer to 5-10%.

Yeah, I'd be surprised if any of the companies have a margin above 10%, unless they're running a barebones operation. That just drives the point home further - you aren't being ruined financially by high/unaffordable premiums; it is the high cost of healthcare in this country that's causing the issue.

 

[OGOC]

No, what the ACA really does is get almost everyone insured. The mechanism is immaterial in the longrun.

"The mechanism is immaterial in the longrun."

Wow. Hardly!
That reminds me of another saying: "The end justifies the means."
No, it does not justify the means.

Places such as the surgery center I posted have been lowering costs despite government trying to stop them, but no one wants to talk about places like that.

People will yell at the top of their lungs for "affordable healthcare" and call others terrorists and extremists who don't agree with their way of going about it, yet those same people yelling for affordability don't want to talk about places that are already lowering prices and making things transparent despite a non-free market working against them.

 

[Juddog]

"The mechanism is immaterial in the longrun."

Wow. Hardly!
That reminds me of another saying: "The end justifies the means."
No, it does not justify the means.

Places such as the surgery center I posted have been lowering costs despite government trying to stop them, but no one wants to talk about places like that.

People will yell at the top of their lungs for "affordable healthcare" and call others terrorists and extremists who don't agree with their way of going about it, yet those same people yelling for affordability don't want to talk about places that are already lowering prices and making things transparent despite a non-free market working against them.

-- edit -- reading link now that you posted.

-- edit 2 -- I agree that transparency from the medical facility performing the operation is a great first step; given that the hospitals charge so much though I have to wonder how they can end up going out of business?

 

[OGOC]

You have a really simple economic indicator. Cost. If in 5 years we're spending less than 17% of GDP we're doing good.

You can't go by GDP since GDP is a manipulated indicator. GDP counts government spending but not debt. Not a very good way to compare costs.

 

[woolfe9998]

Yeah, I'd be surprised if any of the companies have a margin above 10%, unless they're running a barebones operation. That just drives the point home further - you aren't being ruined financially by high/unaffordable premiums; it is the high cost of healthcare in this country that's causing the issue.

Well yes, it's more about the cost of the care than the profit margins of the insurance carriers. But the missing piece is the expensive bureaucracy in the system. In any system involving more than one payer, doctors and hospitals must generate bills. These bills are then reviewed by the various public and private insurers. A typical hospital employs about 50 people just to do the billing. The insurers employ their own people to review the bills.

This bureaucracy is about 15-20% of the total cost of care and premiums. With a single payer, the single payer simply reimburses the providers for their costs. The bureaucracy is substantially reduced. That savings is incurred without even lowering doctor salaries, or the amounts paid for drugs and medical equipment. If you want more savings, then the government payer has to control these costs, but substantial savings are enjoyed in diminished bureaucracy just by switching to a single payer.

 

[Gunslinger08]

Well yes, it's more about the cost of the care than the profit margins of the insurance carriers. But the missing piece is the expensive bureaucracy in the system. In any system involving more than one payer, doctors and hospitals must generate bills. These bills are then reviewed by the various public and private insurers. A typical hospital employs about 50 people just to do the billing. The insurers employ their own people to review the bills.

This bureaucracy is about 15-20% of the total cost of care and premiums. With a single payer, the single payer simply reimburses the providers for their costs. The bureaucracy is substantially reduced. That savings is incurred without even lowering doctor salaries, or the amounts paid for drugs and medical equipment. If you want more savings, then the government payer has to control these costs, but substantial savings are enjoyed in diminished bureaucracy just by switching to a single payer.

Yeah, there will be savings with a single payer system. A negative effect - those savings = some of those people are going to lose their jobs, along with a vast majority of the works in private insurance companies. A lot of them should be able to find new government jobs for the significant expansion of (I assume) Medicare to cover everyone.

The thing I'm not sure about is the increase of healthcare spending per capita in America. That doesn't seem like it's increasing every year due to insurance billing costs and it's increasing faster than inflation. How do we control cost growth?

 

[woolfe9998]

Yeah, there will be savings with a single payer system. A negative effect - those savings = some of those people are going to lose their jobs, along with a vast majority of the works in private insurance companies. A lot of them should be able to find new government jobs for the significant expansion of (I assume) Medicare to cover everyone.

The thing I'm not sure about is the increase of healthcare spending per capita in America. That doesn't seem like it's increasing every year due to insurance billing costs and it's increasing faster than inflation. How do we control cost growth?

How do we control costs without going single payer, or how are cost controlled in a single payer system? If we're talking single payer, in addition to the savings from reduced bureaucracy, since the government pays all the bills for the doctors and hospitals, they set caps on salaries, how much is paid for drugs and equipment, etc. In short, it's done with price/cost controls.

As to the medical bureaucrats losing their jobs, yes some fraction will find government jobs. Obviously not all of them because then there wouldn't be any savings. However, the lower healthcare costs at least partially inure to private employers, who in some cases can use the savings to hire more people or pay existing employees more.

 

[nickbits]

The people in America I know all say the Canadian system sucks because of the "horrible wait times", but the actual people in Canada I know personally all say it's great and haven't had issues with it. So you have to wait a half year for a knee replacement - big deal. It's not like you need a new knee more than twice a year, and the individual cost to employers and employees alike in the US for healthcare insurance is straight up ridiculous.

I'd rather wait a half year for a knee replacement (my left knee is shot and my health insurance doesn't cover it right now anyways), than deal with the current US healthcare system. Every time I've had to go to a hospital and wait in an emergency room for an actual emergency, it was crowded as hell and half the people didn't have actual emergencies.

The people in Canada you know must be either healthy or really sick. For anyone stuck in between those extremes, it sucks. Plus their system is underfunded, many don't have a PCP, and the sales tax is about 13%, top income tax bracket is about 50%, and you don't need to be making millions to hit it.
I'd rather deal with the US system and have good access to health care for myself than have mediocre care for everyone.

 

[Gunslinger08]

How do we control costs without going single payer, or how are cost controlled in a single payer system? If we're talking single payer, in addition to the savings from reduced bureaucracy, since the government pays all the bills for the doctors and hospitals, they set caps on salaries, how much is paid for drugs and equipment, etc. In short, it's done with price/cost controls.

So essentially doctors will have a government mandated maximum salary based on specialty and the number of patients they can see? Will we also have to create a new program for medical school student loans? Maybe include them in the public service programs that pay off 100% of your loans after 5-10 years of service? Will drug companies have as much money to do research, or will that require increased federal funding as well?

As an aside, I don't know many people from countries with single payer systems. The one English family that I know were not happy with their healthcare before moving to the US. I'd be interested in a large scale study on the opinions of ex-pats moving from UHC countries to the US.

 

[woolfe9998]

So essentially doctors will have a government mandated maximum salary based on specialty and the number of patients they can see?

That's probably about right. There is no choice but to control wages with a single payer system. The government payer is literally paying the doctor's salaries. If there was no wage control, the hospitals could pay their doctors $10 million/yr then have the government reimburse them for it.

The question is at what level are these controlled wages? We could, for example, cap them at whatever they are currently on average, with an inflation increase every year, in which case they continue to make approximately the same pay. Or we could do what they do in Canada, which is to pay their doctors about half of what we do here. They save more money that way, but there are consequences.

Will we also have to create a new program for medical school student loans? Maybe include them in the public service programs that pay off 100% of your loans after 5-10 years of service?

Possibly. I think we need more medical schools and/or to expand the capacity of existing ones. This I think we need with or without single payer.

Will drug companies have as much money to do research, or will that require increased federal funding as well?

We could keep allowing them to charge whatever they currently charge, in which case, as with doctor's salaries, we won't save as much money.

Or we can ditch the patent system and have government fund the research and provide large cash rewards to the companies who create new drugs with legitimate medical value.

As an aside, I don't know many people from countries with single payer systems. The one English family that I know were not happy with their healthcare before moving to the US. I'd be interested in a large scale study on the opinions of ex-pats moving from UHC countries to the US.

I haven't seen polling data that measures people who moved from one to the other. I can offer only the anecdote of a buddy of mine (formerly a conservative) who moved from Ohio to Canada and loves the health care system there.

There is, however, this:

http://www.gallup.com/poll/122393/oecd-countries-universal-healthcare-gets-high-marks.aspx

 

[rockyct]

The people in Canada you know must be either healthy or really sick. For anyone stuck in between those extremes, it sucks. Plus their system is underfunded, many don't have a PCP, and the sales tax is about 13%, top income tax bracket is about 50%, and you don't need to be making millions to hit it.
I'd rather deal with the US system and have good access to health care for myself than have mediocre care for everyone.

My relatives have nothing but praise for their system and they're a mix of ages from about 20 to 85. Of course, they hear about the horrors of the American medical system with families forcing to mortgage their home to pay for medical bills or people without insurance going bankrupt because they couldn't afford it in the first place. They are pretty worried when they come here and visit (which is about once a year) so they buy some expensive travel insurance or something. There only complaint is that they wish there was better private supplemental insurance where if they wanted to bypass the wait for some procedures.

I don't think they believe their system to be perfect, but there would probably be rioting if their single payer system was removed even if it meant taxes went down. Some of it may be the FUD they hear about our system but they are pretty happy with theirs. A few of them were almost upset with how "heartless" they viewed our system as.

 

[Juddog]

The people in Canada you know must be either healthy or really sick. For anyone stuck in between those extremes, it sucks. Plus their system is underfunded, many don't have a PCP, and the sales tax is about 13%, top income tax bracket is about 50%, and you don't need to be making millions to hit it.
I'd rather deal with the US system and have good access to health care for myself than have mediocre care for everyone.

Yes every Canadian friend I have must be nuts, to love their free healthcare system where they don't have to worry about going bankrupt if they go to the hospital without insurance.

There is the reality of it (the people I know who actually live in Canada and have experienced the US system) and there is the Fox News spin on it (people I know in the states, that say everybody from Canada travels to the US for an operation because it sucks up there); only one of them is first hand, and the first hand experience tells a different tale.

 

[AViking]

Definitely a disconnect between reality and fantasy when it comes to foreign healthcare. Reality is that these terrible socialist healthcare systems in other countries are pretty good, everyone has access, and they're affordable. Health statistics are better in these countries as well.

You can see in one of the arguments above the often repeated about how they pay more in taxes and the healthcare sucks. Well the high healthcare costs in the US are a "tax" and healthcare does not suck in other countries.

Also, where is the 50% tax rate in Canada from? I'm pretty sure their top tax bracket is less than the one in the US. The US has a top federal tax bracket of 40% which in combination with a state like CA reaches a 50% tax bracket.

 

[Dude111]

He's saying that many here are living paycheck to paycheck. Waiving the magic Obamacare wand doesn't entail people getting a raise.

No and some people DO STILL PREFER THIER PRIVACY!!

 

[EagleKeeper]

Others do not like being foced into doing something