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bdgan

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hawkeyetraveler said:
Yep. If there was a reasonable way to have a truly free market without healthcare fraud I would be all for it. But you know the Snake oil salesmen would go wild. I’m a big free market capitalist in most areas of life. But the reality is healthcare does need some regulation. So the market truly isn’t free and I don’t see how it could be (We already have multi-billion dollar healthcare scams). Imagine what it would be if there was no regulation.

I just don’t see a way out except to essentially offer basic health insurance to everyone and let people buy up to better plans.
Click to expand...
Two thoughts. One is that we don't need government intervene on the quality of items we purchase on Amazon. We look at all the customer reviews then make our own decisions. Of course I understand that a bad doctor can cause more damage than a bad cell phone or toy.

I agree with the idea of basic insurance with the option to buy up but I don't think much of the public or congress would accept it. There's a feeling that everybody deserves the same healthcare regardless of cost.
 
FLaw47

FLaw47

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bdgan said:
My original comment acknowledged that more people are covered (mostly Medicaid) and more preventative things are required to be covered. I didn't spell out things like annual physical or colonoscopy but I thought that was covered under "preventative". No, I don't think there's evidence that the forced inclusion of preventative items has saved money and lowered premiums.

You'll think these two stories are totally unrelated but here goes:
  • Many years ago new cars were sold with only a 12 month, 12,000 mile warranty. My state passed a law that required new cars to have a minimum 18 month, 20,000 mile warranty in order to "protect consumers". I looked at the sticker price of the car and it included an add on option of a few hundred dollars for the state mandated warranty. My point is that the state didn't protect me. They just forced me to purchase an extended warranty.
  • Biden's Inflation Reduction Act addressed the Rx donut hole by limiting out of pocket drug costs to $2,000. I assume the goal was to protect consumers from higher drug costs. When my insurance renewal came the out of pocket Rx max for the next year was reduced to $2,000 but my deductible for Eliquis went from $200 to $450. The point is I don't think the federal government protected me. They just squeezed the balloon and pushed the cost elsewhere.
Click to expand...

Of course forcing more things to be covered would make things more expensive, I don't know what rational person would dispute that (though free preventatives should help drive down long term costs, in theory).

I'm going to include the essential benefits below, because I don't think we're talking about the same things, and stress that individual insurers were allowed to no cover you if you were already sick. So my diabetic buddy would simply not have been able to have health insurance if he couldn't get a group plan.

  • Hospitalization
  • Ambulatory services (visits to doctors and other healthcare professionals and outpatient hospital care)
  • Emergency services
  • Maternity and newborn care
  • Mental health and substance abuse treatment
  • Prescription drugs (including brand-name drugs and specialty drugs)
  • Lab work
  • Preventive care services recommended by the U.S. Preventive Services Task Force (USPSTF), the Health Resources and Services Administration (HRSA), and the CDC's Advisory Committee on Immunization Practices (ACIP). This amounts to a fairly extensive list of services,1 including things like contraception, blood pressure screening, breast cancer screening, colorectal cancer screening, obesity screening and counseling, tobacco use counseling and interventions, and breastfeeding counseling. It also includes recommended vaccines, including COVID vaccines. But not all preventive services are covered, so it’s important to understand how this works before scheduling a checkup. And some services — such as mammography and colonoscopy — are fully paid for by insurance if they’re done as preventive care in an asymptomatic person, but will require normal cost-sharing if they’re done for diagnostic reasons, such as investigating a lump that you or your doctor found.
  • Pediatric dental and vision care (there is some flexibility on the inclusion of pediatric dental if the plan is purchased within the exchange)
  • Rehabilitative and habilitative services
So to connect the dots, insurance before could have just been like "yeah no you're on your own if you go to a hospital" That would have obviously been cheaper but it'd have been pretty useless insurance. And, while I don't enjoy being that guy, I think the average American has demonstrated again (and again) that they can't be trusted to make informed decisions on this topic on their own - they need some baked in protection.
 
FLaw47

FLaw47

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bdgan said:
Two thoughts. One is that we don't need government intervene on the quality of items we purchase on Amazon. We look at all the customer reviews then make our own decisions. Of course I understand that a bad doctor can cause more damage than a bad cell phone or toy.

I agree with the idea of basic insurance with the option to buy up but I don't think much of the public or congress would accept it. There's a feeling that everybody deserves the same healthcare regardless of cost.
Click to expand...

Well there's also the fact that you don't have time to doctor shop when you're getting rushed to the ER unconscious. You might just wake up with a bill.
 
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tarheelbybirth1

tarheelbybirth1

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bdgan said:
  • It was supposed to get more people insured. That definitely happened because Medicaid was greatly expanded.
Click to expand...
Twenty-one million Americans get their insurance via state ACA marketplaces. My youngest son is one of them. He works for a small company that doesn't offer health insurance and getting it privately would be impossible. In fact, fewer than half of those covered under the ACA get their insurance through Medicaid... the rest get theirs through the state marketplaces. And millions will lose their Medicaid coverage thanks to GOP budget cuts.

bdgan said:
  • It was supposed to lower costs for the average family by $2,500. No mixed bag there. Costs have continued to increase at higher and higher rates. I recall two parts of the cost reduction plan. One was non profit government subsidized co-ops that would compete with insurers. Every single one of them failed. The other was that more people covered and preventative care covered would make people healthier and require less expensive treatments in the future. I don't think there's much evidence of that happening.
Click to expand...
No, it did not lower costs overall... however...

Fact Check: Have healthcare costs risen faster since the Affordable Care Act was passed? | Econofact​

By Keshav Srikant·April 22, 2025

No​

While health care costs have continued to increase since President Obama signed the Affordable Care Act into law in 2010, they’ve done so at a slower rate than in the years before the law was passed.

A 2021 study published in JAMA found that out-of-pocket healthcare expenses increased at an average of 3.4% a year from 2000-2009 and 1.9% a year from 2010-2018, after the ACA.

In 2023 dollars, healthcare spending per person was about $11,150 in 2010 and $14,500 by 2023.

That works out to about 2.3%/year over that time frame versus 3.4% in the prior decade.

So prices did drop for those who transitioned from private insurance to the ACA... or become affordable for many who had no insurance. And the rise in per capita spending dropped significantly in the years after the ACA.

bdgan said:
  • Obama promised it wouldn't add one dime to the deficit. The reality is it has added over $200 billion per year to the deficit. The 3.8% investment income tax happened but taxes on medical devices and taxes on insurance companies never happened because congress realized that those taxes would get passed on to policy holders. Taxes on Cadillac plans never happened because congress realized that union/government workers (voters) would be upset. A reduction in reimbursement rates to providers never happened as planned because congress discovered that providers might not accept the insurance.
Click to expand...
Congress... the GOP Congress... made multiple attempts to kill the ACA by stripping away fundamental parts of the plan. They didn't try to improve it. They didn't propose another plan. They've never proposed another plan. The idea that they were worried about costs to policy holders is simply laughable.

bdgan said:
In the end what we got was more people covered because of Medicaid expansion (and some because of premium tax credits) at a large increase to the deficit.
Click to expand...
And, again, twenty-one million Americans get their insurance via state ACA marketplaces... not Medicaid.

bdgan said:
Republican plans to repeal and replace didn't work either.
Click to expand...
Because they have no replacement that isn't the ACA in some form and they know it. It was NEVER "repeal and replace."

bdgan said:
Our system is a mess and neither side has a solution. IMO that's because all "solutions" involve some sort of compromise that many in congress or the general public aren't willing to make. Are we willing to limit medial liability? Are we willing to limit coverage for expensive unproven late life procedures? Are we really willing to reduce payments to providers and impact healthcare salaries? Will high incomes be expected to pay for those with low incomes? Will drug companies lose patent protection? It's not so simple as to say it will be great because the government runs it.
Click to expand...
On this we mostly agree.
 
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TequilasForLoss

TequilasForLoss

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baltimorened said:
look at other nation's health care systems before you jump on the Medicare train. The counties that have "free" healthcare have high tax rates to pay for it...I'm not saying it would be more cost effective for you, but we need to do the math.
Click to expand...
yes, it will require tax dollars to make this happen. great. do it. lots of things we need are expensive. firehouses are expensive, prisons are expensive, police are expensive, schools (including vouchers) are expensive, regulating companies to keep from dumping carcinogens into our drinking water is expensive, and hey none have been perfect. take any/all of them off the books completely? no way.
 
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baltimorened

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bdgan said:
I disagree with mandatory coverage to age 26. A bachelor's degree typically goes from 18-22 yrs old. I think kids should be on their own after that.

I'm not sure about the individual mandate. A few years ago I was checking insurance premiums in my state and they were flat for all age groups. A 60 year old paid the same premium as a 25 year old. Then I looked at another state where premiums were much higher for seniors not yet on Medicare but they were much lower for young people. It seems to me that the individual mandate doesn't lower premiums, it just shifts cost from older people to younger people.
Click to expand...
the mandate does't lower prices...the theory is that by forcing the younger, healthier people to pay premiums with the anticipation that they won't need to use the healthcare system as often, helps to subsidize the older less healthy people.

When the mandate went away, the premiums that they would have paid went away...
 
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bdgan

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tarheelbybirth1 said:
Twenty-one million Americans get their insurance via state ACA marketplaces. My youngest son is one of them. He works for a small company that doesn't offer health insurance and getting it privately would be impossible. In fact, fewer than half of those covered under the ACA get their insurance through Medicaid... the rest get theirs through the state marketplaces. And millions will lose their Medicaid coverage thanks to GOP budget cuts.


No, it did not lower costs overall... however...

Fact Check: Have healthcare costs risen faster since the Affordable Care Act was passed? | Econofact​

By Keshav Srikant·April 22, 2025

No​

While health care costs have continued to increase since President Obama signed the Affordable Care Act into law in 2010, they’ve done so at a slower rate than in the years before the law was passed.

A 2021 study published in JAMA found that out-of-pocket healthcare expenses increased at an average of 3.4% a year from 2000-2009 and 1.9% a year from 2010-2018, after the ACA.

In 2023 dollars, healthcare spending per person was about $11,150 in 2010 and $14,500 by 2023.

That works out to about 2.3%/year over that time frame versus 3.4% in the prior decade.

So prices did drop for those who transitioned from private insurance to the ACA... or become affordable for many who had no insurance. And the rise in per capita spending dropped significantly in the years after the ACA.


Congress... the GOP Congress... made multiple attempts to kill the ACA by stripping away fundamental parts of the plan. They didn't try to improve it. They didn't propose another plan. They've never proposed another plan. The idea that they were worried about costs to policy holders is simply laughable.


And, again, twenty-one million Americans get their insurance via state ACA marketplaces... not Medicaid.


Because they have no replacement that isn't the ACA in some form and they know it. It was NEVER "repeal and replace."


On this we mostly agree.
Click to expand...
We disagree that everybody who buys insurance on the marketplace would be uninsured without it. I retired before 65 and bought my own insurance on my state's marketplace but I didn't that purely out of convenience. I could have purchased directly from the insurance companies or through sites like ehealth.com where rates were similar.
 
TequilasForLoss

TequilasForLoss

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TequilasForLoss said:
Medicare For All would encourage capitalism. Companies no longer would need to budget huge amounts of time and money into annual healthcare plans. Employers and employees would benefit: A company can focus on its true business mission and prioritize quality, innovation, growth. Workers can focus on their role, their craft, and their salary ans they climb the career ladder instead of factoring in the murky health-insurance numbers being attached to employment. That instead becomes a consumer decision free and clear of how you earn your living. (And freed from the shackles of who your bosses chose to be your health-insurance provider… thus creating another plus for Capitalism.)
Click to expand...
well gosh would you look at this …
www.wired.com

Companies Keep Slashing Employees’ Benefits for the Worst Reasons

Workers are getting worse health care, parental leave, and retirement benefits, showing once and for all that your job doesn’t love you back.
www.wired.com www.wired.com
 
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tarheelbybirth1

tarheelbybirth1

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bdgan said:
We disagree that everybody who buys insurance on the marketplace would be uninsured without it.
Click to expand...
We don't disagree because I never made that claim. I did say that those who switched from private insurance to the ACA saved money.
bdgan said:
I retired before 65 and bought my own insurance on my state's marketplace but I didn't that purely out of convenience. I could have purchased directly from the insurance companies or through sites like ehealth.com where rates were similar.
Click to expand...
Getting no subsidy is hardly the standard situation for the vast majority. My son is certainly paying less than he would pay for private insurance.
 
tarheelbybirth1

tarheelbybirth1

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FLaw47

FLaw47

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baltimorened said:
sorry, but don't know what post you're referring to...can you lead me to it?
Click to expand...

Sure thing. Original

Here it is reposted though:

Ok, I've seen you bring this point up about the ACA numerous times and now I have the time and energy to address it so buckle up.

I'll start by reminding you that, in all of your 89 years of glorious experience and accumulated wisdom that make you more rational and generally better than everyone else, you have at no point been covered by private insurance (based on what all you've shared about your life). So on this topic you are at a disadvantage on lived experience and should offer some more credulity to the likes of me.

That being said, you are correct that the ACA did not sufficiently address the made up priorities you imposed upon it. I researched what the stated goals of the ACA actually were at the time it passed (and they largely match my recollection so I'm not just outsourcing my thinking here).

  • The ACA sought to increase the number of people who were covered: Success
    • The uninsured rate has fallen from 16% to 7.7%. Millions more people are insured than they previously were.
    • This was still negatively affected by the fact that certain states (like my own South Carolina) refused to expand Medicaid, which was a key component of the plan.
    • This was further negatively impacted by the GOP doing away with the individual mandate (though this was a smaller deal than most liberals expected) and by the penalty being pretty modest
  • Instilling essential health benefits: Success
    • Here's where I think you're likely quite blind. The ACA required insurance to have a floor for what it covered. Look at this and tell me which of these things shouldn't be covered by insurance.
    • It's important to recognize that Health Insurance is fundamentally different than other insurances. Before it was legal to deny a person coverage if they had a pre-existing condition, effectively condemning some people to die if they weren't on a group plan. Now, I know that it's not "fair" to the insurers (and I actually agree with this but we're stuck with a private insurance model) but one of my groomsmen is a Type 1 diabetic. He's had it since before I met him (he was 6 when we met). Should my friend just not be able to get insulin?
    • I actually tried to get individual insurance in the summer of 2010. We found a plan that would deny coverage for me if alcohol was involved in an accident at all. Not just if I had alcohol in my system, but if I got hit by an uninsured drunk driver my insurance would not pay for my medical care. That's what the individual market looked like back then.
  • Bending the cost curve (not reducing overall costs): Mixed bag. I'll let you read this summary if you want to.

Look, I get it. The ACA isn't what I would have drawn up in a vacuum either. But it did make a big difference for a lot of people and simply is not the "disaster" that people have been parroting about for 16 years now. In the ACA's defense it had to deal with:
  • The GOP, from the jump, doing whatever they could to make sure the ACA was a failure. At no point did they even attempt to help make the plan any better and the states stubbornly refused to expand medicaid to expand coverage, even with a massive federal discount on the program
  • Joe Lieberman being a piece of sh*t and killing the public option
Edit: I'll also add that the ACA apparently did not increase the deficit.
 
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baltimorened

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tarheelbybirth1 said:
*sigh* You made a general declarative statement.

But the request has to go back to Congress for approval.

In fact, that was not true. You have now acknowledged multiple times that it wasn't true. That was the point.
Click to expand...
sorry, I've taken this as far as I can. yep, you're right, the reprogramming process that I described is all wrong.
 
tarheelbybirth1

tarheelbybirth1

Heisman
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baltimorened said:
sorry, I've taken this as far as I can. yep, you're right, the reprogramming process that I described is all wrong.
Click to expand...
Artful Dodger, that has not a single thing to do with your claim that Congress must approve the movement of money from here to there. You were wrong in that claim. Period. That you keep producing this smoke makes it apparent that you now understand that. So, yes, you've taken that about as far as you can.
 
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baltimorened

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FLaw47 said:
Sure thing. Original

Here it is reposted though:

Ok, I've seen you bring this point up about the ACA numerous times and now I have the time and energy to address it so buckle up.

I'll start by reminding you that, in all of your 89 years of glorious experience and accumulated wisdom that make you more rational and generally better than everyone else, you have at no point been covered by private insurance (based on what all you've shared about your life). So on this topic you are at a disadvantage on lived experience and should offer some more credulity to the likes of me.

That being said, you are correct that the ACA did not sufficiently address the made up priorities you imposed upon it. I researched what the stated goals of the ACA actually were at the time it passed (and they largely match my recollection so I'm not just outsourcing my thinking here).

  • The ACA sought to increase the number of people who were covered: Success
    • The uninsured rate has fallen from 16% to 7.7%. Millions more people are insured than they previously were.
    • This was still negatively affected by the fact that certain states (like my own South Carolina) refused to expand Medicaid, which was a key component of the plan.
    • This was further negatively impacted by the GOP doing away with the individual mandate (though this was a smaller deal than most liberals expected) and by the penalty being pretty modest
  • Instilling essential health benefits: Success
    • Here's where I think you're likely quite blind. The ACA required insurance to have a floor for what it covered. Look at this and tell me which of these things shouldn't be covered by insurance.
    • It's important to recognize that Health Insurance is fundamentally different than other insurances. Before it was legal to deny a person coverage if they had a pre-existing condition, effectively condemning some people to die if they weren't on a group plan. Now, I know that it's not "fair" to the insurers (and I actually agree with this but we're stuck with a private insurance model) but one of my groomsmen is a Type 1 diabetic. He's had it since before I met him (he was 6 when we met). Should my friend just not be able to get insulin?
    • I actually tried to get individual insurance in the summer of 2010. We found a plan that would deny coverage for me if alcohol was involved in an accident at all. Not just if I had alcohol in my system, but if I got hit by an uninsured drunk driver my insurance would not pay for my medical care. That's what the individual market looked like back then.
  • Bending the cost curve (not reducing overall costs): Mixed bag. I'll let you read this summary if you want to.

Look, I get it. The ACA isn't what I would have drawn up in a vacuum either. But it did make a big difference for a lot of people and simply is not the "disaster" that people have been parroting about for 16 years now. In the ACA's defense it had to deal with:
  • The GOP, from the jump, doing whatever they could to make sure the ACA was a failure. At no point did they even attempt to help make the plan any better and the states stubbornly refused to expand medicaid to expand coverage, even with a massive federal discount on the program
  • Joe Lieberman being a piece of sh*t and killing the public option
Edit: I'll also add that the ACA apparently did not increase the deficit.
Click to expand...
OK my response...I'm not against the ACA, never way....in fact I've posted many times I think the GOP really screwed the American people by not participating in the drafting and approval. They might have had some good ideas which would have made the program better.

I like some of the provisions, and some of them were really needed...like the precondition requirement. And my family is personally benefitting from the 26 year old thing - grandson. I personally thought the entire debate on contraceptives was dumb...

Where my disagreement come is the financing...At the time of the passage, the medical system was strained (not as bad as today, but strained) Promising better care/competition just didn't make sense to me . You can't take a strained system, add up to 41 million people and expect to get better care. I thought they should have included some kind of incentives to educate more doctors, PAs and Nurses. Next, the promise to not require any federal funds I thought was a pipe dream....kind of like "I'll lower grocery prices on day 1."
I also thought that it was nonsense to tell us that we're going to add all these required benefits but insurance rates won't go up, and they have.

I'm sure I had some additional concerns but can't remember...by the way I'm only 81..closer to 82, am striving for 89.

It is my opinion that the ACA was a great start..not perfect. I don't think the democrats were trying to "lie" to us about the plan, they did the best they could - likely did what most of us do , overestimate the benefits and underestimate the negatives - and accomplished what I think was the purpose...get something on the books that can be "fixed" as we learn realities of effects. We have to recognize thou that the ACA was not and is not intended to cover everyone's total medial bills. If you chose a bronze plan, you'll have lower premiums, but if you have a medical emergency and big bills, you only have 60% coverage....so there is a risk that everyone takes when they make the decision on which plan to take, but I know you already know that.

Now I have the same complaint as a lot of people - both on the left and the right - we need to "fix" the bad things that we've identified from almost 15 years of experience, and insert some things that we deem necessary - medicine has changed since 2010. But in order to do that we have to get our leaders together and throw out all the vitriol (no matter who is responsible), forget which party wins - heck both can claim victory) and do just that....and it's not a one party problem. Yep what you're thinking right now is correct, the first trump administration was more intent on repeal - but we're beyond that. We had 4 years of Biden and Democrats control of the house and Senate from 2021-23, and now we've had Republican control since 2025, and from what I've seen no one has seemed intent on revising the program.
\Sorry I missed the first one
 
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FLaw47

FLaw47

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baltimorened said:
OK my response...I'm not against the ACA, never way....in fact I've posted many times I think the GOP really screwed the American people by not participating in the drafting and approval. They might have had some good ideas which would have made the program better.

I like some of the provisions, and some of them were really needed...like the precondition requirement. And my family is personally benefitting from the 26 year old thing - grandson. I personally thought the entire debate on contraceptives was dumb...

Where my disagreement come is the financing...At the time of the passage, the medical system was strained (not as bad as today, but strained) Promising better care/competition just didn't make sense to me . You can't take a strained system, add up to 41 million people and expect to get better care. I thought they should have included some kind of incentives to educate more doctors, PAs and Nurses. Next, the promise to not require any federal funds I thought was a pipe dream....kind of like "I'll lower grocery prices on day 1."
I also thought that it was nonsense to tell us that we're going to add all these required benefits but insurance rates won't go up, and they have.

I'm sure I had some additional concerns but can't remember...by the way I'm only 81..closer to 82, am striving for 89.

It is my opinion that the ACA was a great start..not perfect. I don't think the democrats were trying to "lie" to us about the plan, they did the best they could - likely did what most of us do , overestimate the benefits and underestimate the negatives - and accomplished what I think was the purpose...get something on the books that can be "fixed" as we learn realities of effects. We have to recognize thou that the ACA was not and is not intended to cover everyone's total medial bills. If you chose a bronze plan, you'll have lower premiums, but if you have a medical emergency and big bills, you only have 60% coverage....so there is a risk that everyone takes when they make the decision on which plan to take, but I know you already know that.

Now I have the same complaint as a lot of people - both on the left and the right - we need to "fix" the bad things that we've identified from almost 15 years of experience, and insert some things that we deem necessary - medicine has changed since 2010. But in order to do that we have to get our leaders together and throw out all the vitriol (no matter who is responsible), forget which party wins - heck both can claim victory) and do just that....and it's not a one party problem. Yep what you're thinking right now is correct, the first trump administration was more intent on repeal - but we're beyond that. We had 4 years of Biden and Democrats control of the house and Senate from 2021-23, and now we've had Republican control since 2025, and from what I've seen no one has seemed intent on revising the program.
\Sorry I missed the first one
Click to expand...

Not sure how I got it in my head that you were 89, sorry about that. I was actually thinking about that earlier, my best friend's dad just turned 80 and was also a helicopter pilot in Vietnam (CH-46) and I was surprised that you'd be that much older than him. Oh well.

I think that was a very good post and I have not to really argue with (other than my thinking Democrats actually want to fix this and the GOP isn't interested).

The way you had been talking about the ACA gave me the impression that you (mostly) thought it was trash legislation and not merely flawed (I don't think you'll find anyone on this board who thinks it's perfect).

Did they really claim premiums wouldn't go up or did they say healthcare spending per capita wouldn't go up? Anecdotal but I had heard (in about 2014) that a lot of companies used the ACA as an excuse to shift way more of the premium costs onto employees than was proportional with the actual increase in premiums.

EDIT: I strongly agree about needing to have more doctors and making it cheaper to have doctors. We can't do much about overall costs without discussing provider pay, as unpleasant as that may be.
 
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baltimorened

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FLaw47 said:
Not sure how I got it in my head that you were 89, sorry about that. I was actually thinking about that earlier, my best friend's dad just turned 80 and was also a helicopter pilot in Vietnam (CH-46) and I was surprised that you'd be that much older than him. Oh well.

I think that was a very good post and I have not to really argue with (other than my thinking Democrats actually want to fix this and the GOP isn't interested).

The way you had been talking about the ACA gave me the impression that you (mostly) thought it was trash legislation and not merely flawed (I don't think you'll find anyone on this board who thinks it's perfect).

Did they really claim premiums wouldn't go up or did they say healthcare spending per capita wouldn't go up? Anecdotal but I had heard (in about 2014) that a lot of companies used the ACA as an excuse to shift way more of the premium costs onto employees than was proportional with the actual increase in premiums.

EDIT: I strongly agree about needing to have more doctors and making it cheaper to have doctors. We can't do much about overall costs without discussing provider pay, as unpleasant as that may be.
Click to expand...
Don't know if we're referring to the same thing...but in addition to adding all the retired provisions, the claim was that each family would save $2,500/year and that the deficit would be decreased by $400 billion (might have been $200 billion, can't remember)

Seriously, I felt the same way about those claims as I did about "I'm going to reduce grocery prices on day 1" or I'm going to end the Russia Ukraine war on day 1". I don't think Obama was purposely lying, I believe that's what he was told by people counting the dollars, making the assumptions. Sometimes in life things don't go exactly as planned.

That's why I realize that the ACA hasn't gone exactly as planned. And the answer is to make the corrections deemed necessary now, with the realization that corrections will also, most likely, be needed in the future.

EDIT: I don't think either party is interested. If they were someone would have created a group tasked with coming up with fixes. We need a leader that can bring the parties together, throw out the vitriol. and come up with fixes acceptable to both parties and the American people.
 
sleepy64561

sleepy64561

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I don’t have the numbers off the top of my head, but I don’t think our country’s health costs are due to a lack of doctors in terms of overall numbers. The more rural areas typically have a lack of doctors and it’s common to see immigrants with MDs take up the slack in those regions for green cards (from what I can remember, might technically be something other than a green card since our immigration laws are quite complicated imo)

I’m pretty sure we don’t have enough nurses.

Capitalism doesn’t exactly work for healthcare. In order to be a rational buyer you have to understand what you’re buying.

I’ve experienced Germany’s healthcare system and it was pretty good. I think it was essentially a nonprofit setup.
 
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bdgan

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baltimorened said:
look at other nation's health care systems before you jump on the Medicare train. The counties that have "free" healthcare have high tax rates to pay for it...I'm not saying it would be more cost effective for you, but we need to do the math.
Click to expand...
Two big questions:
  1. Would the USA be willing to make drastic changes like lower reimbursements to providers, limited medical liability, and limits on late life treatments in order to reduce costs?
  2. Who would pay? Everybody like in many European countries, or skewed heavily towards high earners like in Canada?
 
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baltimorened

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bdgan said:
Two big questions:
  1. Would the USA be willing to make drastic changes like lower reimbursements to providers, limited medical liability, and limits on late life treatments in order to reduce costs?
  2. Who would pay? Everybody like in many European countries, or skewed heavily towards high earners like in Canada?
Click to expand...
the possibilities of getting a single payer system in the US with the lobbies of the medical professionals, liability lawyers and healthcare companies would be a significant feat
 
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FLaw47

FLaw47

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bdgan said:
Two big questions:
  1. Would the USA be willing to make drastic changes like lower reimbursements to providers, limited medical liability, and limits on late life treatments in order to reduce costs?
  2. Who would pay? Everybody like in many European countries, or skewed heavily towards high earners like in Canada?
Click to expand...

While I'd personally have some appetite for addressing reimbursement rates, I don't think we would overall. I think we could get modest savings through economies of scale with having only one payer, creating incentives for everyone to get all of their recommended preventive care, and having a modest co-pay for everything. It doesn't get us in line with other countries but a 5% savings per capita with more complete population coverage is a win for me.

You'd have to raise taxes on everyone and do something to ensure that companies funnel their savings back to employees when they no longer have to pay for health insurance.
 
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baltimorened

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FLaw47 said:
While I'd personally have some appetite for addressing reimbursement rates, I don't think we would overall. I think we could get modest savings through economies of scale with having only one payer, creating incentives for everyone to get all of their recommended preventive care, and having a modest co-pay for everything. It doesn't get us in line with other countries but a 5% savings per capita with more complete population coverage is a win for me.

You'd have to raise taxes on everyone and do something to ensure that companies funnel their savings back to employees when they no longer have to pay for health insurance.
Click to expand...
sounds really, really good..where do I sign up? We'd better do the math to compare current reimbursement rates on government programs Medicaid and Medicare (I have no idea what the rates are with the ACA) against the rates paid by insurance companies. I'm only familiar with the medicare rates, and I will tell you, IMO, if hospitals and doctors were paid only those rates doctors would retire and hospitals would close. In fact there have already been hospitals in areas largely serving Medicaid and Medicare patients who have closed.

And to save you the effort of looking it up, I did....

yes, hospitals and safety-net facilities that principally serve Medicare and Medicaid patients face severe financial distress, and dozens have completely closed or reduced essential services.
These closures and service reductions primarily stem from a combination of rising costs, low government reimbursement rates, and reductions in federal health funding. The industry has faced specific pressure points
  • Rural Closures: More than 190 rural hospitals have closed or converted to outpatient-only facilities over the last two decades. Because these hospitals rely almost entirely on public insurance and have low patient volumes, inadequate reimbursements often force them to shut their doors.
  • Urban Safety-Net Risks: The financial strain extends beyond rural areas. Analyses have identified over 400 hospitals nationwide—many located in urban centers and relying heavily on Medicaid populations—that remain at high risk of closure or service cuts due to ongoing federal healthcare spending reductions.
 
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bdgan

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FLaw47 said:
While I'd personally have some appetite for addressing reimbursement rates, I don't think we would overall. I think we could get modest savings through economies of scale with having only one payer, creating incentives for everyone to get all of their recommended preventive care, and having a modest co-pay for everything. It doesn't get us in line with other countries but a 5% savings per capita with more complete population coverage is a win for me.

You'd have to raise taxes on everyone and do something to ensure that companies funnel their savings back to employees when they no longer have to pay for health insurance.
Click to expand...
I'm skeptical about savings due to economies of scale. Nearly half the country is already on some sort of government healthcare and cost per beneficiary is still quite high. We already have standardized billing codes used among insurers. Some argue that we'd eliminate insurance company profits but most of BC/BS is already non profit and public insurers like UHC "only" make a 5% net profit.

Wrt your last point I don't think employers would save anything. Part of the revenues would come from taxing employers and amount equivalent to what they're currently spending on their share of employee insurance.
 
FLaw47

FLaw47

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baltimorened said:
sounds really, really good..where do I sign up? We'd better do the math to compare current reimbursement rates on government programs Medicaid and Medicare (I have no idea what the rates are with the ACA) against the rates paid by insurance companies. I'm only familiar with the medicare rates, and I will tell you, IMO, if hospitals and doctors were paid only those rates doctors would retire and hospitals would close. In fact there have already been hospitals in areas largely serving Medicaid and Medicare patients who have closed.

And to save you the effort of looking it up, I did....

yes, hospitals and safety-net facilities that principally serve Medicare and Medicaid patients face severe financial distress, and dozens have completely closed or reduced essential services.
These closures and service reductions primarily stem from a combination of rising costs, low government reimbursement rates, and reductions in federal health funding. The industry has faced specific pressure points
  • Rural Closures: More than 190 rural hospitals have closed or converted to outpatient-only facilities over the last two decades. Because these hospitals rely almost entirely on public insurance and have low patient volumes, inadequate reimbursements often force them to shut their doors.
  • Urban Safety-Net Risks: The financial strain extends beyond rural areas. Analyses have identified over 400 hospitals nationwide—many located in urban centers and relying heavily on Medicaid populations—that remain at high risk of closure or service cuts due to ongoing federal healthcare spending reductions.
Click to expand...

Yeah, I agree about the Medicare reimbursement rates. That's one of the things Bernie and his ilk gloss over too much. If we did Medicare for all (which, to be clear, is not my overall preference) we couldn't maintain the rates that we currently have for Medicare, they'd have to increase. Hospitals could likely reduce administrative staff though because of how standardized everything would be.
 
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FLaw47

FLaw47

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bdgan said:
I'm skeptical about savings due to economies of scale. Nearly half the country is already on some sort of government healthcare and cost per beneficiary is still quite high. We already have standardized billing codes used among insurers. Some argue that we'd eliminate insurance company profits but most of BC/BS is already non profit and public insurers like UHC "only" make a 5% net profit.

Wrt your last point I don't think employers would save anything. Part of the revenues would come from taxing employers and amount equivalent to what they're currently spending on their share of employee insurance.
Click to expand...

With regards to employer taxes, that's something of a design question but yeah, if they were taxed the same amount then there'd be no savings to pass on.
 
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baltimorened

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FLaw47 said:
Yeah, I agree about the Medicare reimbursement rates. That's one of the things Bernie and his ilk gloss over too much. If we did Medicare for all (which, to be clear, is not my overall preference) we couldn't maintain the rates that we currently have for Medicare, they'd have to increase. Hospitals could likely reduce administrative staff though because of how standardized everything would be.
Click to expand...
I agree there would likely be a lot of administrative savings...lots of job losses, and money in the right pocket (Admin savings, employer expense reductions etc) never seems to end up going where you expect them to go.

I personally think our system is too embedded to make such a drastic "Medicare for all turn". all those in favor envision a provider system like today only with shorter wait times and better care, and at a lower price...with increases in taxes to be paid by "the other guy". Life doesn't work like that.

I'm in favor of fixing what we have..we need more medical professionals...incentivize to people to go there through education grants, tuition assistance or something....review coverages and individual contributions, strengthen ACA, incentivize health care companies if necessary, look at a high risk pool partially funded by the government There's a bunch of ideas out there...and they all cost money. So be honest with the American people, let them know what's coming and how much it's going to cost. We'll accept higher fees if we get a better system (I think)
 
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