Why the US Makes No Progress with Accessible, Affordable Health Care (McCain, wages)

[wanderlust76]

Originally Posted by upgrader

Nope, you didn't really have health insurance. You only thought you did. You had lifetime caps. You had https://www.healthcare.gov/glossary/rescission

The ACA is much more than the exchanges. The ACA started taking effect in 2010.

Sadly, most people get their health insurance from their employer. Guess what happens when you get an expensive health problem, your employer kicks your butt to the curb.

I would like to see employers taken completely out of the healthcare equation the last thing I want is corporate America involved.

[BobNJ1960]

Originally Posted by upgrader

Nope, you didn't really have health insurance. You only thought you did. You had lifetime caps.
.

Wrong. Our plans had no caps, annual nor lifetime.

3 employers were self-insured, btw.

We did have re-insurance on high $ extreme claims (top 1%).

Our typical employee max cost was $1,500 family out of pocket a year.

PS: We could not see who filed our large claims, nor did we care.

[LINative]

Originally Posted by NY_refugee87

It was affordable before ACA....
No deductible to be met.
Premiums weren't killer...
Many different insurance companies and policies to choose from.
Was optional to have... Not mandatory. Not a fine or taxable offense if you chose not to have it...

So why can't it go back to that?

I don't think health care was affordable before ACA, I think it was just that most people were shielded by their employer sponsored health programs or they were on Medicare/Medicaid so they did not think about the costs. I know, I was one of them.

But the costs were huge and growing. Every year in the 2000s in my bank, we would get new benefits and every year we being asked to chip in more and more for our health benefits. Health costs were skyrocketing and is just a matter of time before the system would be failing for more and more Americans.

ACA - Obamacare was a bureaucratic attempt to fix what is already an expensive rapidly failing system that we increasingly can no longer afford as a nation. We are either going to have to go to a 1. government/private partnership where the government pays private health insurance companies to cover everyone OR option 2. we are going to a completely government run program like Canada or Britain.

The choice is ours. Conservatives should realize the longer they block real health care reform the more and more likely Americans are going to choose the second option.

[craigiri]

Originally Posted by Midpack

Here's what I gather just as a place to start, in no particular order, but please add as you see fit.

• lifestyle (obesity, smoking, drugs)
• high cost and profit for intermediaries (insurance)
• excessive profit for some product and service providers - medical devices, pharma, hospital groups, doctors & other medical professionals
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• plus significantly/ironically, excessive usage by patients who have no idea how much the services are actually costing them
• almost none of us ever asks "what does it cost?" or makes any attempt to be selective - there is little else we buy without considering the price
  

Hopefully there will be some thoughtful posts, including some from the health care sector, between all the overly simplified responses.

It is a natural tendency of human to make simple things complex. Making large lists and then asking for them to be added to...makes the problem seem difficult or impossible to solve, as you must address each and every one of the listings.

As a business guy (efficiency expert) and entrepreneur I've always been a "big picture" fella - because this is how problems are solved. With many machines and systems you cannot fix them because they are simply the wrong tool for the job

And that is our situation. Your list is more about the effects than the cause. For example, a person who has to fear bankruptcy from getting ill and who knows they have to work until they die to keep themselves covered - is perhaps more likely to engage in smoking, overeating, etc. from the anxiety produced.

The Big Picture Problems, IMHO, are all related and are:
Greed
Predatory Capitalism (we consider it "good" when we do more business and when we can legally screw people).
LACK of Government regulation - Predatory Capitalism will not check itself (see Great Recession). It will take and take and take until there is nothing left and then it will continue to take (from debt and deficit as it does now).

I think you can cross a LOT of items off your list....
those legal awards, malpractice costs, etc. have been estimated at .5 to 2%. In other words, less than one years normal increases. There is no scenario where they would be zero....so scratch that off the list.

Under the ACA and proper state regulations, the cost of administration is fixed. In MA is it 12% maximum - in other words the insurance companies must pay out 88% of money they take in. I think with Medicare it is 5%. Either way, these figures represent a reasonable amount and cannot fix the system even if cut in 1/2.
So Scratch that off the list.

Many of the other listing fall under the "Predatory Capitalist Health Care" (fee for service - more money for sicker patients, etc.) - and so can be simply be grouped under that heading. A nicer way of saying it is that the incentive is for people to be made sicker instead of well.

This is a THREE TRILLION+ dollar industry that pervades every home, person, institution, etc. in this country. The US and Wall Street pray at the altar of GDP. When we spend more money on health care, the GDP increases.

The Greed Part also covers the unpatriotic wealthy classes. We cannot afford the health care costs as they are now (10.5K per person per year). We could probably afford them - with proper planning and taxes - at 35% lower (7K per person per year). The extra money ALL comes from increasing the Fed Debt and Deficits - since the government pays 2/3rd of ALL health care in this country.

Now - stay with me a minute here. The very wealthy would rather see higher debt and deficit and tax cuts for themselves. They get the tax cuts NOW (and pretty much forever if the last decades are any indications). But the costs for giving them lower taxes are moved to the Federal Debt which ALL Americans have to pay over a long period of time. So effectively high health care costs are free money for billionaires.

This - and many other problems in this country - cannot be fixed within the current system. Our politics have been gamed (gerrymandered, etc.) and patriotism has taken a back seat to the bank accounts of the pols and their friends in big business.

It would take a revolution of sorts to address these problems.

There is a slight chance that it will slowly work itself out over the next 50 years...but it's laughable to think, for example, that the Republicans (tea partiers, etc.) are going to address it in any positive fashion.

The simplest way to address it is Medicare for all. If we did that we'd then be able to use the power of the purse (and government) to hone prices and services and also set up a parallel systems 100% out of government for those who want super-luxury services, etc.

But you would have to START with a goal. For example, you'd have to state "we wish to provide basic universal health care for all for a figure which is no more than 10% of GDP. Then we would work out the math to get there.

[upgrader]

Originally Posted by BobNJ1960

3 employers were self-insured, btw.

I worked for a large technology company that was self-insured. I'm sure my name appeared on power-point presentations about cost savings.

I don't think heath insurance should be provided by employers.

The great thing about the ACA was the concept of allowing people to go out on their own and know they could still get insured.

[BobNJ1960]

Originally Posted by upgrader

I worked for a large technology company that was self-insured. I'm sure my name appeared on power-point presentations about cost savings.

I don't think heath insurance should be provided by employers.

The great thing about the ACA was the concept of allowing people to go out on their own and know they could still get insured.

I like my employer coverage, always have. I would not mind an exchange if the options were strictly private sector and unsubsidized, as well as no gov't mandates on anyone, or rules from gov't on coverages required.

Let the consumer decide, and pay.

Most will wisely prefer employer coverage.

[detshen]

Originally Posted by NY_refugee87

Was a Ford mechanic for years. Wouldn't call that a great job or claim the benefits were outstanding...

So because someone cant afford health insurance. You want to fine/tax someone for not having it... And make it mandatory or else... A product. Forced into the citizen.

Do you not see the hypocrisy there?

You're right. I don't care and didn't. I don't expect someone else to be responsible for my well being. Thats my call. Not yours. Not uncle sams. Surely not the tax payers. So why should anyone be responsible for others?

Imagine the outrage if the government mandated AR15s be mandatory in every household for that is a constitutionally granted right? A product forced onto the people... That not everyone can afford? And if they refused, just fine them for it...

The problem is that we all end up paying for those who refuse to buy health insurance. The human body can become sick or injured at any time. People who refuse to buy health insurance expect everyone else to pay for their care when they end up needing it. If everyone had health insurance the costs would decrease dramatically, that is the point of a mandate. The healthy policy holders offset the costs of those who need care and when the healthy end up needing care they are covered under thir policy and don't leech off the taxpayers. It is the height of hypocrisy that those on the right are constantly calling for "personal responsibility" but refuse to demand responsibilty when it comes to health insurance.

An individual mandate to purchase healthcare was initially proposed by the politically conservative Heritage Foundation in 1989 as an alternative to single-payer health care. ... From its inception, the idea of an individual mandate was championed by Republican politicians as a free-market approach to health care reform.

[wanderlust76]

Originally Posted by LINative

I don't think health care was affordable before ACA, I think it was just that most people were shielded by their employer sponsored health programs or they were on Medicare/Medicaid so they did not think about the costs. I know, I was one of them.

But the costs were huge and growing. Every year in the 2000s in my bank, we would get new benefits and every year we being asked to chip in more and more for our health benefits. Health costs were skyrocketing and is just a matter of time before the system would be failing for more and more Americans.

ACA - Obamacare was a bureaucratic attempt to fix what is already an expensive rapidly failing system that we increasingly can no longer afford as a nation. We are either going to have to go to a 1. government/private partnership where the government pays private health insurance companies to cover everyone OR option 2. we are going to a completely government run program like Canada or Britain.

The choice is ours. Conservatives should realize the longer they block real health care reform the more and more likely Americans are going to choose the second option.

The health insurance executive teams thank you for all those years of contributing and overpaying for something that should cost much less.

Aetna, Cigna, McKesson, UnitedGroup, Liberty Mutual, these are all some of the richest companies in the world now. Along with their top 1 percenter executives who are filthy rich of course.

[craigiri]

Originally Posted by NY_refugee87

It was affordable before ACA....
No deductible to be met.
Premiums weren't killer...
Many different insurance companies and policies to choose from.
Was optional to have... Not mandatory. Not a fine or taxable offense if you chose not to have it...

So why can't it go back to that?

It was 8600 per person per year in 2006. That was the highest in the world.
If you weren't paying that much someone else (prob the government) was paying for you or you were playing the casino (bad insurance)...

Vast numbers were not insured and were taken care of at taxpayer and government expense after they were much sicker (ER instead of GP). Lifetime caps were in place. Pre-existing conditions were out of luck, You could be dropped any time.

Just for the basics - a state like MA which had the ACA before it was the ACA..

95% insured
Longer life spans, less infant mortality
“health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.”

Now let's take a state like Texas - with vast amounts of money (oil, business), but that decided they like the old ways.
"more than 25 percent of Texans do not have health insurance of any kind, which is the highest uninsured rate in the nation."
"Texas ranks worst in the nation in health care services and delivery, according to an annual scorecard issued by the federal Agency for Health Care Research and Quality."

As I often say, we are living in backwards bizarro world. Up is Down, Wrong is Right, etc.

These things are measureable. Those numbers in Texas are more than just figures - they are dead and suffering people. The state has decided they enjoy making people suffer because....well, because the billionaires there have plenty for themselves and don't want to take any chances on having to pay more taxes.

[craigiri]

Originally Posted by BobNJ1960

I like my employer coverage, always have. I would not mind an exchange if the options were strictly private sector and unsubsidized, as well as no gov't mandates on anyone, or rules from gov't on coverages required.

Let the consumer decide, and pay.

Most will wisely prefer employer coverage.

Portability of insurance is of utmost importance to a economy. If people feel they have to stay working at a place for the health insurance - then new innovations and new businesses are not formed and employees are less likely to innovate and take the risks...that end up making our country great.