Patient Protection & Affordable Care Act "Obamacare"

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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby DreamGoddessLindsey » Wed Jan 07, 2015 8:24 am

Of course it won't work. It's a bandage until the majority of this country cease being terrified of "Commies" and realize that single payer works and that universal health care is a proven success everywhere it's been implemented.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby Shikanosuke » Wed Jan 07, 2015 4:20 pm

DreamGoddessLindsey wrote:Of course it won't work. It's a bandage until the majority of this country cease being terrified of "Commies" and realize that single payer works and that universal health care is a proven success everywhere it's been implemented.


That is a pretty bold statement. You should look into some of these 'amazing' successes. While I have no problem learning from other countries, and acknowledge many do provide some great role models there are problems. First of all some of the same problems are system faces (like rising costs) are still endemic in countries with universal coverage. New problems, like waiting lists for treatment rear there heads in many of those model countries. Finally, many of those models work for those countries individually, but likely wouldn't work for America. Especially since alot of those countries are heavily taxed countries.

Also, I'll grant you there's a lot of 'communistic' rhetoric thrown around in regards to universal health care (and a lot of people buy into that bit) but last I heard the majority of America bought into the idea of Obamacare (at least more access to healthcare). Furthermore, many people simply oppose the idea on its merits and not just fear of a 'communistic' ploy.

As for the ACA and its end-game success, I'm not sure yet. I don't think we'll get it right in one or two years, or that we'll be able to tell if it'll fail in one or two years.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby James » Wed Jan 07, 2015 6:54 pm

DreamGoddessLindsey wrote:Of course it won't work. It's a bandage until the majority of this country cease being terrified of "Commies" and realize that single payer works and that universal health care is a proven success everywhere it's been implemented.

They haven't been a success everywhere they've been implemented and existing implementations have demonstrated adequately that they can be implemented incorrectly or poorly in manners. But I think other countries have also demonstrated that a single payer system/universal healthcare can be implemented far more effectively than what we have in the United States. Too bad what seems possible on paper becomes impossible once politics become involved.

Shikanosuke wrote:That is a pretty bold statement. You should look into some of these 'amazing' successes. While I have no problem learning from other countries, and acknowledge many do provide some great role models there are problems. First of all some of the same problems are system faces (like rising costs) are still endemic in countries with universal coverage. New problems, like waiting lists for treatment rear there heads in many of those model countries. Finally, many of those models work for those countries individually, but likely wouldn't work for America. Especially since alot of those countries are heavily taxed countries.

Also, I'll grant you there's a lot of 'communistic' rhetoric thrown around in regards to universal health care (and a lot of people buy into that bit) but last I heard the majority of America bought into the idea of Obamacare (at least more access to healthcare). Furthermore, many people simply oppose the idea on its merits and not just fear of a 'communistic' ploy.

About the only positive thing I can say about our healthcare system is that it is excellent for those who have excellent coverage, but it drops off precipitously from there. And the biggest flaw with our system, in my opinion, is that it is absolutely ruinous to anybody exposed to the actual expenses that circulate within it. This is the main issue I'd take with what you wrote above—I can't think of any other nation that comes even remotely close to the United States in healthcare costs. And even where those costs aren't exposed much to the actual citizen (such as good company healthcare frequently provides) they are apparent in healthcare premiums. Even good healthcare for the elderly can be quite expensive, but if you don't have a corporation backing you, such as is the case with self-employed people like myself (fortunately not really like myself as I can use my wife's healthcare) the costs are ludicrously high.

I believe this alone is enough to consider the Untied States healthcare system broken. But when you add to that a pool of people who are exposed to those costs without coverage—financially ruining them—you've got a terrible healthcare system. Not because it isn't great for the people who are positioned favorably to take advantage of it; because it is destructive and poor for a large pool of the population who isn't. And it is hard to really defend a system that somehow manages to charge hundreds of dollars for saline solution, or some $40 for a pack of gauze pads equivalent to what can be purchased for $4 at Walgreens.

A fair amount of this is represented in that audio interview, which is why I thought it worth sharing.

Good universal healthcare programs in other countries could be improved by spending more money on them. Canada's for example, while already good, could easily become much better.

Shikanosuke wrote:As for the ACA and its end-game success, I'm not sure yet. I don't think we'll get it right in one or two years, or that we'll be able to tell if it'll fail in one or two years.

I don't think it's that difficult to look at the success of the ACA if one does so in context of what it actually is. ACA does anywhere from very little to nothing to address the biggest problem with the US healthcare system, and that's the extravagant costs and what I'll go ahead and call corruption in many industries (e.g. pharmaceuticals, device manufacturers). It includes no tort reform. So it really is a bandaid. What it does do is take steps to address one facet of our broken system, and that is the system's ability to ruin people by being inaccessible or corrupt (e.g. pre-existing conditions, dropping people when they become liabilities). To that end I personally believe ACA does far more good than harm, but nobody should expect it to fix our system because it wasn't designed to.

And if it had been designed to, the big entities that backed it, like pharmaceuticals, would have opposed it, and it wouldn't have passed. ACA is also a largely Republican vision of what healthcare reform should look like, and now we've got Republicans pretending that it's the worst thing to have happened in the country since the civil war because, I assume, Obama backed it and now it must serve as a political tool (then against a second term of Obama, now for 2016). So I have very little hope that we're going to do anything to solve this problem in the next two years.

As an aside, one thing people are celebrating about the ACA: it has reduced the rate at which healthcare costs are increasing for the population as a whole. But last I checked, it still hasn't reduced the rate of increase to one lower than inflation, and it certainly hasn't reduced the costs which is what it should be doing. It's a pretty bittersweet 'success'.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby Shikanosuke » Wed Jan 07, 2015 7:59 pm

James wrote:About the only positive thing I can say about our healthcare system is that it is excellent for those who have excellent coverage, but it drops off precipitously from there. And the biggest flaw with our system, in my opinion, is that it is absolutely ruinous to anybody exposed to the actual expenses that circulate within it. This is the main issue I'd take with what you wrote above—I can't think of any other nation that comes even remotely close to the United States in healthcare costs. And even where those costs aren't exposed much to the actual citizen (such as good company healthcare frequently provides) they are apparent in healthcare premiums. Even good healthcare for the elderly can be quite expensive, but if you don't have a corporation backing you, such as is the case with self-employed people like myself (fortunately not really like myself as I can use my wife's healthcare) the costs are ludicrously high.


And you'd be right to take issue with it. I fully concede that while we have some of the best healthcare coverage in the world we simultaneously have some of the most dismal. What you wrote about individuals exposed to real costs being ruinous is very true too. We certainly need a mechanism, outside bankruptcy and long-term debt, to better handle certain issues.

I believe this alone is enough to consider the Untied States healthcare system broken. But when you add to that a pool of people who are exposed to those costs without coverage—financially ruining them—you've got a terrible healthcare system. Not because it isn't great for the people who are positioned favorably to take advantage of it; because it is destructive and poor for a large pool of the population who isn't.



Well, yea I guess that could be considered broken. We both concede people have access to healthcare, even at low-income levels though. Though the issue of whether seeking it is financially worth it is worrisome. Wasn't part of what the ACA supposed to do is keep people from being exposed to the some of the costs?

And it is hard to really defend a system that somehow manages to charge hundreds of dollars for saline solution, or some $40 for a pack of gauze pads equivalent to what can be purchased for $4 at Walgreens.


This is true.



As an aside, one thing people are celebrating about the ACA: it has reduced the rate at which healthcare costs are increasing for the population as a whole. But last I checked, it still hasn't reduced the rate of increase to one lower than inflation, and it certainly hasn't reduced the costs which is what it should be doing. It's a pretty bittersweet 'success'.


Well this is part of what I was concerned over. From some of what I read, this isn't an issue exclusive to our country's system at all.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby James » Wed Jan 07, 2015 8:17 pm

Shikanosuke wrote:And you'd be right to take issue with it. I fully concede that while we have some of the best healthcare coverage in the world we simultaneously have some of the most dismal. What you wrote about individuals exposed to real costs being ruinous is very true too. We certainly need a mechanism, outside bankruptcy and long-term debt, to better handle certain issues.

I would like to see a system that doesn't put people in that position in the first place. :(

I don't think there's any way around whether a good healthcare system is expensive to the government or not, but I'd rather see the expense going into getting people good, affordable coverage rather than lining the pockets of the businesses abusing our current system. That's a whole big bag o' hurt, though, with many individual concerns coming into play: the patent system, tort reform, whether it is even possible to do something material outside a single-payer system...

Stories like this shouldn't be a thing.

Shikanosuke wrote:Well, yea I guess that could be considered broken. We both concede people have access to healthcare, even at low-income levels though. Though the issue of whether seeking it is financially worth it is worrisome. Wasn't part of what the ACA supposed to do is keep people from being exposed to the some of the costs?

I remember hearing plenty of talk about how ACA was supposed to reduce costs, and any discussion about keeping people from being exposed to those costs would definitely be an honest representation of the ACA. That's what it does, really. Rather than fix the system, it just patches some of its inhumane problems while largely focusing on getting people coverage so they aren't hit with the full force of the system's expenses rather than trying to solve the problems behind those expenses.

Which got the biggest offenders onboard. They don't need to change less or become less corrupt/opportunistic. Instead, they get more legitimate customers to ultimately charge for their services (even though most of the charges find their way to insurance, the government, healthcare providers). Heck, in context we're subsidizing them.

Now this is supposed to reduce healthcare costs. Mitt Romney envisioned it for his healthcare package, it has been envisioned for this type of 'reform' before, and I'm pretty sure the idea was tossed around for the ACA. By getting everybody onboard in the insurance system it is supposed to create a more stable demand and reduce the 'need' to collect on debts, hence dropping prices. I've become a little jaded, though, and don't hold out hope for this. In my experience when a business raises costs in response to a cause (or because the cause permits it) they don't reduce prices when the cause is mitigated or removed. Instead, they say, "Hey! Let's just keep making the money we're making and more."

I suppose what the airlines are doing right now serves as a more accessible example.

Shikanosuke wrote:Well this is part of what I was concerned over. From some of what I read, this isn't an issue exclusive to our country's system at all.

Ah, agreed here. Rising healthcare costs are not a unique problem to the United States. The United States just enjoys the privilege of rising healthcare costs applied to an already ridiculously overpriced system. And I'll also wager that the businesses taking advantage of the United States healthcare system are doing their part to drive up costs in other countries. I don't know the extent to which that is true, though. The same businesses frequently charge much more for their products in the United States than they do in other countries and currently laws in the United States ensure healthcare providers must purchase these products through the United States.

That interview actually included a fun little historic tidbit. One avenue explored by lawmakers opposed to the ACA was to include a Liberal provision enabling healthcare providers to purchase through Canada (where prices are lower), knowing it would cause pharmesudicals to oppose the legislation.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby DreamGoddessLindsey » Thu Jan 08, 2015 12:12 am

The easiest way to cut medical costs is to forbid profit from it at a regulation level. Hospitals have proven they will charge however much they can get away with, and so will everyone above them in the chain. Doctors have become lazy, equipment is too expensive, and the poor pay the price. Universal healthcare, quite frankly, is the only solution. Medicine and capitalism are a really really really bad mix.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby Shikanosuke » Thu Jan 08, 2015 12:38 am

DreamGoddessLindsey wrote:The easiest way to cut medical costs is to forbid profit from it at a regulation level. Hospitals have proven they will charge however much they can get away with, and so will everyone above them in the chain. Doctors have become lazy, equipment is too expensive, and the poor pay the price.


That is a generalization which many doctors would take issue with. As for charging what you can get away with, most hospitals are in the business are making money.


Universal healthcare, quite frankly, is the only solution. Medicine and capitalism are a really really really bad
mix.


I was under the impression that many/some of the countries which embrace universal health care not only still make profit, but encourage competition.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby DreamGoddessLindsey » Thu Jan 08, 2015 6:20 am

Shikanosuke wrote:most hospitals are in the business are making money.


This, right here, is the entire problem.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby Shikanosuke » Thu Jan 08, 2015 2:47 pm

DreamGoddessLindsey wrote:
Shikanosuke wrote:most hospitals are in the business are making money.


This, right here, is the entire problem.



I'm certainly far far from any kind of experts on other forms of universal health care systems in other countries, but if we're to hold them alot as role models we need to understand what they are. I understand Canada is different, in that the public sector is responsible not only for the majority of the financing but also of the administration of the health care. But from what I've read (if incorrectly anyone inform me) that most of the other countries (such as Germany) still have for-profit private hospitals doing the work while financing is handled by the public sector.

So if we're going to say 'that right there is the entire problem', then we can't hold aloft universal health care in other countries as examples of success.
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Re: Patient Protection & Affordable Care Act "Obamacare"

Unread postby Dong Zhou » Thu Jan 08, 2015 3:48 pm

A few things in the discussion:

Should America have universal healthcare? As an outsider, yes and it just seems weird America doesn't join the rest of us. If a newspaper needs a story, the costs Americans have to pay makes a good one. There are one or two things, from what I understand, that America does well in terms of healthcare but "American healthcare" makes a scarestory overall.

However the costs of such healthcare, even with prescription charges, is immense. It would require America to undergo a fundamental shift in attitude towards government, taxes and maybe cut something like defence and that will be difficult (I would argue worth it but it would be difficult). Certainly finding a self-sustaining model will be a problem as it is for most countries to the best of my knowledge, the NHS has an 8 billion funding gap by 2020 and nobody knows how to fill it. Old age care from those living longer, higher cost of medicine, more and more people using it...

Scarestories: As much as we loved the "NHS death board" stories used to oppose Obamacare, we are no better. Witness every time Andy Burnham speaks. Healthcare is Labour's strategy for the upcoming election and the left love a good old NHS story about how their opponents are going to destroy it by giving extra money, how 1% rise of private providers to 6% is going to lead to America and so on. So far the Illumaniti and unicorns haven't been brought in but Labour has always loved to use the NHS as a scarestory to bash their opponents.

Profit: Got no issue with companies making profits on health-care. Our hospitals are meant to try and keep to a budget anyone, we privatized one on the verge of bankruptcy (but still free to those using it) and it has improved. Like Shi says, others have more profit run hospitals and do those well.
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