Nonsense, the marketplace has worked perfectly, exactly the way the insurance companies wanted when they wrote the laws- they reap millions in taxpayers dollars.
30
Insurance didn't come into existence for things that are definitely going to happen to people; it came into existence for things that might happen to people.
You might die early and unexpectedly, you might not; for that there is life insurance.
Your house may catch fire, ir may not; that's why you have fire insurance. And why fire insurance makes sense.
You may have an auto accident, you may not. Hence, insurance makes sense.
But there isn't anyone alive who will never have a health problem or never need to see a doctor. Insurance is therefore an illegitimate and inapropriate way of paying for this.
Single payor systems needn't have anything to do with altruism or citizens "looking out for each other". The other 99% of developed countries that have it aren't any more humanitarian than we are. Single payor's main virtue, and the only one that counts, is that it's sustainable and it works. For-profit insurance HAS no virtues. It neither works nor is sustainable, and is detested by the populace, as the endless post ACA damage reports have made all too clear.
You might die early and unexpectedly, you might not; for that there is life insurance.
Your house may catch fire, ir may not; that's why you have fire insurance. And why fire insurance makes sense.
You may have an auto accident, you may not. Hence, insurance makes sense.
But there isn't anyone alive who will never have a health problem or never need to see a doctor. Insurance is therefore an illegitimate and inapropriate way of paying for this.
Single payor systems needn't have anything to do with altruism or citizens "looking out for each other". The other 99% of developed countries that have it aren't any more humanitarian than we are. Single payor's main virtue, and the only one that counts, is that it's sustainable and it works. For-profit insurance HAS no virtues. It neither works nor is sustainable, and is detested by the populace, as the endless post ACA damage reports have made all too clear.
56
You left out the biggest problem, Bronze Policies are basically worthless due to their high deductibles, co-payments and limited coverage.
Bronze policies, are an illusion of coverage that make no sense for the vast majority of people in the lower third of the income strata.
Bronze policies, are an illusion of coverage that make no sense for the vast majority of people in the lower third of the income strata.
40
I hear people say all the time that young people are not buying health insurance because they are healthy. I have a friend who was young, healthy and quite robust, energetic and athletic. One day, he got a horrible pain in his stomach. 2 weeks later, he was diagnosed with Stage 4 pancreatic cancer. He had insurance, but I cringe when people say "healthy people do not need insurance" You are only healthy one day at a time. You never know when you will get hit by a car, get cancer, have a heart attack even if you feel well and healthy today. That is why we desperately need Universal Health Care in the US. Everyone will need a doctor sooner or later and we never know when.
20
This idea of decreasing the salaries of physicians and hospital administrators is disconcerting. These individuals make up the second largest segment of the one percent. If we impoverish them then only CEOs and other managers will be rich, and they will rule our land. No one wants that. Freedom!!!
8
The first goal of Obama Care was to provide subsidized insurance to the poor and sick with the cost picked up the the health/young/middle class. Second goal was to disincentivize the same health/young/middle class fro using health care themselves through higher co-pays and deductibles (poor/sick get receive subsidies for this as well but may still not be able to actuality use new insurance. Whoops!) Well there was some resistance once the cat was out of the bag and not enough paying and not using customers signed up. On to plan B. Perhaps Hillary will reveal it soon.
12
Keep in mind that while health care economists and consumers are resurrecting talk of some kind of single payer system, the insurance lobby is hardly paying attention. And why should it? Assuming the Republicans maintain control of Congress (a reasonable supposition), there is no way in heaven or hell any legislation that even suggests a single payer option will ever see the light of day.
I'd wager that every person commenting on this article, the writers of the article, and the experts cited in the article already know that no such plan will ever come about unless the Democratic Party wins the White House and both houses of Congress this year or in some future year. It is not a health care issue, or a health insurance issue, or even a cost issue. It is an issue of political will.
I'd wager that every person commenting on this article, the writers of the article, and the experts cited in the article already know that no such plan will ever come about unless the Democratic Party wins the White House and both houses of Congress this year or in some future year. It is not a health care issue, or a health insurance issue, or even a cost issue. It is an issue of political will.
22
The solution is lowering costs on health care providers. You do that with tort reform and reduced regulation not more lawyers and more regulation.
3
"Then again, Europe doesn't pay obscene sums for militaristic stuff." With the U.S. footing the bill, you don't have to.
24
Suggest requiring insurers who want to participate in corporate health care coverage that to continue they must participate in public option at same rates for all.
7
Re; obamacare - The time and costs to get to where we are today is unfathomable.
Here's a plan: A Kaiser - style healtcare for the entire country paid for by a 10% VAT and a 5% employee contribution. Cap medical at 15% GDP. In about a decade the bumps will be worked out and the problem is solved.
Here's a plan: A Kaiser - style healtcare for the entire country paid for by a 10% VAT and a 5% employee contribution. Cap medical at 15% GDP. In about a decade the bumps will be worked out and the problem is solved.
4
I enrolled in the Affordable Care Act in 2014. I am still with the same insurer.
My premium has risen, over two years , but not to the point that I can not
handle the increase. I opted out of my husband's employer's health care choice, and it was a wise decision. The Affordable Health Care Act provided me with an affordable choice.
However, health care should not be a for profit business. I stand with Senator
Bernie Sanders and his vision of Medicare for All, a single payer health care
system. Let's hope we can move in that direction in the years to come.
My premium has risen, over two years , but not to the point that I can not
handle the increase. I opted out of my husband's employer's health care choice, and it was a wise decision. The Affordable Health Care Act provided me with an affordable choice.
However, health care should not be a for profit business. I stand with Senator
Bernie Sanders and his vision of Medicare for All, a single payer health care
system. Let's hope we can move in that direction in the years to come.
32
It was a half baked plan based on a proposal developed by the Heritage Foundation as a stalking horse proposal to derail a publicly run health insurance system for the public at large. As it was only a stalking horse proposal, when it was proposed in Congress, it had almost universal opposition from Republicans.
Our "friend" Senator Joe Liebermann from the insurance state of Connecticut put the kibosh on a public option. Now that he is out of there, its time to propose a public, single payer system based on Medicare.
Any system like Obamacare that tries to herd private insurance companies to write policies for people (those with prior conditions) whom they prefer to not do business with is bound to be complex and cumbersome And involuntary participants, both individuals and insurance companies, will resent it.
We need to do two things. One, replace Obamacare with a single payer system. And two, repeal the mandate that requires hospitals to treat people who cannot pay. After a few fools die who chose to not insure themselves, signing up for participation in the program will become a matter of choice.
Our "friend" Senator Joe Liebermann from the insurance state of Connecticut put the kibosh on a public option. Now that he is out of there, its time to propose a public, single payer system based on Medicare.
Any system like Obamacare that tries to herd private insurance companies to write policies for people (those with prior conditions) whom they prefer to not do business with is bound to be complex and cumbersome And involuntary participants, both individuals and insurance companies, will resent it.
We need to do two things. One, replace Obamacare with a single payer system. And two, repeal the mandate that requires hospitals to treat people who cannot pay. After a few fools die who chose to not insure themselves, signing up for participation in the program will become a matter of choice.
17
Now that Obamacare is going down the tubes, just as the Republicans predicted, the Democrats are bringing up "single payer" / "the public option", just as the Republicans predicted they would when it failed. But single payer has been tried already in the US, in Vermont. Vermont gave up on it because it was way too expensive. Vermont is a best case. If single payer can't work there, it can't work anywhere. Maybe it's time to start listening to the Republicans. They seem to have a better grasp on economics. Or at least they understand there is no such thing as a free lunch.
30
All the fixes here suggest fixing the ACA by more regulations and more tweaks by the Federal Government.
The assumption that the Government can manage such a monstrous process as national health insurance is the plain error.
Insurance is the business of "risk management". Do it well and you can make a profit. No all can insured. Do it not so well and your company is gone.
Health Insurance is different than Medical Care. Ask the Medical Community what are their solutions. Has anyone done that? Chalk Children's hospital charges nothing to people in need. Catholic Hospitals take all in need. Has anyone asked these people what they do? Many doctors, that I know, take off a few weeks to a month every year and donate their services. Has anyone asked them to help?
Get the Government out of the Health Care Insurance business period.
The assumption that the Government can manage such a monstrous process as national health insurance is the plain error.
Insurance is the business of "risk management". Do it well and you can make a profit. No all can insured. Do it not so well and your company is gone.
Health Insurance is different than Medical Care. Ask the Medical Community what are their solutions. Has anyone done that? Chalk Children's hospital charges nothing to people in need. Catholic Hospitals take all in need. Has anyone asked these people what they do? Many doctors, that I know, take off a few weeks to a month every year and donate their services. Has anyone asked them to help?
Get the Government out of the Health Care Insurance business period.
17
The solutions are simple, but not easy, in that current rent seekers would be threatened and controllers would lose control. In the end the losers would be the government and private corporatists who wish to run other people's lives.
First we must accept that the solutions are plural-not a single plan. We are Americans and should seek solutions that strengthen American values of freedom, independence, and personal responsibility. Medicare works for the elderly. Non-Mandatory individual health markets that are national rather than state--we are a mobile people. Personal health savings accounts that can be started at birth and funded from a variety of sources with back up catastrophic insurance for most and enrollment in Medicare for the uninsurable chronically ill. Emergency care, a public utility, should be paid out of taxes and price regulated as no market mechanism can regulate prices where there is no choice.
First we must accept that the solutions are plural-not a single plan. We are Americans and should seek solutions that strengthen American values of freedom, independence, and personal responsibility. Medicare works for the elderly. Non-Mandatory individual health markets that are national rather than state--we are a mobile people. Personal health savings accounts that can be started at birth and funded from a variety of sources with back up catastrophic insurance for most and enrollment in Medicare for the uninsurable chronically ill. Emergency care, a public utility, should be paid out of taxes and price regulated as no market mechanism can regulate prices where there is no choice.
4
This article is off track in so many ways. The discussion is always framed as a health insurance issue rather than a health care issue. The remainder of the industrialized world has figured that health care is a right but not here in America, where whether you live or die is a function of your privilege. And it's not merely the greed of our insurers; it's the greed of hospital CEOs, our pharmaceutical companies, our surgeons, the hedge funds that run our ambulance services, the advertisers who are paid millions to burnish the brands of our hospitals, and of course the ambulance chasing lawyers. Our system of medical care is effective if you can pay for it, but for tens of millions of people, it just stinks.
interesting how the writers comment that the public option is complicated and unworkable. Ever hear of Medicare? The only reason Medicare is complicated is because the health insurance companies are the middleman.
One solution to bringing down the costs to all would be to expand Medicare to include any persons with a chronic disease diagnosis such as cancer or any of the major chronic diseases such as diabetes, hypertension and cardiac disease. Removing that population from the private insurance pool would be a boon for both private insurers and the exchange itself. Many will say we can't pay for this but we do already. We pay for it in the form of free emergency care. Seeing a primary physician for preventative care is a far more cost effective option.
interesting how the writers comment that the public option is complicated and unworkable. Ever hear of Medicare? The only reason Medicare is complicated is because the health insurance companies are the middleman.
One solution to bringing down the costs to all would be to expand Medicare to include any persons with a chronic disease diagnosis such as cancer or any of the major chronic diseases such as diabetes, hypertension and cardiac disease. Removing that population from the private insurance pool would be a boon for both private insurers and the exchange itself. Many will say we can't pay for this but we do already. We pay for it in the form of free emergency care. Seeing a primary physician for preventative care is a far more cost effective option.
14
After years of Times columnists insisting the ACA is working "just fine" and that "millions more Americans have coverage" ( though not actual access to affordable health care, but never mind), we finally see the denial beginning to recede in the face of overwhelming evidence that it is NOT working just fine. And the denial is only now receding because, with the ACA's inherent flaws on such vivid display right before the election, it's become politically necessary to acknowledge the reality. The fact that the insurance-company driven, hodge-podge, ill-fated ACA may have been the best that Obama and the Dems could manage to cram through Congress without a single Republican vote does not, unfortunately, make it a defensible program.
50
Bernie was right.
Incremental tinkering just won't do it.
We need national healthcare, such as exists in every other Westernized nation. Bye bye, health insurance industry.
It's time to bite the bullet, or replace all of Congress and the Administration with politicians who will not take the payola.
Incremental tinkering just won't do it.
We need national healthcare, such as exists in every other Westernized nation. Bye bye, health insurance industry.
It's time to bite the bullet, or replace all of Congress and the Administration with politicians who will not take the payola.
25
It is just contraindicative to have a for profit industry in preserving life. I's Ghoulish.
Americans first right is the right to life.
Governments first responsibility is to protect the life of its citizens.
Profit motive has not provided better care or better delivery. It has just made several greedy industries rich until they have no restraint.
It's past time to treat health care in the special way we treat utilities. They get a profit based upon performance and delivery of services. They must provide services to all people within a unique territory. All liability is capped rather than litigated.
Most of the rest of the world figured this out long ago, and they enjoy superior health care overall. Our system survives on preying on the vulnerable in support of a few elites.
Americans first right is the right to life.
Governments first responsibility is to protect the life of its citizens.
Profit motive has not provided better care or better delivery. It has just made several greedy industries rich until they have no restraint.
It's past time to treat health care in the special way we treat utilities. They get a profit based upon performance and delivery of services. They must provide services to all people within a unique territory. All liability is capped rather than litigated.
Most of the rest of the world figured this out long ago, and they enjoy superior health care overall. Our system survives on preying on the vulnerable in support of a few elites.
22
Ha, like the unborn, oh right to choose.
2
The current mechanisms of health insurance coverage don't give the free market a chance. As long as every health care transaction is passed through middlemen, costs will be obscured and fabricated. Consumers need to see published prices for their doctors' services, just like they do at every other establishment where they spend money. True price competition is the only effective way to contain costs in the long term, and Obamacare does nothing to address that.
28
The law, as written, requires the redistribution of health insurance benefits among American voters. To work as designed the law requires those who played by the rules and had fared well under the prior system to relinquish their advantage. To, in effect, kick-in to the disadvantaged thereby enabling them to join the ranks of the insured. The laws proponents could not look their voters in the eye and admit this fundamental equation. Out of political expediency the law's proponents delayed or never enforced key provisions. The extra legal exemptions and delays postponed the day of reckoning but the day is nevertheless fast approaching. The Universal Health Care alternative would expand rather than diminish the volume of redistribution. Hillary will not allow her donor class to suffer such a fate. The fundamental truth remains, there is no such thing as a free lunch.
18
Health insurance itself encourages constantly increasing prices for services. Making it mandatory just makes that worse. The moment Romney Care passed in Massachusetts, premiums started going up at double digit rates. Obama Care is the same thing, only worse.
We need a cost competitive market for healthcare products and services. The best bet is to get the young people off health insurance and let them shop for the services and products they need. Getting rid of the ban on drug importation will also help. Eventually we can get rid of employment based insurance and HMO style health insurance generally.
It doesn't make sense to start with the old and the sick. They can't afford our out of control prices or the premiums on a policy to pay for them. The only hope for them is outsourcing: flying to Belgium for their hip replacement, for example. American medicine is a luxury for the rich.
We need a cost competitive market for healthcare products and services. The best bet is to get the young people off health insurance and let them shop for the services and products they need. Getting rid of the ban on drug importation will also help. Eventually we can get rid of employment based insurance and HMO style health insurance generally.
It doesn't make sense to start with the old and the sick. They can't afford our out of control prices or the premiums on a policy to pay for them. The only hope for them is outsourcing: flying to Belgium for their hip replacement, for example. American medicine is a luxury for the rich.
3
Revise the legislation so that if a person is not enrolled in a full coverage plan (basic health care, including primary and urgent care, and hospitalization) then the person will automatically be enrolled in a pool of patients who will be assigned to insurers like automobile coverage for assigned risk, instead of fines or penalties. The rates can be determined with the companies by the public or private agency which does the assignments. That way all are covered without a public option which seems so horrible to Republicans and without any mandates, and insurers will have enough people enrolled to make it worthwhile.
1
Why are Yanks so intent in shooting themselves continually in the foot? We solved this problem in Europe over 50 years ago. Just ask Bernie Sanders.
Then again, Europe doesn't pay obscene sums for militaristic stuff.
Then again, Europe doesn't pay obscene sums for militaristic stuff.
22
Then again, we also have to pay for your military defense, and our "healthcare spending" also includes the patent and copyrights -which helps pretend the European healthcare system is financially and morally responsible.
21
True enough.
You just let us pay for your defense, and then pontificate to us about our militarism.
You just let us pay for your defense, and then pontificate to us about our militarism.
9
Europe doesn't pay obscene sums for "militaristic stuff" because the US is paying it for them. We can debate whether or not we should but that's how it is.
5
Obamacare set out to provide affordable health insurance to the uninsured. Seven years in, it increased the percentage of insured in the US population by a mere 6%. All that trouble for this meager improvement, and I'm not sure I can even count premium reduction as one of its accomplishments! Even if you take out the profit of all the health insurers combined (along with the exorbitant salaries they pay their execs), the US would still have the highest health care cost per capita in the world. Instead, physicians and nurses now have to comply with significantly more regulatory burdens thanks to Obamacare. Every practice now needs (or could very well use) a scribe to document patient records, a dedicated bureaucrat to re-check the documentation, a personnel who is familiar with Medicare/Medicaid peculiarities, etc. (Interesting fact: what is the fastest growing profession in health care in recent years? Medical scribes). You will not find such well "documented" and "paper-trailed" medical practices anywhere else in the world. It is almost as if the policies were dictated by lawyers.... oh wait, I forgot, Obama is a lawyer!
19
"Every practice now needs (or could very well use) a scribe to document patient records, a dedicated bureaucrat to re-check the documentation, a personnel who is familiar with Medicare/Medicaid peculiarities, etc."
That is why the government worshiping "progressives" must love obamacare as it allows them to add even more useless, parasitic, bureaucratic vermin to the millions that already infest every level of government. In their ideal world everyone would work for their great god government just like in the old Soviet Union.
That is why the government worshiping "progressives" must love obamacare as it allows them to add even more useless, parasitic, bureaucratic vermin to the millions that already infest every level of government. In their ideal world everyone would work for their great god government just like in the old Soviet Union.
7
A_Reader, you want madness? Ask a doctor how many people he needs to hire to do the medical billing and coding for the myriad private health insurance plans they have to deal with. All have different deals: different coverage guidelines, different levels of coverage and reimbursement rates. Medicare has published rates for all procedures. No surprises. And, since its been around for 50+ years, it is well understood.
2
Face it: The US resident population, as a whole, is sick. When one-third (and growing) of the population is obese, no health insurance plan (single-payer or universal) is viable.
It is like trying to insure a neighborhood in which one-third of houses are on fire or smoldering. Premiums would be astronomical or non-existent.
It is like trying to insure a neighborhood in which one-third of houses are on fire or smoldering. Premiums would be astronomical or non-existent.
15
The healthy that have gone uninsured since the ACA was passed, and at worst, paid out of pocket for medical expenses that turned out to be well below their annual $12,000 family deductible, are never going to enroll now. They can calculate their 3 years of premium savings and bank them, against a potential future medical event. They needed to be scared into enrolling in year 1.
11
I have a friend who was healthy and quite robust, energetic and athletic. One day, he got a horrible pain in his stomach. 2 weeks later, he was diagnosed with Stage 4 pancreatic cancer. He had insurance, but I cringe when people say "healthy people do not need insurance" You are only healthy one day at a time. You never know when you will get hit by a car, get cancer, have a heart attack even if you feel well and healthy today.
1
I'm not able to see why insurance companies, a bunch of actuaries trying to set rates based on anticipated claims, are the problem. What else are they supposed to do? The basis for those claims, the high costs of medical care, the reasons for which have been amply demonstrated and well understood for years, are the problem. So why scapegoat the insurance companies?
6
We were supposed to believe that the bill was signed by and supported by "industry" (read: the few insurance companies that gained a guaranteed clientele and, in effect, a cartelized health insurance system). The reason we were supposed to believe that is so that now, upon failure, we would blame industry and (by unjust association) also capitalism and free trade. Now, they will say capitalism was tried, and that the only alternative is state-control over economic demand ("single-payer") which will then follow more state-control over supply (further regulation until nationalization). You can get away with this without a big, scary scapegoat to disintegrate public discussion and evade moral and economic principles.
4
Jarvis, it's because they skim 15 per cent off the top and do not provide any service. That's the problem. When I pay for something, I expect service. My doctor and the hospital are providing a service and the insurance company's 'service' is to try and deny my claim. That's not service. That is parasitism.
7
Health Insurance companies do nothing but collect money and dole it out while trying as hard as they can to not pay claims. They do NOTHING else. They have no other purpose but to skim money and deny you access to care as often as they can. That is not a morally acceptable system, in my estimation. Everyone has a body. Everyone will need to see a doctor. The for=profit health insurance industry is an abomination and morally corrupt. Look at the pay packages of CEOs and top C-level execs at the top Health Insurance companies. They are taking about 15% of your premium and sticking it in their pockets.
4
I have friends in Canada and France. They laugh at me when I describe our insurance system. Yes, they pay higher taxes, but they get so much for that increase. After all, the premiums we pay each month are more than a tax increase needed to cover every American in a Universal Health system. It is a no-brainer, but our Congress is bribed by PhARMa and the medical industry lobbyists. So, with our Reps and Senators on the take for big money and promised high-paying jobs as lobbyists after they leave Congress, how can we pass laws that help the 320 Million of us not in Congress?
36
After looking at all of these problems and the solutions, there is a common cause to them all: trying to secure a profit from sequestering risk leaves someone holding the bag every time. There is a solution. It's been tried everywhere else to more positive effect even if not perfect, a single payor plan that works precisely because risk IS equally distributed.
The day is coming when people will finally accept this reality. Insurers best serve their survival not by continuing to win the sequestration battle, especially since their past history is the cause of so much of the acute health issues costing them today because they refused to cover the conditions before they got acute, by figuring out how to be absolutely instrumental to the support of efficient operation of a single payer system. There will still be a lot of work for them to supply, increasingly more efficient batching, big data to catch graft and fraud, and quicker capture of over-payment, duplicative payment, adjudication of contested coverage procedures and negotiated paid amounts for them, even finally determining what the real cost of a procedure really is is wide open territory in healthcare.
Actuarial work will remain important but shifting to where it will really effect cost and efficiency of delivery of care that works best gives the insurance industry a wide open place to compete and make money that will also happen to make healthcare actually result in better health in our country.
4
The day is coming when people will finally accept this reality. Insurers best serve their survival not by continuing to win the sequestration battle, especially since their past history is the cause of so much of the acute health issues costing them today because they refused to cover the conditions before they got acute, by figuring out how to be absolutely instrumental to the support of efficient operation of a single payer system. There will still be a lot of work for them to supply, increasingly more efficient batching, big data to catch graft and fraud, and quicker capture of over-payment, duplicative payment, adjudication of contested coverage procedures and negotiated paid amounts for them, even finally determining what the real cost of a procedure really is is wide open territory in healthcare.
Actuarial work will remain important but shifting to where it will really effect cost and efficiency of delivery of care that works best gives the insurance industry a wide open place to compete and make money that will also happen to make healthcare actually result in better health in our country.
4
6
Close it down, throw out the whole law and revert back to the prior system with enhancements such as:
Allowing interstate insurance purchases
Expanding Health care Savings accounts
Securing block grants to the states for the Medicaid Program
Ending the restrictions placed upon individual providers designed to force them out of their private practices.
Ending the practice of govt forcing specific coverage for unnecessary treatment, EX: Gender surgery.
Dependent age roll back to 18 without a mandate
Allow insurance plans to offer a range of services with options
This is only a drop in the bucket. Most important get the GOVT Out of the health Insurance Mandate Business.
Allowing interstate insurance purchases
Expanding Health care Savings accounts
Securing block grants to the states for the Medicaid Program
Ending the restrictions placed upon individual providers designed to force them out of their private practices.
Ending the practice of govt forcing specific coverage for unnecessary treatment, EX: Gender surgery.
Dependent age roll back to 18 without a mandate
Allow insurance plans to offer a range of services with options
This is only a drop in the bucket. Most important get the GOVT Out of the health Insurance Mandate Business.
14
JGNY, so you go by the Republican plan: if you ain't rich or do not have a good job with health insurance provided, just die already!
The best plan would be Medicare-for-All. Way cheaper than any private insurance and much more efficient. Go ask your grandma if she likes her Medicare. I guarantee she will say, why yes!
The best plan would be Medicare-for-All. Way cheaper than any private insurance and much more efficient. Go ask your grandma if she likes her Medicare. I guarantee she will say, why yes!
4
Easy fix! Obama or his clone Clinton enact a change in ACA forcing insurance companies to sell their insurance on ACA market places or pay a fine. If he can fine individuals for not doing business with his remarkably horrible program then logic says he can force the insurance companies to do business with his remarkably horrible program.
6
like pouring gas on a fire
2
Not to worry, didn't Democrats give the nomination to Hillary so she would protect the President's legacy?
Yes, oh yes, protect the President's legacy with terrible healthcare options for the people.
Bernie was correct: medicare for all.
Yes, oh yes, protect the President's legacy with terrible healthcare options for the people.
Bernie was correct: medicare for all.
17
I'm sorry NYT and rural red states, you can't have a market based solution to the cost of healthcare in this country without enough paying customers per square mile.
It's not possible.
However if the country wants to pull together and come up with public/private solutions to the problems then it becomes quite easy.
Be it telemedicine, IT automation, single payer in rural areas, negotiating drug prices etc.
All we need to do as a country is care about our fellow citizens more than we hate Obamacare!
It's not possible.
However if the country wants to pull together and come up with public/private solutions to the problems then it becomes quite easy.
Be it telemedicine, IT automation, single payer in rural areas, negotiating drug prices etc.
All we need to do as a country is care about our fellow citizens more than we hate Obamacare!
4
So....a very complex bill was passed via reconciliation, attempted to solve a wicked problem, had bipartisan opposition and only partisan support and hasn't produced the expected results? And now it's difficult to get support from the opposition to make the needed changes? You dont say.
We'd be in a much better position today if a water-downed version with bipartisan support was passed. That way both tribes would have motivation for follow on fixes.
The ACA was a huge waste of political capital if anything. But the blue tribe was desperate for a huge policy win.
We'd be in a much better position today if a water-downed version with bipartisan support was passed. That way both tribes would have motivation for follow on fixes.
The ACA was a huge waste of political capital if anything. But the blue tribe was desperate for a huge policy win.
15
Twenty million Americans now have healthcare and YOU have a problem with that?
sddmack, What we got is the watered down version: no public payer.
2
Look this is what they had planed from the start. They knew the marketplace would fail and then they could step in with the single payer plan and take over healthcare. I lived under single payer in the UK and being a person with a serious health condition i lingered on the verge of death for years due to being unable to regularly see my Dr and months of waiting to be admitted to hospital to be treated properly. If this country goes single payer you all will regret it.
14
Link please!
2
Tell me how penalizing Americans for not having insurance isn't extortion? The government is now forcing people to do things they seem necessary. I thought the government worked for the people, not the other way around. Obamacare wasn't popular among the majority of citizens, but it passed. The United States is turning into an oligarchy controlled dictatorship.
14
What is particularly egregious about the penalties is that the young and healthy have a built in penalty if they buy the insurance or not. A policy for a young healthy 25-35 year old with a $5000 deductible should cost $50/month. Instead, it costs $200 so that $150 can subsidize the rates for a wealthy 62 year old early retiree.
The reason the young and healthy aren't joining up is because the deal is structured to take advantage of them to the benefit of their wealthy elders.
The reason the young and healthy aren't joining up is because the deal is structured to take advantage of them to the benefit of their wealthy elders.
11
I agree. It's significant that this had to be the case, as a corollary of the much-lauded "no pre-existing conditions" ban. Considering how much the proponents brag about this ban, I doubt they would've permitted the healthy and young to jump ship and be free of Obamacare.
1
Health care choice is bad for New Yorkers. Here's why.
NYC has a tradition of doctors not accepting insurance. Few doctors here accept Obamacare, and if they do, then it's only one or two of the available plans. When Obamacare came in, most of us had to ditch some of our doctors, because no plan covered them all. As time went on, plans went out of business or became too expensive, or maybe our income or life circumstances changed, and we had to change plans. (To say nothing of doctors and hospitals dropping out.)
Every time this happens, our lives are disrupted, with new and ever narrower networks, new rounds of appointments with new in-network doctors, and battles with the insurer over re-authorizing prescriptions. And if it happens mid-year, there are squandered deductibles.
If we had no choice and were all on the same plan, regardless of income, and there was only one network, we would have better continuity of care, there would be less inefficiency and waste, and we'd all be better off.
In other words, we need a single payor system.
NYC has a tradition of doctors not accepting insurance. Few doctors here accept Obamacare, and if they do, then it's only one or two of the available plans. When Obamacare came in, most of us had to ditch some of our doctors, because no plan covered them all. As time went on, plans went out of business or became too expensive, or maybe our income or life circumstances changed, and we had to change plans. (To say nothing of doctors and hospitals dropping out.)
Every time this happens, our lives are disrupted, with new and ever narrower networks, new rounds of appointments with new in-network doctors, and battles with the insurer over re-authorizing prescriptions. And if it happens mid-year, there are squandered deductibles.
If we had no choice and were all on the same plan, regardless of income, and there was only one network, we would have better continuity of care, there would be less inefficiency and waste, and we'd all be better off.
In other words, we need a single payor system.
11
Like the Veterans Administration. They have done a great job of showing us what Government can do when it comes to providing health care.
3
In order to get to that single payer plan, the 75% of the population that is getting health insurance from their employer or a family member's insurance has to give it up for the benefit of the 3% or fewer people like you who are participating in the ObamaCare exchanges. Liberals will not give up something they have for the benefit of others, which is the reason why the Democrats who wrote this law did not include a public option or single payer.
Liberals are OK with spending other people's money on worthwhile causes but are not willing to personally make any sacrifices.
Insurance in NYS is exceptionally expensive because it includes state mandates like wigs (at $150 per, no cheap internet $25 wigs) for chemo patients, IVF for infertile and gay customers (expensive at $15,000 per try, but is it an essential service?), occupational therapy for children with autism and behavioral problems despite the fact that the public schools are required to provide these services. The list continues. Crony groups have lobbied the legislature to require insurance provide the services, which benefit the cronies but not the people. Payments for non medical and non essential services squeeze out spending on actual medical services.
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Liberals are OK with spending other people's money on worthwhile causes but are not willing to personally make any sacrifices.
Insurance in NYS is exceptionally expensive because it includes state mandates like wigs (at $150 per, no cheap internet $25 wigs) for chemo patients, IVF for infertile and gay customers (expensive at $15,000 per try, but is it an essential service?), occupational therapy for children with autism and behavioral problems despite the fact that the public schools are required to provide these services. The list continues. Crony groups have lobbied the legislature to require insurance provide the services, which benefit the cronies but not the people. Payments for non medical and non essential services squeeze out spending on actual medical services.
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3
Lower the age of Medicare to 60, then 55. This should remove a great amount of the risk from the market place and the cost should go down. If it doesn't then have an enhanced Medicare alternative for anyone not satisfied by the private market place. If the private sector is so competitive and efficient, they should be able to compete with a public insurance option.
10
Currently, the payroll taxes plus premiums cover 50% of the cost of Medicare, and the taxpayers pay the other 50%. If you add millions of 55-64 year olds to Medicare, either they pay $1200 per month for their premiums or the taxpayer picks up 100% of the cost of their care, whether or not the beneficiaries have the means to pay for themselves.
Are you seriously suggesting that the taxpayer should pay for people who can afford their own costs?
If you make participation voluntary, then there is going to be adverse selection and only the sick will sign up.
A free market is the most efficient pricing mechanism. But if the government stands by with a cheap option paid for by the taxpayer, it is not a free market.
Are you seriously suggesting that the taxpayer should pay for people who can afford their own costs?
If you make participation voluntary, then there is going to be adverse selection and only the sick will sign up.
A free market is the most efficient pricing mechanism. But if the government stands by with a cheap option paid for by the taxpayer, it is not a free market.
"If the private sector is so competitive and efficient, they should be able to compete with a public insurance option."
You mean compete against taxes? That's what a Obamacare costs based on income are - taxes. And it's not the nasty 1%'ers paying the cost.
You mean compete against taxes? That's what a Obamacare costs based on income are - taxes. And it's not the nasty 1%'ers paying the cost.
Good idea to expand Medicare for all, but seniors are covered, so start at the other end. Better to cover all kids under age, say, 10, then gradually expand the age limit upward.
Most problems today are complicated and call for complicated solutions. This one is easy. Dump this idiotic program. There is no saving this stupidity.
12
I wonder what would happen if we had Universal Health Care just like every other First-World country? Oh, my! We would never have to worry about our insurance plans and high deductibles. Most doctors would be included as well as hospitals. Doctors would no longer need teams of billing people to figure out the dozens of plans and covered items that drive them nuts, today. We could drive down the cost of drugs and procedures. Sure, doctors and hospitals may not make as much money, but they can deal with that. Maybe the hospital CEOs would need to sell one of their vacation homes in Aspen, Montana and West Palm Beach or give up the fleet of business jets and chauffeured cars. But, the people of this country would be better off.
20
The providers would game the system, as they do today, to maximize their revenues. Hospital CEOs, even those of non-profit hospitals, will still have their corporate jets and vacation homes in Aspen. (Hospital CEOs got pat raises after ObamaCare and have a $350,000 part time job waiting for Michelle Obama.) The government would ration care and limit the number of high tech providers and technology that would be available only to the politically well connected. Price controls on drugs would eliminate progress. Cheaper for those who have illnesses for which the current technology is adequate, not so good for people with cancer.
The wealthy would buy private insurance to obtain the best and fastest care; no waiting list for them. The poor would still have Medicaid and the middle class would now have Medicaid instead of their employer provided heath insurance.
Utopia. Every one is equal, but some people are more equal than others.
The wealthy would buy private insurance to obtain the best and fastest care; no waiting list for them. The poor would still have Medicaid and the middle class would now have Medicaid instead of their employer provided heath insurance.
Utopia. Every one is equal, but some people are more equal than others.
That makes too sense.
1
What can be done: recognize the stupidity of saying Aetna ceases to be an option if I cross the wrong street near the OH/IN border.
And maybe take the time to think about the irony of patting ourselves on the back after letting the industry write the law.
And maybe take the time to think about the irony of patting ourselves on the back after letting the industry write the law.
6
"Letting the industry write the law"- last I checked only a few companies were on board, specifically the instance companies who benefitted from a *legally guaranteed* population of clients. Many doctors, hospitals, and (depending on how you define the "industry") I'd bet most in "industry" -like most in the country, it seems- knew this would not work, and many claimed it was never intended to work. We were called idiots, haters of the poor, selfish, "old time reactionaries", "ideologues", and "regressive" for suggesting that this would happen.
remove all insurance companies..
5
If you go back to 2009-2010 the critics of ObamaCare warned about all these problems, but were ignored and Dems pushed ObamaCare through Congress without any support from Repubs. At the time Repubs were called "obstructionists". Now we know that they were right. All promises of lower medical expenses, keep you doctor, keep your policy, were broken. But this is Dem's MO. They make promises they cannot keep and then blame someone else for that. And it is always Repub's fault!
"Solutions" proposed in this article will not work as the original ObamaCare solutions do not work. The only way to fix our health care system is to repeal this monstrosity and to start anew.
"Solutions" proposed in this article will not work as the original ObamaCare solutions do not work. The only way to fix our health care system is to repeal this monstrosity and to start anew.
14
This is a consequence of pelosi's statement "pass it and read it later". She is obama's puppet. Obamacare never should have passed. Political jargon and the taxpayer is paying the price.
By the way how Come it is never reported how much is collected in premiums?
No wonder I am promoting trump - had enough of crooked politicians.
By the way how Come it is never reported how much is collected in premiums?
No wonder I am promoting trump - had enough of crooked politicians.
5
Intriguing. Promoting a man who has bankrupted several businesses which penalised the 'small man' and lost that man his precious investment dollars. Crooked? I think so. Called Hillary a bigot, on any number of occasions, and then accusing her of 'starting it'. A liar? I think so. Making so many racist, sexist and hate inciting remarks that he is losing the support of his own party. Dangerously stupid? I fear so.
1
single payer.
get on with it and get it over with.
get on with it and get it over with.
10
The sky is NOT falling. We knew it needed fixes, we have been saying we need to implement those fixes, but the party of STUPID won't let it happen. Let us organize and reboot this Republican tainted plan, AHA. Single payer sounds OK. But what are we going to do with all of the LONG TERM CARE patients, and why aren't we talking about them? Average cost on long term care plus the end costs are into the 100K's.
Maybe we should spend some of that P-drug money on actual cures, not what will make the most money.
Can we expect the youth to pay for this? Or will we make them pay for this?
Maybe we should spend some of that P-drug money on actual cures, not what will make the most money.
Can we expect the youth to pay for this? Or will we make them pay for this?
4
The Republicans have not tainted this plan, it is a creation solely of the Democrat party that crammed it onto an unwilling public before anyone had time to even read the law, because Nancy thought laws had to be passed before they could be read. Every Republican and Independent said it was not a sustainable plan, that premiums would be in a death spiral within a couple of years, that the poor and middle class would not have access to high quality care, etc.
ObamaCare had a fix for long term care. The law had them plugging a gap in the spending budget by having people buy long term care insurance, which would have reduced Medicaid spending, of which 50% is for long term care. The only problem with the plan is that it is cheaper for the wealthy to "Medicaid Plan" their assets than it is to pay for long term care insurance. It took the "experts" at HHS less than two years to determine that they couldn't set premiums low enough to entice anyone to pay them as long as the wealthy and middle class had Medicaid as a backstop. And they weren't about to remove an entitlement from the wealthy.
You make the statement that long term care plus end of life care are in the $100's. How many people are there who do not have a house worth in the $100s that cold be used for their long term and end-of-life care if they weren't able to "Medicaid plan"?
You want people to be able to leave their assets to their heirs after having the taxpayer cover their living costs.
ObamaCare had a fix for long term care. The law had them plugging a gap in the spending budget by having people buy long term care insurance, which would have reduced Medicaid spending, of which 50% is for long term care. The only problem with the plan is that it is cheaper for the wealthy to "Medicaid Plan" their assets than it is to pay for long term care insurance. It took the "experts" at HHS less than two years to determine that they couldn't set premiums low enough to entice anyone to pay them as long as the wealthy and middle class had Medicaid as a backstop. And they weren't about to remove an entitlement from the wealthy.
You make the statement that long term care plus end of life care are in the $100's. How many people are there who do not have a house worth in the $100s that cold be used for their long term and end-of-life care if they weren't able to "Medicaid plan"?
You want people to be able to leave their assets to their heirs after having the taxpayer cover their living costs.
2
Thinking as of today I will be leaving Obamacare program. Going it another option....It's just not working or made to work for the insured.
1
"Obamacare Marketplaces Are in Trouble. What Can Be Done?"
Eliminate the free market from the equation entirely. There ya go.
Eliminate the free market from the equation entirely. There ya go.
7
Insurance companies aren't in business to keep people healty. They are in business to make money. It's time for the public option, which is what they should have done in the first place, rather than going with something originally devised by the Heritage Foundation.
11
What did people think would happen? That they would get something for nothing? That there would be no cost to underwrite the uninsured? That those costs would not be passed through to insured individuals in the form of higher premiums.
Hardly coincidental that the cost crisis is coming to a head at the end of the administration. Come next January, it will be someone else's mess to clean up, while those who pay will continue to pay more.
Hardly coincidental that the cost crisis is coming to a head at the end of the administration. Come next January, it will be someone else's mess to clean up, while those who pay will continue to pay more.
14
In answer to the question of the article: Nothing!
This is nothing more than an orchestrated move by the Republicans and their big-money insurance companies to return things to the way they were. The insurance companies don't want to have to take everyone, regardless of the current problems. The Republicans in Congress want the big money to keep flowing into their pockets. It's just that simple.
This is nothing more than an orchestrated move by the Republicans and their big-money insurance companies to return things to the way they were. The insurance companies don't want to have to take everyone, regardless of the current problems. The Republicans in Congress want the big money to keep flowing into their pockets. It's just that simple.
4
Last I recall the Republicans were the ones who didn't cast a single vote to cartelize the health insurance industry, nor are they running the paid-for, "pragmatic" candidate favored by industry to keep the pull going.
1
If only there were some kind of functioning model or example of a health care system that works. If only there were some other country or countries that delivered cheaper health care with better results to all their citizens. If only we could use something like that to structure US health care. Too bad that's just a hollow dream. Once again the US has to invent it's own system, from the ground up, and set an example for the rest of the world.
4
There was a time when our healthcare and (economy in general) was the envy of the world, because we did exactly that. I hope this wasn't sarcasm, because I'm still of the opinion that progress in the future will begin with a reassertion and expansion of our original political philosophy of individualism and capitalism.
1
For the last 4 decades or so the incomes of those in the upper decile has gone up much more than for other workers. Most US healthcare workers tend to be in the upper decile or close to it. Until incomes of healthcare workers in the US start moderating, there will be no conceivable way to afford healthcare for every American without bankrupting our society.
What many do not realize is that there are many countries with private insurance, but what they have in addition is a public option that is the default. Germany is a perfect example. Everyone is automatically covered on the public plan. If you want bells and whistles, sign up for the private plans. Of course, we have to kill fee for service for this to work.
7
Single-payer, Medicare for all is the ONLY way for healthcare to work. Take the for-profit insurance companies out of the equation. Find them other jobs, McDonald's workers, waiters, dishwashers, etc.
9
"The market is too small"
"The problem: There are currently about half as many people in the exchanges as the Congressional Budget Office expected."
Well one solution that neither Reed Abelson or Margot Sanger-Katz did not offer is the federal government needs to implement more attractive policies and tax incentives so there is an increase of the labor force in the public sector of full time employees eligible for medical benefits. This should decrease a percentage of those with pre-conditions to obtain coverage through a larger pool.
"The problem: There are currently about half as many people in the exchanges as the Congressional Budget Office expected."
Well one solution that neither Reed Abelson or Margot Sanger-Katz did not offer is the federal government needs to implement more attractive policies and tax incentives so there is an increase of the labor force in the public sector of full time employees eligible for medical benefits. This should decrease a percentage of those with pre-conditions to obtain coverage through a larger pool.
Obamacare has a fatal flaw: Community rating. The ACA mandates that the sick can't be charged more than the healthy and the very costly older enrollees can't be charged anywhere close to what they cost. The young and healthy are grossly overcharged to subsidize the older and sick. Guess what. The young and healthy are not going to pay a lot of money for health insurance they really don't need at rates absolutely disconnected from their cost. Do you know what it means to have a $5,000 deductible? It means that for the first $5,000 of expenditures, you have no insurance. Yet, young, healthy people are charged a lot of money for this. They are smart enough to know that they are being forced to pay a lot for nothing. They aren't doing it and they won't do it. Try raising the tax penalties to force them to overpay for overpriced insurance and they will revolt.
5
Revolt? How? Camping out?
2
Charging the young and healthy to subsidize the old and sick is exactly the principle behind insurance. That's how it works (or doesn't, in this case).
3
No, insurance is when a group of people voluntarily pool a determined amount of contributions, and in return can expect a certain (and limited) benefit in the case of an unusual event.
Forcing universal (and potentially unlimited) contributions from everyone, in order to cover predictable (and also potentially unlimited) costs for both routine and unexpected medical costs might work (for a while), but it is not insurance.
Forcing universal (and potentially unlimited) contributions from everyone, in order to cover predictable (and also potentially unlimited) costs for both routine and unexpected medical costs might work (for a while), but it is not insurance.
3
I stopped buying health care insurance in 1996. I feel pretty good and try and eat correctly and take walks and do light exercise. I figure I would rather spend any money I have after my tax bill is paid to pay for Congressional health care insurance for our elected officials instead I should go to pay for my son's policy and also perhaps to take him to a movie now and then.
My family has a history of heart disease and I have asthma. I feel pretty good and thought the stress of paying out a bunch of money to vampires was greater than living without coverage.
By fate later I moved to a country that has socialized medicine. It is O.K. and I guess they will take care of me if I get ill.Perhaps not with all the hoopla of American health care but at least they will not make me wait 412 hours in an ER. I pay taxes now here and in the U.S. so both countries can buy great coverage for their officials. After all they are special people and they require special treatment. People here seem to take it for granted (coverage) here but at least the government works to take care of their sick. They usually go to private hospitals here if they get sick.I go to the government hospitals.They have better Q.A. then the private ones so I have a shot at surviving their care.
For some reason here they do more with less. Go figure.
My family has a history of heart disease and I have asthma. I feel pretty good and thought the stress of paying out a bunch of money to vampires was greater than living without coverage.
By fate later I moved to a country that has socialized medicine. It is O.K. and I guess they will take care of me if I get ill.Perhaps not with all the hoopla of American health care but at least they will not make me wait 412 hours in an ER. I pay taxes now here and in the U.S. so both countries can buy great coverage for their officials. After all they are special people and they require special treatment. People here seem to take it for granted (coverage) here but at least the government works to take care of their sick. They usually go to private hospitals here if they get sick.I go to the government hospitals.They have better Q.A. then the private ones so I have a shot at surviving their care.
For some reason here they do more with less. Go figure.
6
I have been hoping that Canada would just say to us that every US citizen that is not covered, or poorly covered would be covered under their system. Gratis. No questions asked.
How embarrassing.
How embarrassing.
Canada's health care system works fine for maintenance of chronic diseases and minor ailments. But when it comes to something major, Canadians who can afford it come to US. I know, my childhood friend lives in Toronto. She praised their system when she has to maintain her high blood pressure and diabetes. But when she got cancer, she changed her tune.
8
The big reason for disappearing choices and a small ACA marketplace is that insurers got caught in a Republican bait-and-switch scheme. In 2009 health economists and health insurance execs saw that with adoption of the ACA millions of very sick people would be signed up who were previously too sick to be insurable or had too much income to qualify for Medicaid.
Health insurers were promised to be held harmless through a clause in the ACA that created risk corridors. "The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law." (see Note 1) Once these peoples' conditions were being managed, projections indicated insurers would no longer need government help to be profitable.
However, in 2013 as a way to kill Obamacare, Senator Marco Rubio pushed the idea of restricting CMS' ability to fund these risk corridors adequately despite the government's prior promise. Language was dutifully incorporated into the 2014 Omnibus Budget Bill by Republican staffers on the Senate Budget Committee and the House Energy and Commerce Committee (See Note 2) which restricted monies usable for the risk corridors.
Notes:
1. http://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affo...
2. http://www.nationalreview.com/corner/428706/did-rubio-kill-obamacares-ri...
Health insurers were promised to be held harmless through a clause in the ACA that created risk corridors. "The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law." (see Note 1) Once these peoples' conditions were being managed, projections indicated insurers would no longer need government help to be profitable.
However, in 2013 as a way to kill Obamacare, Senator Marco Rubio pushed the idea of restricting CMS' ability to fund these risk corridors adequately despite the government's prior promise. Language was dutifully incorporated into the 2014 Omnibus Budget Bill by Republican staffers on the Senate Budget Committee and the House Energy and Commerce Committee (See Note 2) which restricted monies usable for the risk corridors.
Notes:
1. http://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affo...
2. http://www.nationalreview.com/corner/428706/did-rubio-kill-obamacares-ri...
7
How could a senator do such a thing without the POTUS signing it into law? Did you sleep during 5th grade civics? By the way, there were also committees and both houses that had to approve lol
4
The law says that I participate or be penalized. Yet private companies have the freedom to exit or change their participation status.....the premiums under Obama Care are more expensive and policies are even more complicated than they were 10 years ago when I decided to stop paying ridiculous premiums for nothing.
I started to put that money in my own insurance account. And I DID have a medical crisis that cost me $30,000. I paid cash, and I am still $25,000 ahead of the game had I continued paying premiums and I did not have to deal with anyone else's agenda during that very trying few months. All services rendered were %50 less than they would have cost with insurance and every doctor I dealt with sighed relief and spoke more freely with me than they would have.
ACA is an expensive joke .
I started to put that money in my own insurance account. And I DID have a medical crisis that cost me $30,000. I paid cash, and I am still $25,000 ahead of the game had I continued paying premiums and I did not have to deal with anyone else's agenda during that very trying few months. All services rendered were %50 less than they would have cost with insurance and every doctor I dealt with sighed relief and spoke more freely with me than they would have.
ACA is an expensive joke .
17
This is GREAT news. Just kidding.
After having our pre OBAMAcare coverage made unavailable to us we signed up with Aetna last year with a 286% increase in our Premium with little difference in the care available to us. If we see any additional increases we may just consider a move out of the country where healthcare is a bit more Sane.
After having our pre OBAMAcare coverage made unavailable to us we signed up with Aetna last year with a 286% increase in our Premium with little difference in the care available to us. If we see any additional increases we may just consider a move out of the country where healthcare is a bit more Sane.
13
I was hospitalized when I was around 11 yrs old for painful abdominal cramps. My single Mom worked full time at a Five and Dime store, but didn't have health insurance for us. Because of this, the hospital kept me on a bed in the hallway overnight--rather than putting me in a room.
Maybe they were trying to protect my poor Mom for a huge room bill; I don't know. But she was mortified that her child was in a public hallway and that she hadn't been able to provide better. She remembered that her whole life.
I'm 70 now--and have a"Cadillac" health plan, but I'm sure there are people who still have to deal with the "shame" of not having the means to take care of their family's illnesses. It isn't right. We should be able to take care of our people without piling on debt or misery.
Maybe they were trying to protect my poor Mom for a huge room bill; I don't know. But she was mortified that her child was in a public hallway and that she hadn't been able to provide better. She remembered that her whole life.
I'm 70 now--and have a"Cadillac" health plan, but I'm sure there are people who still have to deal with the "shame" of not having the means to take care of their family's illnesses. It isn't right. We should be able to take care of our people without piling on debt or misery.
13
I'm one of the 27 million without health insurance. I had individual coverage for nearly 30 years. I bought the coverage that I needed for my lifestyle and health status. Obamacare caused my plan to be cancelled. The replacement insurance available is crap, pure and simple. It would cost me more than I was paying before and cover almost nothing until I pay another $6,000 out-of-pocket. I might as well burn my cash. I would get the same benefit from burning it as I would by giving it to an insurance company. And, frankly, burning it at the front door of the an insurance company would be much more satisfying. I am not eligible for tax subsidies because I'm married and the threshold for receiving subsidies (per person) is much less than for a single person. And the cheapest individual plan available for the 50+ crowd is more than 8% of my income. So I don't have to pay the fine. This whole program has been a fiasco and is simply a tax that's paid directly to a private company.
25
What is collapsing is the profit driven medical racket. It's a model that cannot work anymore - top heavy with greedy executives and management (insurance companies, pharma and hospitals) and demands for 'shareholder return' on people's lives. Obamacare's problems are just a sad, highly visible part of this Faustian bargain.
For all of you outside of the ACA,with decent employee plans, don't smirk - you're next.
For all of you outside of the ACA,with decent employee plans, don't smirk - you're next.
15
How about if all Americans got their weight under control, started exercising, forego McDonalds, and cut out frivolous medical visits? I bet that would dent health care costs. Oh yeah, throw in tort reform.
5
If more choice and increased competition is supposed to drive down insurance prices, shouldn't increasing the number of doctors and hospitals in an insurance place increase competition and so drive down medical costs? Why then do insurance companies try to control medical costs by limiting the number of doctors and hospitals covered?
6
Why do we keep thinking America is so special that it is impossible for us to learn from the experiences of other countries. Perhaps health insurance should be limited to special coverage with standard care a human right.
As for Part C - the drug companies have abandoned their American identities for tax benefits. Why do we continue to subsidize them by not negotiating the price we pay for drugs like in other countries?
It looks like the drug and insurance companies continue to get value for their lobbying efforts.
As for Part C - the drug companies have abandoned their American identities for tax benefits. Why do we continue to subsidize them by not negotiating the price we pay for drugs like in other countries?
It looks like the drug and insurance companies continue to get value for their lobbying efforts.
16
Obamacare was never going to work well. Its real purpose was to make Obama look good. It was a cynical political move confirmed by the fact Obama gave the the insurance companies veto power over what he would propose. The only plan that will ever work is single payer. Real leadership would be a President making that case to the nation. NOT lying to us about what what Obamacare would accomplish.
18
How right you are!
3
The article failed to mention one of the primary reasons why the ACA is not fulfilling its promise, which is that far too few young healthy people are enrolling. A basic premise of Obamacare was that millions of these people would enroll, but require little care, thus subsiding lower costs for others. In theory, this was correct.
The questions becomes how to get them to enroll, and it seems to me that the solution relies on obvious economic principles. It is to increase the penalties on this group,for not enrolling. When it's in their economic interest to enroll, meaning when the cost of enrolling becomes cheaper than not enrolling, there will be a significant rise in the enrollment of this critical group.
The questions becomes how to get them to enroll, and it seems to me that the solution relies on obvious economic principles. It is to increase the penalties on this group,for not enrolling. When it's in their economic interest to enroll, meaning when the cost of enrolling becomes cheaper than not enrolling, there will be a significant rise in the enrollment of this critical group.
7
No changes to cost, coverage, networks or outcomes? Those are all working great. Just increase the penalties?
"The beatings will continue until morale improves".
"The beatings will continue until morale improves".
15
If the penalty for not enrolling in obamacare is made too great, it might result in a political backlash at election time against the democrats who support it.
5
When the fundamental premise of your policy is to use extortion and coercion to force people to act against their own interest then you have abandoned the principles of liberty and a free society.
15
It is easy to 'tighten the penalties' on the not insured. There are far too many advisers and experts who are out of touch. If the general public cannot afford the premiums, how can they afford the penalties? Tighten the providers to accept Obamacare, and reduce the costs to the uninsured.
5
I know a 20-something who says the insurance prices are too high for her - but I know that she is making $60-80k a year as a pretty conservative estimate. I think it's possible the price issue for a lot of younger people is cutting out indulgences is far less than the penalty and since they feel invulnerable as the young often do...
Longer-term coverage periods, universal health care, revoking coverage retroactively after a major medical expense if the individual drops out - or best, making health care a right rather than a discretionary item on the individual's budget would all take care of this problem.
But that would mean the will and compassion to make this work instead of continuing to sabotoge and weaken the program as those who are covered for life are doing....
Longer-term coverage periods, universal health care, revoking coverage retroactively after a major medical expense if the individual drops out - or best, making health care a right rather than a discretionary item on the individual's budget would all take care of this problem.
But that would mean the will and compassion to make this work instead of continuing to sabotoge and weaken the program as those who are covered for life are doing....
4
Even if you make healthcare a so-called "right", it will still cost $3-trillion/year to fund this "right". Do you really think doctors and nurses will do it for free? Do you think they will do it for the same money we pay a road crew laborer?
Or perhaps you intend to create a 75% tax on the wealthy like France did... I hear it solved all of their problems.
What you speak of is the road to East Germany my friend.
Or perhaps you intend to create a 75% tax on the wealthy like France did... I hear it solved all of their problems.
What you speak of is the road to East Germany my friend.
5
Make smokers and overweight people pay more, or don't insure them at all.
3
What can be done?? Are you serious? Pull the thing out by the roots so it can't grow back. My insurance rates have doubled because I have to pay the rates for the crack addicted HIV infected prostitute down the road. There's a problem with that.
Those who were insurable and insured before are all suffering today. Is underwriting immoral? Should people have to pay for the risk they'll get sick? No and Yes.
Those who were insurable and insured before are all suffering today. Is underwriting immoral? Should people have to pay for the risk they'll get sick? No and Yes.
13
Now you want to chip away at employee benefits - that's not fixing the system! Doctor's in this country use to be middle class, now they're part of the upper echelon. Insurance companies are about profits not healthcare or protection We are surrounded by GREED!
9
I beg to differ- doctors are all on salary now. They make less than when they were in business for themselves because they are chained to the insurance companies.
3
single payer
single payer
single payer.
single payer
single payer.
25
America should just give up. Declare Victory and buy the Japanese or German Healthcare system flat out. Then VA, Medicaid, Medicare, Tricare, Chip, Somecare, Maybe Care Brokecare, Aetna can't afford 17 G-6 jets on ACA care, can be scrapped for a Private - Non Government uniform Healthcare IT and Payment system by Private insurers with Single Price Schedule that the Two countries do so well at half the cost (Germany) and 1/3 the cost (Japan) than we do - and they live longer. And - And Japan has long term care insurance that everyone participates starting at age 40. (sigh) so no more bankrupting Grandma to make her eligible for state Medicaid. - 100% covered - And they do all this with Free college to Boot.
10
The EpiPen CEO should consider what it would be like some day.. To be at the beach in a roaring surf and to watch her grandchild being carried out in trouble by the rip tide. To see her loved one struggle to keep her head up and to start to go under. To look toward the lifeguards for their help and instead of the lifeguards helping the lifeguards hand her a form and ask her to fill it out.
Universal Healthcare coverage should be a no-brainer just as lifeguards are at the beach.
8
What a shock. Tax payer subsidies of for profit insurers is causing prices to rise. Too bad our taxes couldn't be used to expand Medicare.
17
This is the end-game of the Tea Party agenda in the House. Ignore the work of fixing the bugs, and wait for healthcare to fall apart.
Time to vote the calculating miscreants out.
Time to vote the calculating miscreants out.
4
Just plant the magic trees that all the free stuff will grow on....
10
...or we can think happy thoughts about our stock options while we step over the bodies of fellow Americans in the streets, whose paychecks just weren't large enough to cover, say, the cost of their EpiPens. I mean, Mylan's profits were only $847 million last year. Can't squeeze blood from a turnip.
5
You've got a problem. The conglomerate hospitals are having a feeding frenzy ordering tests, outrageous salaries, ridiculous advertising, easy billing with computers using jacked-up visit times, paid for by high deductibles, soaring insurance rates, hidden fees. You've got clinicians sitting at computers all day long, logging in their hours, complying with out-of-control regulations. Right now it's being barely covered but there's going to be a crunch, with layoffs, insurance companies bailing out, VP's walking away with huge packages. It's getting ugly. The worse yet to come.
7
Every conservative who accurately predicted this was stoned and shunned by the liberals and their media allies. Will they ever admit they were wrong? Of course not, they will probably blame Trump somehow.
6
Declining: ACA is a fail, there's no doubt in my mind. But that's because the President abdicated responsibility for healthcare reform to a cabal led by dimwitted Max Baucus and kitchen cabinet insider Valerie Jarrett who cut deals w hospitals, big pharma and device manufacturers to buy their silence. There is no earthly reason the United States can't have universal health care ala Switzerland, Singapore, Denmark, Austria, Sweden or any other industrialized nation. Germany has a government run scheme that can aggressively control cost because of 91% participation. It also offers access to 200+ private, for profit medical provider consortiums. All of the nations I listed, and more, have longer life expectancies and lower infant mortality rates. These countries actually exist and they are not bankrupt. Take a look at CIA World Factbook/Guide to Country Comparisons/People and Society
11
Germany and others also benefit from the life-saving patents and copyrights which are (mostly) privately funded by the evil corporation and it's evil profit-motive in what is remaining of the evil capitalism of the US. Remove US's scope and scale of innovation from this past generation of medical experts (unmatched anywhere else by capita or any other parameter) and no one would be able to pretend that the medical-welfare statist scheme is financially or morally sustainable. We don't have the luxury of relying on some other country to invent things which we can repatent (or not patent at all, like in China or India). So yes, there is a glaring reason why we cannot adopt the anti-mind, anti-ability, anti-profit, anti-freedom philosophy of the rest of the world.
Here in Southern California I've met several young people who don't purchase health insurance. When I asked them why the responses can be paraphrased as "I just didn't want to spend the money." At least one of them ended up in the emergency room with a broken jaw that needed to be fixed. This, of course, is paid for by all of us who chose to do the right thing i.e. skip the $2000 4K TV and get health insurance instead.
Please...bring on a single payer system. Take it out of their taxes so they never even see it to begin with. If they can't bring themselves to do the responsible thing then let the government do it for them. Weed out these moochers. Is this not Republican?
Please...bring on a single payer system. Take it out of their taxes so they never even see it to begin with. If they can't bring themselves to do the responsible thing then let the government do it for them. Weed out these moochers. Is this not Republican?
13
From the beginning the ACA was seen as, "not perfect", by President Obama. He said that it is a work in progress, as I am sure we can remember, perhaps some need more remember stretching than others.
The republican hold over the house and senate has prevented any movement to better the ACA. In fact, from the very beginning the republicans have stormed against this without bringing ANY reasonable alternative to the floor for examination and/or debate.
I have no kind words for those that hold the house and senate as hostage to their own prejudice. This has hurt millions of good folks that have no other choice for their health care and bring enormous profits ONLY for the benefit of the stock holders and the officers of those companies, and care nothing about the health of our nation, or people.
The republican hold over the house and senate has prevented any movement to better the ACA. In fact, from the very beginning the republicans have stormed against this without bringing ANY reasonable alternative to the floor for examination and/or debate.
I have no kind words for those that hold the house and senate as hostage to their own prejudice. This has hurt millions of good folks that have no other choice for their health care and bring enormous profits ONLY for the benefit of the stock holders and the officers of those companies, and care nothing about the health of our nation, or people.
5
Despite the fact that Republicans held the house and senate (which the gained because of, and arguably solely because of the disdain for Obamacare), president Obama and the Democrats chose to expend all of their political power to keep and maintain this law- even resorting to several Executive Orders to amend parts of the law (see: the deadline extensions by Obama). This is the Democrats' law, and not the republicans. If they regret it and wish to place the blame on someone else, I'd count it as a confession that it was not worth the time and effort to force this law in the first place.
2
From a political perspective, the bottom line is this: President Obama simply didn't have the political skill and/or guts to try to get the DINOs in the Senate (Baucus, Lieberman, etc.) to relax their opposition to the public option. He caved right away. The PPACA as it was enacted was a tremendous waste of political power for the Democrats and has been a negative infomercial against them ever since. If that was the best they could do, when they had the largest majorities in both houses of Congress that they had since the 1970s and that they are likely to have for a long time, then what's the point of making the Democrats the governing party of this country? The Democrats have yet to come up with a good answer for that one (notwithstanding a likely victory in this year's presidential election, since that victory will be by default due to how flawed Trump is).
5
Who could possibly have seen this coming. I hate to be a bearer of bad news but our health care system is out of control expensive. There isn't one new treatment,drug or procedure that isn't priced way too high. Everyone wants the best of everything at Walmart prices, with our sense of entitlement on health care being borderline delusional. I could list a thousand things that our society should not be paying for but what's the point.
11
So we dismiss a public option as "controversial, and hard to make work in practice"?
Oh, that's right. Obamacare without a public option is not controversial - everyone across the spectrum sings its praises. And as this piece makes clear, it's easy as pie to make work.
To write a responsible piece on this subject that does not simply transcribe the spin of politicians, insurance companies, hospitals, and others with a stake in the current system, you need to get down in the trenches and talk to the workers and advocates who see on a daily basis the devastating effects of our massively redundant, incredibly complex, market-driven model which measures success by the fraction of those who have insurance rather than the fraction who actually receive the care they need. Talk to the nurses and other community providers, and see if they agree that a public system like those in the rest of the world that are much simpler and easier to administer, and produce far better outcomes at far lower cost, would be impractical to implement here.
Oh, that's right. Obamacare without a public option is not controversial - everyone across the spectrum sings its praises. And as this piece makes clear, it's easy as pie to make work.
To write a responsible piece on this subject that does not simply transcribe the spin of politicians, insurance companies, hospitals, and others with a stake in the current system, you need to get down in the trenches and talk to the workers and advocates who see on a daily basis the devastating effects of our massively redundant, incredibly complex, market-driven model which measures success by the fraction of those who have insurance rather than the fraction who actually receive the care they need. Talk to the nurses and other community providers, and see if they agree that a public system like those in the rest of the world that are much simpler and easier to administer, and produce far better outcomes at far lower cost, would be impractical to implement here.
7
Yes, indeed, the heavy hand and boot of the government making it even more unsavory to get insurance and penalizing the citizens in the land of the free trying to pursuit happiness by increasing the penalties for not doing what most of the citizens didn't want in the first place.
Brilliant strategy, all on the advice of some economist who believes people will only obey when beat hard enough.
Brilliant strategy, all on the advice of some economist who believes people will only obey when beat hard enough.
5
I've seen well-reasoned articles lately discussing that one of the biggest issues is that the doctors were not a key part of the discussion of where the costs were/are the greatest. So we now have the most expensive patients in the system, getting care, which is great, but not enough of the healthy and their premiums to balance the system out.
And then there's the ACA equivalent of the Medicare "donut hole". Those of us who make just enough to have a limited subsidy, but not enough income to really cover both the cost of the insurance and the deductible, while being healthy enough not to really need regular service.
Many cannot afford what is essentially only major medical insurance, and gamble that the combination of the penalty for non-insurance plus any out-of-pocket costs will be less than the combination of costly ($500-$1000/month/individual) monthly insurance and a high deductible of $6K or more.
The insurance companies are more than covering their costs, while more and more medicines are being dropped from the formularies, so even those with insurance often cannot get the meds they need except by out-of-pocket costs, and they are limiting how much time docs can spend with patients, while literally making the docs and nurses itemize every single part of a patient's visit. If one is employed, maybe there's decent insurance, but probably not. It's a mess. And I was a supporter of the concept of ACA.
And then there's the ACA equivalent of the Medicare "donut hole". Those of us who make just enough to have a limited subsidy, but not enough income to really cover both the cost of the insurance and the deductible, while being healthy enough not to really need regular service.
Many cannot afford what is essentially only major medical insurance, and gamble that the combination of the penalty for non-insurance plus any out-of-pocket costs will be less than the combination of costly ($500-$1000/month/individual) monthly insurance and a high deductible of $6K or more.
The insurance companies are more than covering their costs, while more and more medicines are being dropped from the formularies, so even those with insurance often cannot get the meds they need except by out-of-pocket costs, and they are limiting how much time docs can spend with patients, while literally making the docs and nurses itemize every single part of a patient's visit. If one is employed, maybe there's decent insurance, but probably not. It's a mess. And I was a supporter of the concept of ACA.
11
The Dems caved when they had both houses and the presidency. They are so often cowards, unfortunately.
Lieberman threatens a filibuster over the public option, and they all quake and get in bed with private health firms.
Now we have a real mess.
Lieberman threatens a filibuster over the public option, and they all quake and get in bed with private health firms.
Now we have a real mess.
13
Obama caved even before he got started. That's how he "negotiates" everything. Give away the store before even trying to get a good deal.
8
And, yet, it is a miracle they did anything at all. The problem is not simply the Democrats. It is the Republicans and everyone else.
2
One additional point: most of the insurance available in the pools is near worthless. I could have purchased a $328 per month policy (down from $429) that carried $14,600 annually in out-of-pocket (OOP) and deductible expenses. An ER visit cost $400 OOP, and my co-pays were quite high. Unless I suffered a major injury or illness I was paying almost $4,000 to pay $14,600 before insurance really kicked in. Very few policies in the marketplace are better than "bronze" and insurers offer high deductibles and OOP expenses, I assume, intentionally, since the odds of having to actually cover something are in their favor. Give people something worthwhile to purchase, and the market will thrive.
21
This reminds me of the mess that is the student loan industry. We all have to pay back our student loans so that other students can take advantage of the student loan programs.
Unless the healthy are told they have to buy insurance, Obamacare won't work. SO if we want something other than single-payer, we have to beef up the penalties to half or 2/3 the annual premium of the policy (instead of income-based penalty, which just allows the healthy working/middle class young people to opt out).
Unless the healthy are told they have to buy insurance, Obamacare won't work. SO if we want something other than single-payer, we have to beef up the penalties to half or 2/3 the annual premium of the policy (instead of income-based penalty, which just allows the healthy working/middle class young people to opt out).
1
Finally, in a very casual manner, it is mentioned that the doctors and hospitals charge a lot more in the USA than in other countries. And, sir, that is the root cause of the runaway costs. Unless this is addressed by price control or introducing extreme competition like what has been done to engineers, lawyers, etc. the costs will continue to go up and we will end up like a third world country.
12
This has been out for ever... Nobody checks on the price presented by HC providers... That is the issue. In most developed countries if u select private insurance with max 500$ x month u r fully covered for everything... All private... No deductibles no out of pocket. In the US the system is a legalized robbery plain and simple... And nobody does anything to change that!!
6
You can control, if you wish, what doctors charge in a national system, but you can't make young people choose medicine as a profession. Guess what you run out of?
1
The affordability exemption, when the low cost bronze plan costs more than 8.05% of income, becomes an option for many in 2017. Its the math of 25% premium hikes and the ACA age premium scale. The healthy, middle aged with moderate incomes in excess of 400% of the federal poverty level will opt out of the ACA without penalty. The unhealthy and unsubsidized will still pay for plans. In trouble? Wait until the young figure out they still have to pay the penalty while their older neighbors do not.
3
One reads all about the woos of insurers losing money from the marketplace exchanges, but do we read from anyone, yes, anyone about the costs running wild. Now from day one has costs been given any attention. So, now insurers are complaining they are losing money. I don't think we are getting the whole story about Obamacare. Again, the problem has been, and still is, all about this wonderful medical healthcare in the U.S. that is driven by profits. The attention should be for healthcare for Americans, not profits for businesses.
5
The cost issue is very important. I had an emergency when I was uncovered (for a month) and the hospital bill ended up being in excess of $100,000 for everything. But when they found I was uninsured they offered a one-time only reduction in the bill to $18,800. I paid, but I still wonder what the mark ups must be. This was a for-profit hospital.
8
Separate the system. Divide the day-to-day healthcare needs from the extraordinary needs. (I despise the entire notion of insurance as it is a national form of institutionalized gambling.) At the moment with deductibles and co-pays even the most basic care is a cost on top of the premium. These are inexpensive, routine matters. But the deductible acts as a disincentive to engage the system even at the preventative stage or for routine matters. And make incentives for those who do pursue health. There is no incentive in the system to pursue health. Just one to avoid the punishment of cost. The whole thing is upside down and run by people (including the people who set up the system, including the President) who work within a fatally flawed system and show a lack of intelligence and leadership for doing so.
4
"(I despise the entire notion of insurance as it is a national form of institutionalized gambling)"
I despise the entire notion of life, as it is just a natural form of gambling...
I despise the entire notion of life, as it is just a natural form of gambling...
2
The answer has been staring us in the face for years: a single payer system. Medicare for all. It's really not a hard concept, unless you own stock in a private insurance company.
I lived in Canada for about a decade. Health care was among the items I paid for in each paycheck, about $200 as recall. I received excellent care, including hospital stays and treatment from specialists. Only thing missing was a bill.
I lived in Canada for about a decade. Health care was among the items I paid for in each paycheck, about $200 as recall. I received excellent care, including hospital stays and treatment from specialists. Only thing missing was a bill.
12
Was this for a single person, or a family?
Was this a weekly, semi monthly, monthly or what?
Was this for the medical premium or extended health benefits (dental, prescriptions..)?
Current monthly medical premiums (only for 3 provinces, others 'free') are income adjusted but if above an annual income of $30,000, $75 (single), $136 (family of 2), $150 (family 3+). If less than $22,000 annual, no premiums.
http://www.canadian-healthcare.org/page3.html
Was this a weekly, semi monthly, monthly or what?
Was this for the medical premium or extended health benefits (dental, prescriptions..)?
Current monthly medical premiums (only for 3 provinces, others 'free') are income adjusted but if above an annual income of $30,000, $75 (single), $136 (family of 2), $150 (family 3+). If less than $22,000 annual, no premiums.
http://www.canadian-healthcare.org/page3.html
1
Between Medicare and Medicaid, the US' single payer system has 100 million participants. 5 times the population of Canada.
2
"Obamacare Marketplaces Are in Trouble. What Can Be Done?"
Maybe those who were constantly bashing Republicans for having any doubts about ACA can now apologize?
Nyah, forget it. Trump does not apologize and neither do Democrats.
Soon after 2009, I blamed Obama for not having the courage to campaign for single payer health care.
I did not know then that courage is not his strong suit.
Maybe those who were constantly bashing Republicans for having any doubts about ACA can now apologize?
Nyah, forget it. Trump does not apologize and neither do Democrats.
Soon after 2009, I blamed Obama for not having the courage to campaign for single payer health care.
I did not know then that courage is not his strong suit.
11
Don't disagree, but he was never going to get that passed.
Republicans are the problem here, showing up to "work" about one-half of the year, only to vote some 52 plus times to "repeal" the ACA, without any attempt to work on the bugs, fix them and get more Americans insured.
This is reprehensible behavior on the part of the Republican Party and the blame for this rests squarely upon their shoulders. And, in the House, they are paid on average $175,000 per year at the taxpayer's expense, with benefit of top-notch, single-payer healthcare. Disgusting.
Would you keep your job with such record-breaking absenteeism and failure to produce? Vote the down-ticket freeloaders out of office.
This is reprehensible behavior on the part of the Republican Party and the blame for this rests squarely upon their shoulders. And, in the House, they are paid on average $175,000 per year at the taxpayer's expense, with benefit of top-notch, single-payer healthcare. Disgusting.
Would you keep your job with such record-breaking absenteeism and failure to produce? Vote the down-ticket freeloaders out of office.
2
Obama's courage or lack thereof has nothing to do with it. We will have single payer if and when a substantial majority of voters demand it.
1
Just because insurers are not finding adequate profits does not mean that the ACA is failing, it means that the assertion that markets can satisfy the need for health care is a crock because health care is a necessity throughout people's lives, everyone's lives, and can only offer profits if all of those needs are not met by the insurers.
3
When a family of four with a husband and wufe both working have to pay $1100 per month for their coverage, then $300 deductibles for ER visits and $100 deductibles for urgent care visits -- and then get to watch Medicaid parent and kids walk in for the exact same care while paying zero -- something smells.
33
You are more than right. Now, would you care to explain where you believe the fault lies? My answer, we have no National Health Care and so there are those who can profit handily from illness.
Your turn.
Your turn.
1
The Medicaid recipients aren't paying anything but you and I are.
4
Promises Promises. Keep your doctor - nope, lower prices - nope, market competition - nope, all insured - nope, economy benefits - nope, less government spending - nope. Should've been called ObamaCareLess
19
What did anyone expect when the speaker of the house announced that the bill would be read after enactment? That there would be a public benefit in such a shoddy, railroaded maneuver?
Cold comfort that it will be difficult to spin this debacle as a massive humanitarian achievement on the history books.
Cold comfort that it will be difficult to spin this debacle as a massive humanitarian achievement on the history books.
1
For profit health insurance companies will never make enough profit! It's time for a single payer program! Obama chose this for profit model and it's appalling. He's a corporatist and has never embraced policies that were good for humans. His goal is to protect corporations, CEOs and billionaires. Why else would he be fighting so hard for the TPP?
9
"I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody." - BHO
You would do well to review the climate in congress when the ACA was passed....you'll see that there was no way single payer was going to pass.
You would do well to review the climate in congress when the ACA was passed....you'll see that there was no way single payer was going to pass.
most people don't want to pay 40-50% rate income tax so they can get a 2nd rate single payer health care system. everyone and every experts know that expanding medicare for everyone is going to cost more money. right now, we do have a health care system that is rationed based upon wealth and ability to pay, but if our health care system was so bad, people with money wouldn't be coming to the US to get their treatments. So it's the same old story ... how much money are we willing to take from the rich to support the poor? And do you think rich people are going to let that happen laying down?
25
Its not as simple as taking from the rich to give to the poor. The socialists seem to define rich as anyone who makes more than Sixty thousand. Pretty soon, it will be anyone who has a job.
1
Here in the real world it is the rich who are extracting ever greater sums from the rest. "Redistribution" is going up the economic ladder, not down. The people fleecing you just want you to feel sorry for them. It appears they have succeeded.
1
NO I do not expect them to take it laying down, I expect them to throw a screaming-spoiled-brat-tantrum! But what can they do?
If everyone pays their 10 years into the system to subsequently receive Medicare, sure, let's give it a try.
2
The individual mandate needs to be larger, $675 is not high enough. Too many healthy people are forgoing insurance until the moment they get sick. More healthy people in the insurance pools would help cover the cost of the sick.
1
The $675 decision was political, not pragmatic.
Problem Number 5
When the government sticks their sausage fingers into a market and stirs the pot, they create all manner of distortions that the all-seeing never-run-a-business bureaucrats did not foresee.
When the government sticks their sausage fingers into a market and stirs the pot, they create all manner of distortions that the all-seeing never-run-a-business bureaucrats did not foresee.
6
Professor Maxwell,
Please provide the equation reconciling "for profit insurance", cost to business for illness and its remediation, efficiency of market place, just compensation of insurance company execs, societal costs for the uninsured and concomitant cost for the insured for the loss of services due to overload by the uninsured. There are a few other factors, but you can leave them out for the moment.
Please provide the equation reconciling "for profit insurance", cost to business for illness and its remediation, efficiency of market place, just compensation of insurance company execs, societal costs for the uninsured and concomitant cost for the insured for the loss of services due to overload by the uninsured. There are a few other factors, but you can leave them out for the moment.
1
The capitalist invisible hand has been giving American workers the finger for most of American history.
30 Million uninsured before Obamacare (why set up a program to deal with the 30 Million when you can destroy everyone's healthcare?) and 27 Million still uninsured 3 years into Obamacare.....higher premiums, higher deductibles, fewer choices.......complete success: US healthcare ruined....
18
How can so many be misinformed? Obama wanted health care for all; Republicans said no.
It's disgusting that this is happening in this country. We are becoming the most corrupt in the world instead of being progressive. The insurance companies are in charge of the government for their own benefit. We are forced to buy car insurance, hence people are not careful about driving. We are forced to buy home insurance, otherwise, we cannot get a mortgage. Now, we are forced to buy healthcare that won't pay our bills anyway with the high deductibles. And if we don't buy we get penalized in our taxes as punishment for being basically healthy. Some want this penalty to increase. Some want employees to leave the plans offered by employers. Employers would love that! Less benefits to pay. Etc. etc. etc. Top 1% makes all the money, at the expense (burglary) of an increasing workforce that is underemployed or with no job security. We are returning to the dark ages with no signs of hope. We are being robbed. There is no way these thieves, oh sorry, insurance companies are going to let governments take their pot of gold away.
7
You got it wrong: the doctors and hospitals RIP you off. Insurance companies only add a percentage. I do not work for any insurance company
1
Hillary told us months ago we "never, ever" will have single payer and faux liberal pundits like Krugman cheered. Of course the millions donated by Big Pharm, Big medical and Big insurance to Hillary's campaign and speaking fees have nothing to do with her policy advocacy. Even if they did not give her a dime, she would oppose single payer because. . . .
11
Gee, isn't this result the one that was described in detail as the negative case against Obamacare prior to its' passing? And for three years we have heard how successful this program was for President Obama's term in office.
First, a foreseeable and predicted result, Second - we've been lied to ever since about its' true costs and success. And they called President Bush a liar.
First, a foreseeable and predicted result, Second - we've been lied to ever since about its' true costs and success. And they called President Bush a liar.
15
Obama's good intentions = corporate lies and greed. Bush's lies = thousands dead and destruction.
1
Healthcare--and health insurance--would improve in this country if we considered it a basic human right, not a profit center. I have a relative who is an MD, and while I know he worked very hard in medical school, it's hard to listen to him complain that he doesn't get paid enough when he's living in a $2 million house, pays for two kids in private colleges, trades in the family's luxury cars every two years for the latest models, and takes vacations at least four times a year? I don't begrudge him his success or his comfortable lifestyle, but at some point, shouldn't the public good outweigh his desire to live the high life?
14
"I don't begrudge him his success..." Hah!
5
Medical school costs about $300,000 nowadays. Are the taxpayers ready to pay for free medical school? Doctors don't even begin to live "the good life" until way into their 40's after school, loans and residency. The sacrifices are enormous. And not all doctors make incredible incomes. Those on Wall Street do much better. You have sour grapes. When you are ready to do all of the above, work weekends and evenings on-call and get woken in the middle of the night for little pay, then we can talk!
8
A few typical, related confusions should be clarified, here. First, both ACA tax credits and tax deductions for premiums paid by those whose incomes exceed the maximum for ACA tax credits are tax (taxpayer) subsidies, recalculated variously at the time of income tax filing. So all insurance payers are receiving some form of Federal healthcare subsidy; and any healthcare cost reductions benefit "taxpayers" across the board. Second, any increase in health care premiums charged those not receiving ACA credits are not borne full-brunt by the insured, but discounted in relation to their effective marginal tax rate taking into account federal, social security, state, and local taxes. Third, the 400% of poverty level requirement for ACA tax credits reaches above the median national income, so we should not play fast and loose with the term "middle-income customers" when discussing those who find premium increases unaffordable. For all but a borderline slice of these so-called "middle-income customers" above 400% of the poverty level, premium increases are "unaffordable" in relation to discretionary income disposed elsewhere - choices most receiving ACA tax credits do not have. In sum, it is best to forge consensus around reducing overall healthcare costs than pitting two forms of tax subsidy against each other, those of the haves and those of the majority of the American people who, by the ACA's measures, are the have nots.
2
In that list of "problems" the major one is omitted: the penalty for not having health insurance is too low: $695 per adult and $347.50 per child (up to $2,085 for a family). That penalty is so far below the cost of health insurance that many go without ... and those who go without tend to be the healthier, no surprise.
5
Single payer (Medicare to all) would solve all of these problems. The only system that is going to work is one in which people pay a percentage of their income for health insurance.
11
No, Medicare for all does not fix price gouging by hospitals & big pharmacy. Nationalize the whole healthcare industry.
3
Randy Johnson: add the doctors to your list below. They are the root cause.
Well, friends. The "death spiral" of Obamacare was both predictable and predicted. But there's an opportunity here.
Some folks will observe that some of Obamacare's architects expected it to prove unsustainable, thus requiring a fix. That fix would be a "public option."
Let me suggest this: We already a number of public options: Medicaid, Medicare, Tricare (for the military) and the VA system (for veterans). They are all badly designed. (Among other things, healthcare providers lose money on Medicaid and Tricare -- I've seen decades of hospitals' records -- and they have to make up the losses on "commercial" payers.)
So, how about this?: Consolidate some of these badly-run programs with a single, better-designed "public option"? Cap the annual public expenditures, and let everyone know that people are going to line up for access to the "free" public option. (That's virtually a law of economics, friends: If you make stuff "free", there are going to be long lines. Grow up and get used to it.) Let them also know that they can dispense with the long lines and pay out of pocket to go to a healthcare provider who doesn't accept compensation from the government.
Everyone's happy that way.
To folks who complain that no one should be able to pay out of pocket to get fast service: You're basically asking for the Soviet system, a system by which the State hires all physicians and bans "private" care.
Some folks will observe that some of Obamacare's architects expected it to prove unsustainable, thus requiring a fix. That fix would be a "public option."
Let me suggest this: We already a number of public options: Medicaid, Medicare, Tricare (for the military) and the VA system (for veterans). They are all badly designed. (Among other things, healthcare providers lose money on Medicaid and Tricare -- I've seen decades of hospitals' records -- and they have to make up the losses on "commercial" payers.)
So, how about this?: Consolidate some of these badly-run programs with a single, better-designed "public option"? Cap the annual public expenditures, and let everyone know that people are going to line up for access to the "free" public option. (That's virtually a law of economics, friends: If you make stuff "free", there are going to be long lines. Grow up and get used to it.) Let them also know that they can dispense with the long lines and pay out of pocket to go to a healthcare provider who doesn't accept compensation from the government.
Everyone's happy that way.
To folks who complain that no one should be able to pay out of pocket to get fast service: You're basically asking for the Soviet system, a system by which the State hires all physicians and bans "private" care.
5
No, I am asking for the British national healthcare system where the government (the people) hire hospitals and doctors and force CEOs to steal from others than the sick.
2
Having lived and worked overseas for a few years, I can tell you that europeans look upon the US in this matter with a mixture of amusement and pity.
It's sort of like looking at a dull child trying to invent the wheel, while everyone else is riding around on bicycles.
Canada, England, Australia, Japan, France, Germany -- Every other industrial nation on earth has figured this out. Their systems are not perfect. But they are far better than what the US has.
Citizens of those countries simply don't have to worry about healthcare.
Pick the best system. The one with the best outcomes and lowest cost. Copy and paste.
It's sort of like looking at a dull child trying to invent the wheel, while everyone else is riding around on bicycles.
Canada, England, Australia, Japan, France, Germany -- Every other industrial nation on earth has figured this out. Their systems are not perfect. But they are far better than what the US has.
Citizens of those countries simply don't have to worry about healthcare.
Pick the best system. The one with the best outcomes and lowest cost. Copy and paste.
54
And here we cannot even nominate a candidate who believes in single payer for all Americans. They are all bought and paid for by big medical which is driven by greed and profits.
We all know it, but have no power to change the system. And for the privilege of crummy healthcare, we pay twice as much as most other Countries that obtain better results.
The solution--if you oppose single payer for everyone you have to oppose Medicare. Now I wonder how long a politician would stay in power threatening to get rid of Medicare?
We all know it, but have no power to change the system. And for the privilege of crummy healthcare, we pay twice as much as most other Countries that obtain better results.
The solution--if you oppose single payer for everyone you have to oppose Medicare. Now I wonder how long a politician would stay in power threatening to get rid of Medicare?
1
So what if we get a presidential candidate that supports single payer, when Congress would not let that happen.
The only option is a National Health Service to which all must belong and pay premiums, all physicians and hospitals must offer services. Private institutions and doctors can have part time private practice, if they wish, for patients that are willing to pay the price. Concierge medicine anyone. And it is here the insurance companies can find their clients.
All are covered, drug prices are negotiated.
All are covered, drug prices are negotiated.
14
I am concerned that under the National Health Services system that people are proposing, 80% of us of will end up in Medicaid, and the other 20% will have the "concierge" + private pay medicine (cash and/or gold standard, private pay health insurance). The best doctors will not work "full time" or "part time" for the 80% ("all physicians . . . must offer services" - says who under the 13th Amendment?). The best doctors will work "full time" for the 20%. There are doctors and practices, today, that do not accept Medicare. Most don't take Medicaid, period! For it to work, the benefits of the "NHS-USA" better be equal to or exceed those of the existing Medicare program. It must pay the medical services community enough - so that a private pay market will not prosper.
3
There's a private pay market in the UK that exists alongside the NHS, but 8%, not 20% take advantage of it. Complaints about NHS need to be weighed against the everyday personal medical and financial disasters caused by the US system, and the fundamental reality that we pay much more for care than those in the UK while receiving less and poorer care on every metric.
1
His "signature accomplish" -- a multibillion dollar failure.
Quite the legacy, Barry -- heck of a job.
Quite the legacy, Barry -- heck of a job.
12
And yet it's working quite well in states like California where they are actually trying to make it work. Only the kind of Republicans who voted for Bush twice would think that it's a failure to insure 20 million more people. Only a loyal Republican thinks Bushcare - when premiums and health care costs were soaring (more than they have since the ACA was enacted) and millions were losing their health insurance - is somehow preferable to the Obamacare reforms. Just wait and see what a fiasco it will be if Republicans ever get their wish and Obamacare is repealed. For starters, you could deduct about ten years from the solvency of Medicare, reversing much of the improvement in solvency since Obamacare was enacted.
5
If the Republicans had not torpedoed it at every turn it might have worked. And it still might. So it was not the concept, bad as it is because it still keeps private insurance companies in the loop, it was sabotage by those sworn to protect and defend the Constitution which has a clause "and provide for the general welfare", welfare in this case not meaning handouts but state of well being.
3
"Failure"? Millions are now insured who weren't before, including half a million now covered through Medicaid expansion in your state. Not exactly a failure.
5
The sooner we get to the public option the better for all of us. Even if it takes a few bumpy years. Let's go. I'd love to see these third party rip off artists disappear. And hopefully we can curtail big pharma while we are at it.
12
Let me get this straight: I have to buy obama care, but the insurers do not have to provide it and it is an effective monopoly therefor expensive and getting morte expensive. Remind me how this helps me?
12
One of the primary reasons the public exchanges are struggling is because Marco Rubio greatly reduced the federal insurance risk corridor via amendment to a funding bill. This little known legislative tactic - aimed at trying to kill the ACA - has left private insurance companies responsible for costs they cannot bear without raising premiums.
The New York Times would do well to explain the legislative reason why the exchanges are struggling and employers are facing rapidly rising premiums. If Rubio had not reduced the risk corridor the health insurance industry would be in a far different place right now.
The New York Times would do well to explain the legislative reason why the exchanges are struggling and employers are facing rapidly rising premiums. If Rubio had not reduced the risk corridor the health insurance industry would be in a far different place right now.
16
put everyone on medicare, paying it at fair rates. let the federal government do some work - don't rely on the states.
8
If they would just let us grow our own medical marijuana, all our health needs would be solved.
Of course, we'd have to be on the lookout for intrusions by "Big Farma!"
Of course, we'd have to be on the lookout for intrusions by "Big Farma!"
5
It seems like some expenses for insurance companies will go down naturally as people who were not insured for many years start to resolve long-untreated problems.
4
Yeah, right here in these pages of the Times folks, the public option is "controversial and hard to make work in practice." Lets just not consider that for the entirety of the article. We only print what rich people want to hear, not the truth. "All the news that's fit for rich people to hear" should be the banner. From trashing Bernie to letting Bill Gates foist ads on all of us telling us what a great schlemiel he is for ridding us of disease and oh yeah, fixing education. What a maroon. He was the idea guy behind no child left behind, except that we now have left entire generations behind due to his "brilliance". And now we're supposed to sit by while the Times through these two, gazes at its own navel and ignores the elephant in the room which is, there will never, ever be a for profit medical insurance that is fair. The entirety of my understanding of Capitalism is that there will be winners and losers and right now, the American people are losing. This Affordable Care act was never going to work from the get go because it must account for losers, or the dead due to lack of healthcare. I'm not willing to accept this or these experts shortsighted pro business assessment. Healthcare is a right not a perk. The Times is once again to the right of center while claiming to be dead center. It is a lie. The Times is no longer a progressive publication in any way. This isn't even an opinion piece and it reeks of one opinion. Single payer. The only solution.
15
In the absence of a universal system of health care, the United States will continue to falter in it's aim to manage health care costs. Why the United States persists in this fruitless endeavor is largely ideological; only the so-called marketplace can provide health care, and maintain profits, without the pesky interference of government. But health care in countries that maintain a universal system deem health care as a "right", and do away with the profit motive. It's nearly impossible to control the costs of medicine, hospital stays, etc., without complete command and control from the top. Wishing that for-profit corporations behave in a more altruistic fashion is a fantasy at best, and a highly inefficient way to control costs.
9
The capitalist market place killed many people for many years by denying healthcare via preexisting conditions, caps on payouts and pricing many Americans out of the market.
Partisan dogma will not protect Americans.
Partisan dogma will not protect Americans.
1
We didn't want to destroy health insurance carriers with the public option. Now the ingrates are pulling out. If Hillary is elected and Democrats take Congress we can get Medicare for all.
9
You must be dreaming. Hillary won't double cross the insurance companies!
5
Nor would Mitchell McConnell or Paul Ryan.
Just offer Medicare for all and get it over with. Let some private insurance companies offer supplemental plans, and let the rest go bankrupt. As for Dr. & Hospitals charging a lot, when they see most people are on Medicare like insurance, either they'll change their minds or leave.
Dr. have been charging a lot for a long time. My gastro stopped taking ANY insurance when he was spoiled by the largess of Katie Couric after her husband died. They are too spoiled.
Dr. have been charging a lot for a long time. My gastro stopped taking ANY insurance when he was spoiled by the largess of Katie Couric after her husband died. They are too spoiled.
10
There are multiple reasons for people lacking health ins. And there is no on solution for all:
1. Young invincibles - Young people are healthier and therefore their health ins should be cheap. Yet, the "Community Rating" aspect of ACA restricts how much more you can charge the older (sicker) patients thereby increasing the cost for the young.
2. Short Term Unemployed - A lot of people who lack health insurance do so for a short time when they are out of work (49% of Americans). In 1985, Reagan signed COBRA which allowed those who leave a job to pay for their old ins on their own. But 30 yrs of health inflation have made COBRA less workable.
3. Affluent Individuals - With the growth of the "gig" economy, more people earn money but do not get health benefits. And the natural risk pooling of an employer is not available. The solution here doesn't require government but simply any large group such as the ABA which provides insurance for small law firms.
4. Poor - This one is not confined to just health ins. Too many Americans simply lack the education (29% of poor drop out of HS) and family (40% of the poor are single parents) to earn enough to pay for basic necessities.
5. Sick - "by making it harder for sick people to buy coverage ... by subsidizing the plans’ losses for very expensive patients, and ... by charging higher prices to older customers". It's not insurance when someone is already very sick. Like buying home ins after the house burned down.
1. Young invincibles - Young people are healthier and therefore their health ins should be cheap. Yet, the "Community Rating" aspect of ACA restricts how much more you can charge the older (sicker) patients thereby increasing the cost for the young.
2. Short Term Unemployed - A lot of people who lack health insurance do so for a short time when they are out of work (49% of Americans). In 1985, Reagan signed COBRA which allowed those who leave a job to pay for their old ins on their own. But 30 yrs of health inflation have made COBRA less workable.
3. Affluent Individuals - With the growth of the "gig" economy, more people earn money but do not get health benefits. And the natural risk pooling of an employer is not available. The solution here doesn't require government but simply any large group such as the ABA which provides insurance for small law firms.
4. Poor - This one is not confined to just health ins. Too many Americans simply lack the education (29% of poor drop out of HS) and family (40% of the poor are single parents) to earn enough to pay for basic necessities.
5. Sick - "by making it harder for sick people to buy coverage ... by subsidizing the plans’ losses for very expensive patients, and ... by charging higher prices to older customers". It's not insurance when someone is already very sick. Like buying home ins after the house burned down.
5
I add my total support for the single payer option, traditional Medicare (NOT Medicare Advantage) with Medigap-F and a drug plan. They have made a huge difference in my ability to get excellent health, largely covered (except for spendy drugs, dental and optical) without bills, billing errors for co-pays, deductibles and the numerous other complexities and hassles associated with Romneycare turned into Obamacare.
It is great that more people are now covered in some fashion with Obamacare but healthcare remains a commodity made unnecessarily complex by conflating the words healthcare and marketplace.
It is great that more people are now covered in some fashion with Obamacare but healthcare remains a commodity made unnecessarily complex by conflating the words healthcare and marketplace.
8
We don't have a health insurance crises. We have a well-documented healthcare cost crisis. Since the industry has had ample opportunity to reconsider their business model, where the majority of money doesn't go to actual care, it appears an intervention is needed. That must take the form of single payer or some sort of price regulation. More direct relationship between the consumer and healthcare providers might also be tried. I understand there are some 'closed systems' that are providing the full range of services locally, offering efficiency, improved cost and better care.
13
Maybe the law should have been read by those who voted on it! Just like the TPP it was negotiated practically in secret by the big players in health care and the lobbyists. Expect more of the same if Clinton is elected. It pains me when my Canadian friends say thy "used" to envy America. Now they look aghast at our individual health care bills, the college tuition we pay for our children and the never ending wars we fight! We have millions of people living, working illegally in the country while our own high school graduates go without jobs. We have a former president (William Jefferson Clinton) who collected $17 million by being a spokesman for a for profit education company. It is all a disgrace. Watch Obama become a member of the .01% in a New York minute after leaving the presidency. Should he be handsomely rewarded for passing a failed health care policy? Why not. They are all for sale and we, the American citizens, are the losers.
13
" It pains me when my Canadian friends say thy "used" to envy America."
Yet it would appear that many Canadians come to the US for medical treatments after being told to wait in line for six months or more for treatment in Canada.
Yet it would appear that many Canadians come to the US for medical treatments after being told to wait in line for six months or more for treatment in Canada.
9
Hillary had advocated for universal care for decades. If it can be done (gotten through Congress), she'll do it.
Clinton income is chump change compared to Trump's. The Clintons pay taxes, Trump doesn't. The Clintons have served in office, Trump hasn't. The Clintons have attempted health care for all, Trump has not. Trump will rip out ACA root and branch, and leave sick Americans dying in the streers.
1
The principal and basic purpose of universal health care is to enhance the health of the people of the nation. It is not a commodity the value of which is measured by profit in free markets.
Around the world there are numerous examples of working national health systems, all of which we ignore, chiefly because conservatives in the US insist that health care should treated as a free market commodity, like, perhaps, an orange.
As a nation we must come to recognize that universal health care is a Good Thing in itself, that virtually all electorates consider it highly desirable, perhaps even necessary, and that it is worth paying for. One might hope that even conservatives might come to understand that it's not like an orange, the price, availability, and quality of which can be successfully left to the "invisible hand".
Government is the solution. Medicare for all.
Around the world there are numerous examples of working national health systems, all of which we ignore, chiefly because conservatives in the US insist that health care should treated as a free market commodity, like, perhaps, an orange.
As a nation we must come to recognize that universal health care is a Good Thing in itself, that virtually all electorates consider it highly desirable, perhaps even necessary, and that it is worth paying for. One might hope that even conservatives might come to understand that it's not like an orange, the price, availability, and quality of which can be successfully left to the "invisible hand".
Government is the solution. Medicare for all.
19
NO, as Reagan said "Government is the problem not the solution". What else would you expect from an organization that is 10% politicians who are only interested in their reelection and 90% useless, parasitic bureaucrats who are only interested in doing the least amount of work for the most amount of money.
4
@Charles W
So what as to what Reagan said about anything.
Reagan kicked off his 1980 presidential campaign against the Neshoba County Fair, a few miles from where three civil rights workers had been lynched, AND HE SAID states rights was a good thing, code for lynching is a good thing.
I don’t care what that old racist said.
So what as to what Reagan said about anything.
Reagan kicked off his 1980 presidential campaign against the Neshoba County Fair, a few miles from where three civil rights workers had been lynched, AND HE SAID states rights was a good thing, code for lynching is a good thing.
I don’t care what that old racist said.
1
Wait. Wait. I confess I did not read the article in full, but I looked in scance for the headline about deductibles. I am just about to pay off my $4300 in deductibles before they pay anything but the Obamacare mandated requirements, PLUS my monthly premiums, and I will just get my decuctibles paid off before the new year stars and the new deductibles kick in.
This is the biggest travesty of Obamacare, and one I rarely hear about. I will not be able to pay premiums AND for all my doctors visits and emergency care and x- rays and meds and other regular care next year. I will be uninsured again and living off your largess if I have a real bad emergency which is what I really need coverage for.
Thanks.
This is the biggest travesty of Obamacare, and one I rarely hear about. I will not be able to pay premiums AND for all my doctors visits and emergency care and x- rays and meds and other regular care next year. I will be uninsured again and living off your largess if I have a real bad emergency which is what I really need coverage for.
Thanks.
21
By the way, after working since I was 16, I'm 63 now, I get about $1,000 a month in SS. My savings were stolen by those who were Too Big to Fail. I guess I wasn't.
2
it is such a relief to see that we, the consumers, are finally redefining the terms of the discussion. As long as the boogeyman of 'socialized' medicine held sway - debates were kept away from the true problem which is the insane cost of healthcare in this country. Our bodies are nothing more than sliced and diced profit centers. The major healthcare system here is a revenue generating juggernaut. Their profit was $9 billion last year. Yet they purport to be non-profit. Those rules have to change as do the write-offs for advertising (if they still exist).
Universal healthcare is the way to go and if the system won't do it then we're going to have to create work arounds (and this includes where one can purchase prescriptions.) But why aren't all hospitals legally required to publish fees for all their services? Basically I've developed an intense dislike of the fact that I could work and save my entire life only to be destroyed by healthcare costs. I refuse to let this happen. We all should.
Universal healthcare is the way to go and if the system won't do it then we're going to have to create work arounds (and this includes where one can purchase prescriptions.) But why aren't all hospitals legally required to publish fees for all their services? Basically I've developed an intense dislike of the fact that I could work and save my entire life only to be destroyed by healthcare costs. I refuse to let this happen. We all should.
14
Obamacare was a bad plan from the beginning. Notice how this op-ed dismisses the public option. Medicare is efficient and works. The only reason for not expanding it to everyone is simple- corporate greed. The public option will never happen with Clinton or our congress. They are owned body and soul by the corporatists.
19
Could you limit your practice to Medicare patients and stay in business?
2
Clinton has fought for universal health care for decades. She may be too hawkish, but if you care about Healthcare, she's perfect.
ACA is better than what preceeded it: preexisting conditions, payout caps, no subsidies.
Cost? Not mentioned was a factor in the news today, the ability of Big Pharma to raise prices on dirt-cheap drugs, such as EpiPens. Insurance pays for the fat profits and the multi-million dollar salaries of Pharma CEOs, and so insurance cost goes up.
Allowing older Americans to buy into Medicare early would not only help better fund Medicare but also lower costs for the insurance pool of younger people.
There are many things that could be done, but we have a GOP-controlled Congress that has blocked Obama every step of the way, and that will block HRC every step of the way as well. Those who think the GOP will cooperate with HRC any more than they did with Obama are wrong.
Allowing older Americans to buy into Medicare early would not only help better fund Medicare but also lower costs for the insurance pool of younger people.
There are many things that could be done, but we have a GOP-controlled Congress that has blocked Obama every step of the way, and that will block HRC every step of the way as well. Those who think the GOP will cooperate with HRC any more than they did with Obama are wrong.
12
The GOP-controlled Congress has urged Obama to incorporate tort reform into the ACA so as to reduce the number of unnecessary tests ordered by doctors and to reduce the fees of doctors, which are inflated by their insurance costs and practice risk. Obama and the Dems however have supported the plaintiff-bar- greed instead of acting in the interests of the patients.
5
@anycomment
Whereas Republicans have supported hospital-insurance-big-pharma greed; e.g. passing Medicare Part B with Medicare prohibited from negotiating drug costs.
Whereas Republicans have supported hospital-insurance-big-pharma greed; e.g. passing Medicare Part B with Medicare prohibited from negotiating drug costs.
1
But I thought with a statute and lots of good will you can create something out of nothing.
6
All the solutions this article discusses are just costly ways to protect the health insurance industry. They ignore the fundamental problem: Free markets cannot be applied to offering an essential public service such as health care because in order for them to make a profit, it would mean denying care to the very people who need it. https://sewnmitts.wordpress.com/2016/08/29/capitalist-principles-cannot-...
14
Canadian health care is guided by five simple principles: universality, comprehensiveness, accessibility, portability, and public administration.
Try it.
Try it.
15
But even the government loving NYTs has admitted many times that "government is always inefficient and usually corrupt" and that would apply to "public administration" as well. Anything that involves politics will always be inefficient and corrupt.
1
With... what... 10% of the population of the United States - the majority of whom live in cities within a few hundred kilometers of the U.S.?
1
My Medicare is way more efficient than my private supp coverage.
With brand name insurers pulling out of the ACA markets, there couldn't be a stronger argument made for a single payer system. The for profit health care system, including big pharma, is actually killing us all...either you die from lack of health insurance or go bankrupt because it has become so unaffordable for millions of people and employers. And on top of it, we have a political system that works for health insurance and pharmaceutical companies...not for the people. It's time to join the rest of the world.
15
The real problem is that "Obamacare" was not the much-needed reform of a medical industry focused on the wealth of wealth of corporate executives and shareholders rather than the health of patients. While the ACA's modest insurance reform addressed a few egregious failings, and allowed millions of people to obtain insurance, it did nothing about the real problem of the United States having a medical industry rather than a health care system.
The ACA also added the complexity of government bureaucracy and regulation (exchanges, subsidies, tax provisions) to the existing duplicative private bureaucracies and complexity of health insurance (copays, coinsurance, deductibles, networks, formulary tiers-- all of which exist solely to help insurance companies avoid "medical loss," their term for actually providing health care). When you add Republican obstruction, problems are inevitable.
Insurance CEOs have apparently decided the exchanges aren't meeting their shareholders' needs. That would indicate the real failure of the ACA is the continued reliance on private insurance companies. The simplest solution would be to offer Medicare on the exchanges. Medicare already serves the oldest and sickest Americans, and would only benefit from adding younger, healthier patients. Insurers could "dump" an unprofitable market, while still selling Medigap plans. If an insurer thinks they can profit from offering better value than Medicare, they'd be welcome to compete on the exchanges.
The ACA also added the complexity of government bureaucracy and regulation (exchanges, subsidies, tax provisions) to the existing duplicative private bureaucracies and complexity of health insurance (copays, coinsurance, deductibles, networks, formulary tiers-- all of which exist solely to help insurance companies avoid "medical loss," their term for actually providing health care). When you add Republican obstruction, problems are inevitable.
Insurance CEOs have apparently decided the exchanges aren't meeting their shareholders' needs. That would indicate the real failure of the ACA is the continued reliance on private insurance companies. The simplest solution would be to offer Medicare on the exchanges. Medicare already serves the oldest and sickest Americans, and would only benefit from adding younger, healthier patients. Insurers could "dump" an unprofitable market, while still selling Medigap plans. If an insurer thinks they can profit from offering better value than Medicare, they'd be welcome to compete on the exchanges.
17
I'll say it again. Was the Republicans who forced our present system on us. President Obama wanted Medicare for all and the Republicans said no.
Health insurance--which is a distinctly different market than health care, is failing due to the failure of insurance companies to extract the kind of profits they dreamed about when their lobbyists were writing the ACA legislation. Health CARE has been a market failure for as long as prices have been hidden from end users--the patients. As a market failure, at this point the only rational solution is to make health care a public good. The least disruptive way to do so is to lower the Medicare age over time--first to 55 or 60, then progressively lower over the next 5-10 years. Healthcare providers can be paid as they are through the VA and Indian Healthcare services, and the government can reduce or assist with medical school debt as part of a doctor's compensation. Payroll taxes will have to increase to pay for it, but in the long run, it is the only way out of this mess.
12
Other wealthy democracies spend 11 per cent of gdp on health care; the U.S. spends 17 per cent thanks to price-gouging and profit-taking at every step. Other countries have national health insurance running on three per cent overhead, the American system has 30 per cent overhead, except for medicare which matches the three per cent overhead.
Citizens of other wealthy democracies tend to live longer, healthier lives than Americans.
The solution is to expand medicare to make it universal. You won’t believe the trillions of yuuuge savings you will make. Believe me. Americans will also move into the twentieth century in providing health care for all. Americans will also live in a more just society. What have you got to lose?
Citizens of other wealthy democracies tend to live longer, healthier lives than Americans.
The solution is to expand medicare to make it universal. You won’t believe the trillions of yuuuge savings you will make. Believe me. Americans will also move into the twentieth century in providing health care for all. Americans will also live in a more just society. What have you got to lose?
14
What do I have to lose? How about my coverage if my illness and hospital stay is long enough to exhaust my Lifetime Reserve Days bank. As far as overhead is concerned, Medicare freeloads on the SSA and IRS for much of its administrative costs.
2
Another solution - Start over.
12
One more time.
Single payer, universal NON-PROFIT governmental health care the absolute gold standard.
Platinum? The public option within the private, CEO bonus driven, private insurance scam.
Again. Have we not experienced enough of the private insurance boondoggle? Why do we continue to self - flagellate on this issue? Could it be that the political "donor" Wall St. lobbywart juggernaut is in reality calling all of the shots in the statecraft space?
If so, "I'm shocked, absolutely shocked".
Single payer, universal NON-PROFIT governmental health care the absolute gold standard.
Platinum? The public option within the private, CEO bonus driven, private insurance scam.
Again. Have we not experienced enough of the private insurance boondoggle? Why do we continue to self - flagellate on this issue? Could it be that the political "donor" Wall St. lobbywart juggernaut is in reality calling all of the shots in the statecraft space?
If so, "I'm shocked, absolutely shocked".
10
For those who don't own a home or have a bank account with much in it, it's simpler to pay the penalty than it is to pay for health insurance. That's the choice. That the rest of the working people who pay tax may have to cover them doesn't matter to them. There are also people who never pay into Social Security and when old age comes, they get nothing in return. It's more humane to make people make the decisions they themselves don't want to make.
4
Oh. That way, when you get old or sick, you can a) just die, b) stick the rest of us with the bill.
Good thinking. Odd how the libertarians--Paul Ryan, Ayn Rand--always have their fat hand out first, but good thinking.
Good thinking. Odd how the libertarians--Paul Ryan, Ayn Rand--always have their fat hand out first, but good thinking.
4
SF Bay Area Male, 58, healthy. ACA Bronze plan. Premiums $750/mo. Deductible $6000/yr.
I have enrolled and paid premiums faithfully. I'm willing to help subsidize those in my pool who cannot pay, but it seems that many abuse the pool, and the government allows or encourages it.
I live in a major city, with many providers, but there is little difference in pricing, and the industry has consolidated into huge conglomerates of insurers and hospital/doctor groups that fight every year. There are only two insurers accepted by my doctor's large group, That's not very much choice.
I only want INSURANCE -- bankrupty protection, not health maintenance. If "narrow networks" are really the solution, then how am I protected for emergency services when I travel both within state and out of state? Particularly when hospitals use providers that are out-of-network and who charge rates in excess of out-of-network prices covered by my plan? Go bankrupt?
I was privately insured before ACA at less than half the price with larger networks. For me, ACA provides neither true bankruptcy protection nor health care.
Now I must decide how to protect myself financially and medically in the face of a broken system in which few players act with integrity.
I have enrolled and paid premiums faithfully. I'm willing to help subsidize those in my pool who cannot pay, but it seems that many abuse the pool, and the government allows or encourages it.
I live in a major city, with many providers, but there is little difference in pricing, and the industry has consolidated into huge conglomerates of insurers and hospital/doctor groups that fight every year. There are only two insurers accepted by my doctor's large group, That's not very much choice.
I only want INSURANCE -- bankrupty protection, not health maintenance. If "narrow networks" are really the solution, then how am I protected for emergency services when I travel both within state and out of state? Particularly when hospitals use providers that are out-of-network and who charge rates in excess of out-of-network prices covered by my plan? Go bankrupt?
I was privately insured before ACA at less than half the price with larger networks. For me, ACA provides neither true bankruptcy protection nor health care.
Now I must decide how to protect myself financially and medically in the face of a broken system in which few players act with integrity.
49
The Bay Area is about the most expensive market in the country.
And unless you're making a ton of money, I bet you're not paying the whole premium. You're also probably underinsured.
In 2009, the average family medical insurance plan cost north of $15, 000.
And unless you're making a ton of money, I bet you're not paying the whole premium. You're also probably underinsured.
In 2009, the average family medical insurance plan cost north of $15, 000.
A public health plan like that in the UK and Canada would work wonders. Medicare for all would be great.
1
Apples and oranges here. any private pre- Obama plan that was affordable would have been nearly useless in a major illness. plus, if it matters to you, you would have been SOL with a pre-existing condition.
No matter what quick fix is suggested or recommended by a politician, medical professional, insurance industry representative, etc., an affordable effective national healthcare system will never happen without one thing: standardized service delivery costs for hospitals and clinics. The dental industry has the right idea with discount plan itemized pricing structure. Without it, there can be no cost transparency, and the need for for-profit healthcare industry businesses to annually generate more profits will win out every time.
The reason these problems arise is that we insist on dodging the central question: Do we want healthy people to have to chip in on the health care costs of unhealthy people, or do they have the right to keep the economic benefits of their good health for themselves as well as the other benefits (like not having to worry about health or avoid certain activities or take certain precautions etc.).
We want the healthy to take out health insurance so their premiums can offset the medical costs of the unhealthy. We discourage or prevent the healthy from buying health insurance that is available only to the healthy and is therefore cheaper, which would allow them to keep the economic benefits of their good health. But we do not explicitly require the healthy to forego their economic good fortune, and we do not explicitly ask or discuss the question. Instead we create a complex system that tries to get the healthy to chip in for the health expenses of the unhealthy by back-door, underhanded methods and impenetrable complexity.
Healthy people can do without health care insurance, but if they want to buy it, the available policies are and must be constructed so that their cost will be enough to provide subsidies for health care for the not so healthy. We want to make health and health insurance a social good or a right in fact without doing so in theory, as is done in other countries. This essential dishonesty gets us the complexity of our current system.
We want the healthy to take out health insurance so their premiums can offset the medical costs of the unhealthy. We discourage or prevent the healthy from buying health insurance that is available only to the healthy and is therefore cheaper, which would allow them to keep the economic benefits of their good health. But we do not explicitly require the healthy to forego their economic good fortune, and we do not explicitly ask or discuss the question. Instead we create a complex system that tries to get the healthy to chip in for the health expenses of the unhealthy by back-door, underhanded methods and impenetrable complexity.
Healthy people can do without health care insurance, but if they want to buy it, the available policies are and must be constructed so that their cost will be enough to provide subsidies for health care for the not so healthy. We want to make health and health insurance a social good or a right in fact without doing so in theory, as is done in other countries. This essential dishonesty gets us the complexity of our current system.
4
Two Words: Public Option
After only being on Medicare for 5 months it, along with my supplemental, has paid my over $100,000 and counting bills for my surgery and chemo. Now I do understand that we all pay into Medicare our whole working lives and that's what funds it. BUT what really ticks me off is that I always had health insurance, and all the money I paid to private insurers when I was young went into their for profit coffers and not a dime of it is available to pay my bills now! And yes, I do realize some of my dollars went towards paying the bills of others who were in the same pools, and that consoles me somewhat. But I'd feel much better if ALL the premiums people paid for health insurance went into the same pool and was then divvied out to those who needed it when the occasions arose. I just cannot for the life of me fathom why we don't go the Public Option and extend Medicare to all. The system is already in place and even allows for private insurance in the form of supplementals for those who have the wherewithal to afford it. So for those Capitalist Fundamentalists who don't like the Government doing it all, there's still room for the private sector. What's not to like?!?!
After only being on Medicare for 5 months it, along with my supplemental, has paid my over $100,000 and counting bills for my surgery and chemo. Now I do understand that we all pay into Medicare our whole working lives and that's what funds it. BUT what really ticks me off is that I always had health insurance, and all the money I paid to private insurers when I was young went into their for profit coffers and not a dime of it is available to pay my bills now! And yes, I do realize some of my dollars went towards paying the bills of others who were in the same pools, and that consoles me somewhat. But I'd feel much better if ALL the premiums people paid for health insurance went into the same pool and was then divvied out to those who needed it when the occasions arose. I just cannot for the life of me fathom why we don't go the Public Option and extend Medicare to all. The system is already in place and even allows for private insurance in the form of supplementals for those who have the wherewithal to afford it. So for those Capitalist Fundamentalists who don't like the Government doing it all, there's still room for the private sector. What's not to like?!?!
6
You do realize if you'd been hospitalized for the period, you'd just have exhausted your Lifetime Reserve Days and Medicare wouldn't pay another penny until you were out of the hospital for 60 days and you'd be paying for every dollar of your health care during that period that your supplemental Medigap policy didn't.
2
Why doesn't anybody spell it out? We missed the opportunity for a public option, since in the meantime the health insurance industry has consolidated and is even more powerful than before.
In order to really make health care available for everybody and not stick with this idiotic concept of health insurance with the Kafkaesque concepts of copays, in network, out of network, deductables.........., we would have to either introduce a highly regulated insurance system similar to Switzerland or a tax based system where everybody pays into.
What we have now, is the worst combination of private and some public systems that will eventually bankrupt everybody. Since the numbers of insurance pencil pushers working hard at making the system ever more costly and incomprehensible have increased exponentially, any change in our system would probably lead to an increase of the unemployment rate by at least 1%. Therefore the chance of any meaningful reform is practically nil.
I would love to send all the opponents of taxpayer financed systems to some European countries to get health care. I bet, after coming back they would be ready to attack their representatives with pitchforks.
No wonder, all the middling people in this country are in much worse shape than their European counterparts due to the constant stress and anxiety of being bankrupted by just one health emergency.
In order to really make health care available for everybody and not stick with this idiotic concept of health insurance with the Kafkaesque concepts of copays, in network, out of network, deductables.........., we would have to either introduce a highly regulated insurance system similar to Switzerland or a tax based system where everybody pays into.
What we have now, is the worst combination of private and some public systems that will eventually bankrupt everybody. Since the numbers of insurance pencil pushers working hard at making the system ever more costly and incomprehensible have increased exponentially, any change in our system would probably lead to an increase of the unemployment rate by at least 1%. Therefore the chance of any meaningful reform is practically nil.
I would love to send all the opponents of taxpayer financed systems to some European countries to get health care. I bet, after coming back they would be ready to attack their representatives with pitchforks.
No wonder, all the middling people in this country are in much worse shape than their European counterparts due to the constant stress and anxiety of being bankrupted by just one health emergency.
2
We don't need a moonshot program to cure cancer. We need such a program to bring universal healthcare to our country.
Look at all the fury directed at the company that sells the Epipen. Imagine if we can channel that anger into a voting block that will get our elected officials to fix our broken healthcare system.
Everyone needs to realize that unless you are wealthy, it only takes one serious illness to bankrupt you and your family. I have seen so many GoFundMe pleas from people who cannot afford some life saving medical treatment for their loved one. Begging shouldn't be the only way many Americans can get the medical care they need.
Look at all the fury directed at the company that sells the Epipen. Imagine if we can channel that anger into a voting block that will get our elected officials to fix our broken healthcare system.
Everyone needs to realize that unless you are wealthy, it only takes one serious illness to bankrupt you and your family. I have seen so many GoFundMe pleas from people who cannot afford some life saving medical treatment for their loved one. Begging shouldn't be the only way many Americans can get the medical care they need.
7
Sorry to be rude, but about half these comments show that people haven't the least little notion of what the PPACA actually says.
I've no idea what to do about this--especially since a fair chunk of the ignorance is coming from Trump voters, and right-wingers who are allergic to reality--but for anybody who doesn't know but would like to:
http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
The commonest myths here:
--no catastrophic plans
--costs me 20% of my salary!
--no interstate plans allowed!
--doesn't do nothing to control costs
--forces my small business to buy!
--doesn't show what costs are!
I've no idea what to do about this--especially since a fair chunk of the ignorance is coming from Trump voters, and right-wingers who are allergic to reality--but for anybody who doesn't know but would like to:
http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
The commonest myths here:
--no catastrophic plans
--costs me 20% of my salary!
--no interstate plans allowed!
--doesn't do nothing to control costs
--forces my small business to buy!
--doesn't show what costs are!
2
From that same document, the PPACA also:
-Limited the amount of contributions to a flexible spending account for medical expenses to $2,500 per year increased annually by the cost of living adjustment. (Effective 1/1/2013)
-Increased the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes (Effective 1/1/13)
-Excluded the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through an HRA or health FSA and from being reimbursed on a tax-free basis through an HSA or Archer Medical Savings Account. (Effective 1/1/11)
-Increased the tax on distributions from a HSA or an Archer MSA that are not used for qualified medical expenses to 20% (from 10% for HSAs and from 15% for Archer MSAs) of the disbursed amount. (Effective 1/1/11)
-Increased the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and impose a 3.8% tax on unearned income for higher-income taxpayers (thresholds are not indexed). (Effective 1/1/13)
-Imposed an excise tax on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage (these threshold values will be indexed to the consumer price index for urban consumers (CPI-U) for years beginning in 2020)
-Limited the amount of contributions to a flexible spending account for medical expenses to $2,500 per year increased annually by the cost of living adjustment. (Effective 1/1/2013)
-Increased the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes (Effective 1/1/13)
-Excluded the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through an HRA or health FSA and from being reimbursed on a tax-free basis through an HSA or Archer Medical Savings Account. (Effective 1/1/11)
-Increased the tax on distributions from a HSA or an Archer MSA that are not used for qualified medical expenses to 20% (from 10% for HSAs and from 15% for Archer MSAs) of the disbursed amount. (Effective 1/1/11)
-Increased the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and impose a 3.8% tax on unearned income for higher-income taxpayers (thresholds are not indexed). (Effective 1/1/13)
-Imposed an excise tax on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage (these threshold values will be indexed to the consumer price index for urban consumers (CPI-U) for years beginning in 2020)
4
The price of essential healthcare is inelastic, meaning that we inherently value life and wellness at any cost. This a fundamental tenet of our moral frameworks. The laws of supply and demand no longer apply. When you or a loved one are mortally ill, price is no object if the prospect of a cure is in the offing. An efficient market for essential healthcare can not exist.
Market based economies can work well, but when there are no balance points between supply and demand these markets fail. Consider the example of widespread famine or disaster. During these events good government steps in to supply, regulate, and distribute lifesaving goods. Without intervention markets become dysfunctional, price gouging and starvation become the norm, and ultimately chaos and civil unrest result.
Insurance adds a bit of price elasticity of demand because it it generally not purchased in a time of acute sickness, but it also adds another layer of price, efficacy, and quality opacity which again undermines the benefits of a market based system, along with a 20% markup.
That said, "Obamacare" is a misnomer. The ACA is the product of a well documented give and take between the President's initiative and a Senate and House largely beholden to the healthcare and insurance industries. The votes required to pass the ACA were bought with concessions to individual legislators' sources of campaign funding. This is the only aspect of Obamacare that is truly market based.
Market based economies can work well, but when there are no balance points between supply and demand these markets fail. Consider the example of widespread famine or disaster. During these events good government steps in to supply, regulate, and distribute lifesaving goods. Without intervention markets become dysfunctional, price gouging and starvation become the norm, and ultimately chaos and civil unrest result.
Insurance adds a bit of price elasticity of demand because it it generally not purchased in a time of acute sickness, but it also adds another layer of price, efficacy, and quality opacity which again undermines the benefits of a market based system, along with a 20% markup.
That said, "Obamacare" is a misnomer. The ACA is the product of a well documented give and take between the President's initiative and a Senate and House largely beholden to the healthcare and insurance industries. The votes required to pass the ACA were bought with concessions to individual legislators' sources of campaign funding. This is the only aspect of Obamacare that is truly market based.
17
Unfortunately, it really does look like Obamacare is failing. Too few have signed up, the coverage for those who do is too expensive, and there is too little choice.
Medical care in the US costs too much. There are fixes for this. First, the politically motivated coverage mandates in the law need to be rethought. This includes the mandate that all forms of contraception be covered with no dedjuctible, and the unlimited mental health coverage, with no provisions to prevent abuse.
Second, there must be more to prevent fraud and abuse, including rules that today allow some to buy coverage only when they have an immediate need for medical care.
The government should not set prices, but it should require that providers disclose costs before care is rendered. This is a no-brainer.
The FDA must continue to regulate drugs to ensure safety, but it should not over-regulate in such a way that protects monopolies. As the Epipen illustrates, drug monopolies allow prices to rise to extortionate levels.
Malpractice reform could reduce the high cost of defensive medicine; such costs are higher than most realize.
Finally, society as a whole must learn to ask how much care is really a good idea, especially near the end of life. This is a horribly difficult but very important issue. The final months of life are the most expensive, and it is not clear that such end of life care is always a good thing.
Medical care in the US costs too much. There are fixes for this. First, the politically motivated coverage mandates in the law need to be rethought. This includes the mandate that all forms of contraception be covered with no dedjuctible, and the unlimited mental health coverage, with no provisions to prevent abuse.
Second, there must be more to prevent fraud and abuse, including rules that today allow some to buy coverage only when they have an immediate need for medical care.
The government should not set prices, but it should require that providers disclose costs before care is rendered. This is a no-brainer.
The FDA must continue to regulate drugs to ensure safety, but it should not over-regulate in such a way that protects monopolies. As the Epipen illustrates, drug monopolies allow prices to rise to extortionate levels.
Malpractice reform could reduce the high cost of defensive medicine; such costs are higher than most realize.
Finally, society as a whole must learn to ask how much care is really a good idea, especially near the end of life. This is a horribly difficult but very important issue. The final months of life are the most expensive, and it is not clear that such end of life care is always a good thing.
5
One of the complications of Obamacare, which I think is a great idea, BTW, is that it is geared to people with a fixed paycheck and known salary, as opposed to artists, writers, and freelancers or entrepreneurs of all stripes, who may have no idea what their annual income will be until the very end of the year. This makes it enrolling ridiculously complicated and staying within "the rules" very difficult. It is crazy that in a country supposedly geared to small, self-starting businesses, whether in the arts or of any kind, this lack of foresight exists. I may be in danger of losing my tax credits, just because the system isn't geared to people working outside the mainstream. This is a huge and absurd disconnect. If part of the idea of Obamacare is to encourage mobility between jobs, deal with the reality of the economy that exists, not with a system that vanished sometime in the 1960's. Artist rarely know what they will make in a given year. How is this new? If you make it simple, they will come.
9
This is simply a collision of societal goods in America's consumer driven market capitalistic economy. Healthcare is a societal good to which every American should have equal access. On the other hand, healthcare is an industry from which every American should receive a decent return on their retirement savings and investments. CEO's and boards of directors in the healthcare industry are doing what they should be doing to maximize profits and return on investments. Insurance networks are doing what they should be doing in negotiating the best prices for healthcare goods and services. The end result is our currently unworkable system. Without government regulations that remove market pressures for larger and larger profits each quarter, America's healthcare costs will continue to grow faster than the GDP. Their growth is after all what's driving the GDP! With regulations in place, the innovative marketplace energy that drives progress in the healthcare industry will be attenuated or lost. Communism proved that point. We can do a good job of nationalizing R&D through NIH and CDC investments, but we still need the market driven profit motive to get things out of the lab and into the market. We should at minimum force the other advanced societies with universal healthcare to pay the same prices for goods and services that we do rather than forcing Americans to make up the difference.
1
Until Obamacare is repealed in its entirety, it is impossible as a matter of law for universal healthcare to exist.
Let me repeat that.
Until Obamacare no longer exists as the law of the land, no human being in the United States of America has the legal authority to enact a law creating universal healthcare.
One more time.
No breathing being, in the universe can create a universal healthcare plan and enact it into law in the United States of America as long as Obamacare exists and has not been completely repealed.
And once more.
If a word, letter or stray pencil mark contained on the pages of the Affordable Care Act is still the law of the land, there will never be a federal law enacting universal healthcare in the United States of America.
Let me repeat that.
Until Obamacare no longer exists as the law of the land, no human being in the United States of America has the legal authority to enact a law creating universal healthcare.
One more time.
No breathing being, in the universe can create a universal healthcare plan and enact it into law in the United States of America as long as Obamacare exists and has not been completely repealed.
And once more.
If a word, letter or stray pencil mark contained on the pages of the Affordable Care Act is still the law of the land, there will never be a federal law enacting universal healthcare in the United States of America.
3
You know, any legislation could do both at the same time: repeal one thing and establish another. There's no plan for what to do after a simple repeal, that's the problem. We can't go back to having those with pre-existing conditions uncovered, at a minimum.
2
I promise that there isn't a single part of the POACA that you understand correctly.
And by the way--somebody who brags about their work with the homeless and the poor as much as you do, should be ashamed of themselves for not doing everything that they can to sign up the poor and the homeless.
And by the way--somebody who brags about their work with the homeless and the poor as much as you do, should be ashamed of themselves for not doing everything that they can to sign up the poor and the homeless.
1
The actual problem is the insurance industry, which has become less competitive through its own devices. If the insurance industry were more competitive, prices would drop and care options would rise.
2
We knew the insurance industry was the "actual" problem before Obamacare was passed. In 2009. Yet Obama and his followers refused to listen to reason.
3
How are insurance companies, a bunch of actuaries trying to figure out what premiums to charge based on anticipated claims, the problem? The problem is the claims, I.e., the costs of medical treatment, which for a host of reasons, all well known, are far too high.
@DCBarrister
Republicans would not listen/compromise. Ran out the clock. Not a Republican voted for ACA.
Republican leaders met on night of first Obama inauguration, vowed to block all Obama legislation -- general Welfare of the Country, lives/health of its citizens be damned.
Republicans would not listen/compromise. Ran out the clock. Not a Republican voted for ACA.
Republican leaders met on night of first Obama inauguration, vowed to block all Obama legislation -- general Welfare of the Country, lives/health of its citizens be damned.
Democracy is a very fragile political system. It takes a great deal more effort to make it work than it does to make it fail.
Sixty years of fighting Brown has been a great success--the Supreme Court's decision has been successfully thwarted. But, as Donald Trump cited in his acceptance speech, "America's public education has gone from First in the world to 30th in the world."
Republican's didn't want Affordable Health Care because they had no part in its passage. They wanted it dead and they have succeeded. Let it die; at least a few people will be happy in this tenuous Democracy
Sixty years of fighting Brown has been a great success--the Supreme Court's decision has been successfully thwarted. But, as Donald Trump cited in his acceptance speech, "America's public education has gone from First in the world to 30th in the world."
Republican's didn't want Affordable Health Care because they had no part in its passage. They wanted it dead and they have succeeded. Let it die; at least a few people will be happy in this tenuous Democracy
The goal's and inception of Obamacare has been admirable, and a significant portions of those uninsured, now have coverage. But the total cost of the system, is not sustainable. Total Deductibles in exchange care, in most cases are still so high, that many non-emergency procedures and care needs are avoided. There is a oversupply of medical care, hospitals compete for patients, like high class hotels. Most of those with great corporate or government coverage, are sheltered from significant co-payments, and have no incentive to reduce any usage of the system. They do not see the costs of their care, or arrogantly look at those with exchange care as second class citizens. A majority of physicians are in large private groups, often hospital owned, for profit groups, and fees, expenses, and malpractice expenses have spiraled out of control. Medical tourism out of USA by many who have been priced out of the US system, is a growth industry. Every other country in the developed world has a national health care system, where the government, and the various jurisdictional agencies, control costs, fees and access for everyone at a fraction of the cost. A Medicare for all, with various Corporate, and individual buy in options, is the next logical progression.
3
So many of the concerns that were so cavalierly discounted by supporters (they just hvae junk policies) have turned out to be correct. Skyrocketing prices, you can't keep your you doctor, policy and choice is horrible. Yeah, Obama lied about it to push it down our throats.
14
I'm self employed, and eagerly bought a BCBS PPO as soon as the exchange was up and running. However, our doctors refused to take the plan. I canceled the exchange plan, and bought the identical plan directly from BCBS, which our doctors were happy to accept. And I mean literally identical, except for the Plan# - same cost, same deductibles, same coverage. I can't help but to conclude that my doctors are colluding against Obamacare. Am I wrong? What other reason could there be?
12
Of course you're wrong.
And extremely lucky.
Aetna recently left the Obamacare exchanges. My employer offers Aetna coverage. Not one policy offered by Aetna through the exchanges costs less than it's equivalent policy available through employers.
And after reading your comments, I visited the Blue Cross website and opened another browser window with the ACA Obamacare exchanges.
I haven't found a single insurance plan offered by BCBS on the Obamacare exchange that costs the same privately. If anything, the out of pocket self employed rates are higher.
Maybe I will find one if I keep looking, but so far, nothing.
And extremely lucky.
Aetna recently left the Obamacare exchanges. My employer offers Aetna coverage. Not one policy offered by Aetna through the exchanges costs less than it's equivalent policy available through employers.
And after reading your comments, I visited the Blue Cross website and opened another browser window with the ACA Obamacare exchanges.
I haven't found a single insurance plan offered by BCBS on the Obamacare exchange that costs the same privately. If anything, the out of pocket self employed rates are higher.
Maybe I will find one if I keep looking, but so far, nothing.
1
BCBS dropped their PPO at the end of 2015. That's why you can't find anything comparable. I switched to Aetna for 2016, the only company offering an individual PPO in our area (or or off the exchange).
Having learned my lesson, I bought directly from Aetna, after researching plans on the exchange. On the exchange, Aetna offers Plan 91716TX0200001 for my family of 4, $1435/mo, $2800 deductible per, $10,000 max out of pocket. My doctors will NOT take this plan. The plan I purchased direct from Aetna, 479452-010-00049, 1,388.71/mo, $2800 deductible per, $10,000 max out of pocket.
NEARLY identical plans. My doctors will not accept the plan from the exchange. Maybe this is not collusion, but I don't see another valid explanation. Do you?
Having learned my lesson, I bought directly from Aetna, after researching plans on the exchange. On the exchange, Aetna offers Plan 91716TX0200001 for my family of 4, $1435/mo, $2800 deductible per, $10,000 max out of pocket. My doctors will NOT take this plan. The plan I purchased direct from Aetna, 479452-010-00049, 1,388.71/mo, $2800 deductible per, $10,000 max out of pocket.
NEARLY identical plans. My doctors will not accept the plan from the exchange. Maybe this is not collusion, but I don't see another valid explanation. Do you?
3
Wait a second Kevin.
In your first comment you said you bought the "same" plan from Blue Cross Blue Shield. same cost, same deductible, same coverage.
Now you're saying you left BCBS and switched to Aetna, which isn't BCBS.
I don't see a valid explanation because you're talking about two different insurance companies, and just as an observation, there's a 0% chance that Blue Cross Blue Shield are offering identical health insurance plans at identical prices covering identical things. That would be anticompetitive, illegal market activity, meaning somebody had to collude with somebody to offer identical items to consumers at identical prices, which is antithetical to the American business model.
We compete in a free market economy. Two widget companies aren't going to manufacture and produce the same widget and charge the exact same price for the exact same widget. That doesn't make sense. Even Coke and Pepsi, products that aren't identical but similar have different price points.
And because I am a lawyer, you lose me with "nearly" because "nearly" is "impossibly" nebulous for purposes of establishing or proving fact.
In your first comment you said you bought the "same" plan from Blue Cross Blue Shield. same cost, same deductible, same coverage.
Now you're saying you left BCBS and switched to Aetna, which isn't BCBS.
I don't see a valid explanation because you're talking about two different insurance companies, and just as an observation, there's a 0% chance that Blue Cross Blue Shield are offering identical health insurance plans at identical prices covering identical things. That would be anticompetitive, illegal market activity, meaning somebody had to collude with somebody to offer identical items to consumers at identical prices, which is antithetical to the American business model.
We compete in a free market economy. Two widget companies aren't going to manufacture and produce the same widget and charge the exact same price for the exact same widget. That doesn't make sense. Even Coke and Pepsi, products that aren't identical but similar have different price points.
And because I am a lawyer, you lose me with "nearly" because "nearly" is "impossibly" nebulous for purposes of establishing or proving fact.
1
Sorry to wake you up Obama liberals but here's a few quick pointers:
* Obamacare cannot co-exist with a single payer plan because a single payer plan undermines the healthcare exchanges private insurance companies sent their lawyers to the Obama WH to bake into the rules and regulations of Obamacare. A public health insurance option cannot exist within Obamacare, it is the opposite of the rules the ACA are built on.
* Obamacare cannot co-exist with universal healthcare (for obvious reasons). Why would anybody opt for Obamacare coverage that costs more, when you are already paying for universal healthcare with your tax dollars? Moreover, government managed healthcare would again, destroy the private insurance market and function as a monopoly more than capable of putting insurance companies out of business.
Can you name a CEO or billion dollar corporation that hires lawyers who isn't looking to protect THEIR profits at all costs? Do you really think high powered, corporate lawyers are going to just roll over and let a public option put their clients out of business and THEM out of a job as well?
Hint: No.
The system is rigged. And this time it's the healthcare system.
Thanks Obama.
* Obamacare cannot co-exist with a single payer plan because a single payer plan undermines the healthcare exchanges private insurance companies sent their lawyers to the Obama WH to bake into the rules and regulations of Obamacare. A public health insurance option cannot exist within Obamacare, it is the opposite of the rules the ACA are built on.
* Obamacare cannot co-exist with universal healthcare (for obvious reasons). Why would anybody opt for Obamacare coverage that costs more, when you are already paying for universal healthcare with your tax dollars? Moreover, government managed healthcare would again, destroy the private insurance market and function as a monopoly more than capable of putting insurance companies out of business.
Can you name a CEO or billion dollar corporation that hires lawyers who isn't looking to protect THEIR profits at all costs? Do you really think high powered, corporate lawyers are going to just roll over and let a public option put their clients out of business and THEM out of a job as well?
Hint: No.
The system is rigged. And this time it's the healthcare system.
Thanks Obama.
6
I have universal health care and I carry private insurance for hospitalization, income protection, and to cover care at home in the event of us being temporarily invalided and a few other things I will hopefully never need. When we shopped for private insurance we had more than one provider to choose from. All doctor visits are free for our 6 y.o. child. Visits for me/husband are $40. We don't see specialists as a first point of contact. Diagnostic tests are not routinely ordered but free if they are and you can opt pay for them if you like. $200 for an ultrasound. We pay less than $200/month in US dollars per month for coverage for all of us. We paid out of pocket for a normal delivery of our daughter (as we didn't have NZ residency status yet), used a midwife, had 3 ultrasounds throughout, stayed in hospital for a couple of hours after the birth, was attended to at home. Total out of pocket about $2500.
3
No, DCBarrister, let's thank the people who voted for the GOP. And then let's thank people like you who bash everything Obama wanted to try to do while not having any suggestions of your own.
The ACA was a good idea. The problems, which should have been obvious to people like you and the party you seem to support, are these: letting the insurance companies call the shots was a mistake as was letting big pharma call the shots, and every other health provider. We regulate cars and trucks more than we regulate health care to see that everyone can use it when they need to. Ironically, we don't need cars if we use public transportation. We do need health care. In other words, single payor universal access health care is a public good that should not be left to the whims of the free market. Cars are heavily regulated than health care.
However, I don't have to have a car. I do need to have health care. Why should the care I need to have be dependent upon what I can afford to pay? I'm not asking for a luxury plan. I'm asking for a plan that covers what I need, not what I want.
The ACA was a good idea. The problems, which should have been obvious to people like you and the party you seem to support, are these: letting the insurance companies call the shots was a mistake as was letting big pharma call the shots, and every other health provider. We regulate cars and trucks more than we regulate health care to see that everyone can use it when they need to. Ironically, we don't need cars if we use public transportation. We do need health care. In other words, single payor universal access health care is a public good that should not be left to the whims of the free market. Cars are heavily regulated than health care.
However, I don't have to have a car. I do need to have health care. Why should the care I need to have be dependent upon what I can afford to pay? I'm not asking for a luxury plan. I'm asking for a plan that covers what I need, not what I want.
1
@DCBarrister
The healthcare system was fixed before Obamacare. UnitedHealth Group gave a $1.7 billion severance package to CEO William Mcguire in 2006 -- princely sums taken from policies sold. More difficult now, since ACA caps insurance company overhead.
Americans cannot afford high-powered insurance company lawyers who work to shake CEO-shareholder greed.
The healthcare system was fixed before Obamacare. UnitedHealth Group gave a $1.7 billion severance package to CEO William Mcguire in 2006 -- princely sums taken from policies sold. More difficult now, since ACA caps insurance company overhead.
Americans cannot afford high-powered insurance company lawyers who work to shake CEO-shareholder greed.
1
Finely, a NYTimes article that doesn't try to put a positive spin on what is happening in the real world ACA. I am one of the unfortunates who is individually insurerd and doesn't qualify for a subsidy. We need relief. In 2016, for the first time in twenty years, I went without health insurance. Since the ACA passed, my premium had increased 120% and my deductible increased from $2,500 to $6,000, worthless, expensive insurance. In my naivity, I had hoped that in 2017, relief might come and I could be insured again. Instead, Blue Cross of Montana, my only real option, has proposed a 62% increase. It will be approved. This is crazy. Ethical progressive legislation doesn't pick winners and losers.
9
Describe legislation that would "fix" Obamacare and make it a single payer, universal healthcare program in one word or less:
Unconstitutional.
Unconstitutional.
4
Why not put ex-postal workers in charge of a national health service?
1
Why can't the Supreme Court ban gerrymandering? If our votes actually counted, the state and federal legislatures would be better and all states would accept the federally-funded expansion of Medicaid.
1
Elect Democrat governors!
4
Answer: Bernie's Single Payer. Spread the resources so thin only those with money get the services they need.
3
I guess we are going back to the time when every democrat would point at the Republican party and say "40 Million people don't have health insurance."
Considering the President and President-to-be both, at least according to this article, seem to be looking at a single pay system, it would have been nice, if during the primary, supposedly Liberal economists like Paul Krugman, pooh-poohed Sander's idea of Single Payer Health Care as being too expensive and unworkable.
Considering the President and President-to-be both, at least according to this article, seem to be looking at a single pay system, it would have been nice, if during the primary, supposedly Liberal economists like Paul Krugman, pooh-poohed Sander's idea of Single Payer Health Care as being too expensive and unworkable.
1
Intelligent informed observers knew out of the gate the ACA was a mishmash of competing interest with no one advocating for logic or sanity. And the neoliberal Democratic Party lead by Max Baucus steered the actual writing of the bill in favor of profit over creating a sane affordable care act.
While there is much to discuss here I want to shine a light on the fact that powerful Democrats are not working for the middle class. They are selling us out one step at a time everywhere one looks. What will it take for middle class voting Democrats to get over their delusional self satisfaction and realize that they have sold the farm out from under themselves? Get a clue, though we will all vote for Clinton nothing will change. If via a miracle we could take back both houses our elected representatives may feel secure enough to actually represent us. But as the vast majority of Americans can't be bothered to vote, what the hell?
While there is much to discuss here I want to shine a light on the fact that powerful Democrats are not working for the middle class. They are selling us out one step at a time everywhere one looks. What will it take for middle class voting Democrats to get over their delusional self satisfaction and realize that they have sold the farm out from under themselves? Get a clue, though we will all vote for Clinton nothing will change. If via a miracle we could take back both houses our elected representatives may feel secure enough to actually represent us. But as the vast majority of Americans can't be bothered to vote, what the hell?
6
And Obama thanked Max Baucus with an ambassadorship. Surprised he hasn't given Lieberman the medal of honor.
1
Allowing people to take out the insurance when they get sick is ridiculous. It's like saying Oh! I just smashed my car up I guess I should see if I can get an insurance policy and get them to pay for it.
6
but isn't ridiculous if you are denied the coverage because you missed your monthly bill, despite the fact you paid premiums for years
I believe if I miss paying my car insurance premium then yes, even though I paid reliably for years, I'm not covered if I'm in an accident. Works the same way.
1
Anyone make a connection between anemic GNP growth and Obamacare premiums sucking up a huge part of what used to be household's disposable income? Just askin'.
10
Everything - EVERY thing - that critics of Obamacare predicted would happen - and were called racist for predicting it - has happened. In article after article, the NYT itself has documented its failures even as the editorial page continues to insist the Titanic just has a little hole, nothing a plug here and there won't fix.
What can be done? What should have been done from the beginning, if the administration hadn't been so desperate for a midterm 'accomplishment' going into the 2010 elections and rammed the bill through. (The one thing they did competently was to time all the penalties and drawbacks to kick in after the 2010 midterms and then after Obama's 2012 re-election campaign.)
Draft a single-payer system, like every other First-World country has. In the interim, establish a public option. I'm not saying it'll be easy; just debating on what constitutes 'basic care' to be covered by a National Health will cause screaming matches. (Sex changes? Elective abortion? Experimental procedures? Etc. etc.) But it was taking the quick-'n-dirty route that made this mess. 'Why is there never enough time to do it right, but always enough time to do it over?'
Write off the billions wasted on this mess. Shoot it and put it out of its misery, and do what you should have done in the first place.
What can be done? What should have been done from the beginning, if the administration hadn't been so desperate for a midterm 'accomplishment' going into the 2010 elections and rammed the bill through. (The one thing they did competently was to time all the penalties and drawbacks to kick in after the 2010 midterms and then after Obama's 2012 re-election campaign.)
Draft a single-payer system, like every other First-World country has. In the interim, establish a public option. I'm not saying it'll be easy; just debating on what constitutes 'basic care' to be covered by a National Health will cause screaming matches. (Sex changes? Elective abortion? Experimental procedures? Etc. etc.) But it was taking the quick-'n-dirty route that made this mess. 'Why is there never enough time to do it right, but always enough time to do it over?'
Write off the billions wasted on this mess. Shoot it and put it out of its misery, and do what you should have done in the first place.
89
Actually, one part of your argument is wrong. "Every other First-World country" does NOT have a single-payer system. Some have multi-payer systems with a mix of government & private insurance, as we do. Germany is perhaps the best example. Of course, those other countries do it way better than we do, whether your comparison is with Obamacare or our previous non-system.
That said, I don't doubt that a well-structured and well-managed single-payer system would be better than what we have now. The problem is, how do we get there? One of the earliest of Atul Gawande's excellent health care & insurance articles in the "New Yorker" some years ago described how other advanced countries did not start from scratch, but they built their national health coverage systems on what they had at the time, so countries ended up with a variety of systems from Britain's National Health, to single payer systems, to mixed or multi-payer systems. Our problem may be that we waited so much longer than other countries to build a national system, allowing costs to skyrocket and other dysfunctions to fester before we tried to build on what was in place here. Obamacare is better than what we had before but it's not good enough. But as desirable as"single payer" may be, it is not the only viable option, and it may be the least practical given where we are now. Perhaps a series of fixes, such as those suggested here, to stabilize the market and improve people's coverage and care experiences will work.
That said, I don't doubt that a well-structured and well-managed single-payer system would be better than what we have now. The problem is, how do we get there? One of the earliest of Atul Gawande's excellent health care & insurance articles in the "New Yorker" some years ago described how other advanced countries did not start from scratch, but they built their national health coverage systems on what they had at the time, so countries ended up with a variety of systems from Britain's National Health, to single payer systems, to mixed or multi-payer systems. Our problem may be that we waited so much longer than other countries to build a national system, allowing costs to skyrocket and other dysfunctions to fester before we tried to build on what was in place here. Obamacare is better than what we had before but it's not good enough. But as desirable as"single payer" may be, it is not the only viable option, and it may be the least practical given where we are now. Perhaps a series of fixes, such as those suggested here, to stabilize the market and improve people's coverage and care experiences will work.
2
I disagree with your premise. I followed the health care debate and the creation of this law and it was not rammed through Congress. It was a long process, and it barely passed. Everyone knew that the law would have to be tweaked as we went along, but with a hostile Congress (i.e., the Republicans who only want to dismantle it) that hasn't happened. Perhaps if Dems win back the Senate some much-needed fixes will take place.
1
If the public option is such a panacea, then why have even the most liberal States in the nation not adopted it ? Obamacare made specific provisions to allow States to try the public option. And Vermont (with Sanders, a socialist Senator) considered it but balked when they found that starting a single-payer health care would require a 9% increase in payroll taxes and an 11% increase in income taxes.
https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-sin...
And THAT is what single payer means in "every other First World country". It means high taxes on EVERYONE including the poor. But Americans want the benefits without paying for the cost. Rather, they'd prefer to just stick the bill the someone else ("the rich"). That's not single payer. That's the Bolshevik Revolution.
https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-sin...
And THAT is what single payer means in "every other First World country". It means high taxes on EVERYONE including the poor. But Americans want the benefits without paying for the cost. Rather, they'd prefer to just stick the bill the someone else ("the rich"). That's not single payer. That's the Bolshevik Revolution.
Could we please just get some price transparency? I just want to know what a procedure would cost BEFORE I need it. This would create a revolution in health-care pricing. Why don't we do it already?
8
Why we can not have Medicare for all? With all this premiums, copays it seems to be much more affordable than insurance. And maybe, we .ca not get away with employer based plan, there could be more attractive alternatives
1
Medicare for all would not have prevented UnitedHealth Group from providing CEO William McGuire a $1.7 billion severance package in 2006.
Nationalize the entire healthcare industry.
Nationalize the entire healthcare industry.
1
Any politician who runs on single payer or the public option is going to be dead in the water. Those of us with decent employer provided plans make up a huge numerical majority of the health insurance market, something like 80-85% of it.
We're the ones who already subsidize Medicare, Medicaid, the ACA, and the uninsured, and because of this we're the ones who tend to vote, religiously. Per our ability to carry all of these people, we usually "carry" other things too - like local PTAs, care of property that we own, and communities that are genuinely home, and not just a stop over on the way to the next gig or apartment to rent. So don't count on us rolling over.
Hence a GOP dominated House, Senate, and 39 state legislatures. Occasionally the GOP goes too far to the social-right for us, and so we elect a centrist Democrat like Obama or Clinton, but if we're asked to not only subsidize the half of the population that can't carry it's own weight and afford its own care but to also give up the slightly better care we have to boot, things probably aren't going to go as well as the progressives who don't pay taxes think they will.
Now add to our number the elderly on Medicare (yes, they'll suffer along with us), the medical caretaker community, and hospitals and insurers - and the hill gets steeper.
So look elsewhere for someone to gouge, because we've had a enough. I suggest you look at yourselves, and accept a lower albeit cheaper standard of care.
We're the ones who already subsidize Medicare, Medicaid, the ACA, and the uninsured, and because of this we're the ones who tend to vote, religiously. Per our ability to carry all of these people, we usually "carry" other things too - like local PTAs, care of property that we own, and communities that are genuinely home, and not just a stop over on the way to the next gig or apartment to rent. So don't count on us rolling over.
Hence a GOP dominated House, Senate, and 39 state legislatures. Occasionally the GOP goes too far to the social-right for us, and so we elect a centrist Democrat like Obama or Clinton, but if we're asked to not only subsidize the half of the population that can't carry it's own weight and afford its own care but to also give up the slightly better care we have to boot, things probably aren't going to go as well as the progressives who don't pay taxes think they will.
Now add to our number the elderly on Medicare (yes, they'll suffer along with us), the medical caretaker community, and hospitals and insurers - and the hill gets steeper.
So look elsewhere for someone to gouge, because we've had a enough. I suggest you look at yourselves, and accept a lower albeit cheaper standard of care.
12
We can't go on as we are either. Even with employer based plans, we get only catastrophic coverage for astronomical monthly payments.
2
@Ben G
I never had kids, but paid taxes to educate gourmet kids.
I never had kids, but paid taxes to educate gourmet kids.
Gee whiz! Nobody predicted any of this!
10
Increase the Medicare payroll tax every year and lower the age that people qualify for it by a year. The program already exists, so no new government bureaucracy required. People will retire younger if they know they have a health care plan, freeing up those jobs for younger generations, instead of having three generations in the workplace, with the older people hanging in there until they reach 65 and qualify for Medicare.
We will all have to pay more, nothing is 'free', but as the tax increases (for most of us, our employers pay 50%), many people will drop their private insurance, although others will choose to keep it.
And yes, there will be rationing, as there is in every country with national health care, as no society can afford to spend the majority of the costs of medical care on the last three months of a person's life.
We will all have to pay more, nothing is 'free', but as the tax increases (for most of us, our employers pay 50%), many people will drop their private insurance, although others will choose to keep it.
And yes, there will be rationing, as there is in every country with national health care, as no society can afford to spend the majority of the costs of medical care on the last three months of a person's life.
4
Remove the cap on payroll taxes, and subject all income (including capital gains). As it is a billionaire like Donald Trump, a Walton, a hedge fund manager pays little to nothing.
Wow, are you not aware that this has already been done? Wage based Medicare premiums do not have a cap and, for those making more than $200K, wages above that is subject to an additional 0.9% tax and non-wage income is subject to 3.8% tax. Also, did you know this applies to home sales with a capital gain larger the exclusion amount, also?
1
The first step in a crisis is to admit that you have a problem.
The President, who sold the program on "If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold" needs to get on TV and admit that he was wrong.
That done go to work, in his remaining days in office, to fix it.
The President, who sold the program on "If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold" needs to get on TV and admit that he was wrong.
That done go to work, in his remaining days in office, to fix it.
3
Sounds like a good ad for Trump to start airing.
2
Taking a page from Heather Bresch, Hillary Clinton might explain that she is more frustrated by this than anyone, and as a mother, she understands.
1
I am self employed. I have health insurance because it's the law. But I don't have health care-the out of pocket costs are simply too high for me so I avoid going to the doctor. If something serious happens and I end up sick or in the hospital I will not be able to pay the bills and the others insured will end up paying for whatever services I get. Neither of my kids have insurance, ages 26 and 27, because of the expense, and my sister who has cerebral palsy has no insurance because she lives in Florida. So yeah it was a great effort but as long as the insurance companies, hospitals and big pharma are in control lots of us will try to stay safe and healthy. I never thought I would look forward to being 65 so I will have health care.
12
Our current health care delivery system is extraordinarily expensive, incredibly convoluted and disorganized and does not have patient outcomes as positive as other developed countries. Money and profit rule and have become the driving forces in the industry; not the needs of patients. If you are well off financially and/or have great insurance coverage, you have the possibility of receiving excellent medical care; otherwise, it's pretty iffy.
Anyone with a heart and soul and a modicum of humanity will admit that basic health care is a human right for all people and not a privilege for the well off, well connected and the lucky. We need to return health care to a patient centered profession; we have many fine medical professionals to do just that, but the current system is a disorganized mess. A single payer program has the possibility of greatly improving the delivery of medical care while reducing costs and making the system more fair and effective. Let's give it a try.
Anyone with a heart and soul and a modicum of humanity will admit that basic health care is a human right for all people and not a privilege for the well off, well connected and the lucky. We need to return health care to a patient centered profession; we have many fine medical professionals to do just that, but the current system is a disorganized mess. A single payer program has the possibility of greatly improving the delivery of medical care while reducing costs and making the system more fair and effective. Let's give it a try.
6
The simplest way to understand what is wrong with our health care system is to look at working systems in other developed countries. What they all have in common, whether they are insurance based systems or nationalized systems is that provider costs are strictly controlled, by government. The rest of us simply must face down the health care industry, as incredibly contentious as that would be, and tell them what they are allowed to charge.
7
As medical insurance costs rise, due mainly to "adverse selection" of health insurance by the most ill of the US population, it is easy to dismiss the significant contributions of the AFC act. Medical insurance costs rise partially because more robust and healthy individuals will simply eschew coverage, as evidenced by today's data showing total enrollment significantly trailing earlier projections. And, such demographic trends as an aging US population may also help to drive costs up.
Establishing treatment benchmarks, and tracking compliance with these benchmarks, for many healthcare hospital services, via management-by-exception (MBE) principles, help to identify poorer performing hospitals. Then, their services can be improved via monetary incentive schemes. Hospitals have become more accountable to their patients for "due diligence" when supposedly providing their patients with the "best methods and practices" of regional healthcare. The recently initiated "Overall Hospital Quality Star Rating" system would be an example of such a comparative system. Fewer and shorter hospital stays should result from such improvements.
The integrated use of IT in the medical sector, an important AFC goal, has helped doctors coordinate care across specialties, too.
The successes of the AFC act have been many, including improved overall healthcare. Rises in medical costs are inevitable, especially in a sector undergoing concentration of those services.
[JJL 8/29 M 2:06p]
Establishing treatment benchmarks, and tracking compliance with these benchmarks, for many healthcare hospital services, via management-by-exception (MBE) principles, help to identify poorer performing hospitals. Then, their services can be improved via monetary incentive schemes. Hospitals have become more accountable to their patients for "due diligence" when supposedly providing their patients with the "best methods and practices" of regional healthcare. The recently initiated "Overall Hospital Quality Star Rating" system would be an example of such a comparative system. Fewer and shorter hospital stays should result from such improvements.
The integrated use of IT in the medical sector, an important AFC goal, has helped doctors coordinate care across specialties, too.
The successes of the AFC act have been many, including improved overall healthcare. Rises in medical costs are inevitable, especially in a sector undergoing concentration of those services.
[JJL 8/29 M 2:06p]
I'm healthy, have never eschewed coverage, and my family is reduced essentially to catastrophic coverage for astronomic monthly premiums through workplace provided insurance, from a large employer.
7
None of the supposed solutions work. Health insurers administrate; they generally slow down and confuse actual healthcare delivery. Markets can function only when pricing and quality information is readily available, when there is sufficient time for consumers to evaluate and choose, and when choices are broad and relatively unfettered.
The idea that insurance which covers (ever) smaller groups of providers will somehow result in lower prices is absurd. For what it worth, promoting severe limitations on choice contradicts the whole notion of competition and the "marketplace".
The goal of "stabilizing the markets" (to appease the insurers) is off target. The goal should be quality healthcare for the population as a whole.
Americans need to get over their worship of the marketplace and their disdain of the role of the government. The people as a whole can ordain and establish processes for ensuring their welfare– including healthcare. We can expand Medicare to include everyone.
The idea that insurance which covers (ever) smaller groups of providers will somehow result in lower prices is absurd. For what it worth, promoting severe limitations on choice contradicts the whole notion of competition and the "marketplace".
The goal of "stabilizing the markets" (to appease the insurers) is off target. The goal should be quality healthcare for the population as a whole.
Americans need to get over their worship of the marketplace and their disdain of the role of the government. The people as a whole can ordain and establish processes for ensuring their welfare– including healthcare. We can expand Medicare to include everyone.
4
The individuals most motivated to purchase individual policies are those
who need a lot of health care. Obamacare's primary disaster is creating
an incentive (take all pre existing conditions) for the sick to enroll first
rather than the healthy. How we get out of this mess is anyone's guess
but I suspect a Medicare option for individuals is the only viable way.
who need a lot of health care. Obamacare's primary disaster is creating
an incentive (take all pre existing conditions) for the sick to enroll first
rather than the healthy. How we get out of this mess is anyone's guess
but I suspect a Medicare option for individuals is the only viable way.
2
In my legal practice I often guide people toward Washington State's health plan exchange. Many of my clients are below the poverty level or make only a modest income. Those below the poverty threshold qualify for free coverage. While the plan provides only a limited number of providers, and limits certain kinds of coverage, it insures those previously uninsured - a vast improvement over what was available prior to the affordable care act. Other clients qualify for subsidized plans that are remarkably affordable, have reasonable deductibles, and provide excellent coverage. Do the plans make it easy for the insured to get whatever coverage they want, wherever they want? No, but this has always been the case. At least now, the plans available are vastly less expensive, and the insurers cannot deny the insured coverage for pre-exiting conditions - a vast improvement over the abysmal options available to them pre-affordable care act (there's no such thing as Obamacare - please can we stop using that FOX News pejorative?).
I now buy my own health care through the exchange. While I don't qualify for the great subsidies my clients do, I pay slightly less that I did pre-affordable care act, have a deductible that is about 5 times smaller now, and the pre-existing condition my pre-affordable care plan would not cover is now covered. This alone means my health care costs me about 4-5 times less than it did before the much criticized "Obamacare" came into existence.
I now buy my own health care through the exchange. While I don't qualify for the great subsidies my clients do, I pay slightly less that I did pre-affordable care act, have a deductible that is about 5 times smaller now, and the pre-existing condition my pre-affordable care plan would not cover is now covered. This alone means my health care costs me about 4-5 times less than it did before the much criticized "Obamacare" came into existence.
5
In my volunteer weekend legal practice in Washington DC, I do the exact opposite. Over half the people I work for are my age or younger, and are drowning in debt because of student loan payments, stagnant wages and the 75% increase in insurance costs due to Obamacare.
We have an emerging new working poor, with over half the people under the age of 45 unable to afford the insurance coverage Obamacare forced them to buy, and are suffering economic hardships NOW.
With major insurers backing out of the Obamacare exchanges, we are seeing consolidation and monopolization. That means fewer choices, higher prices and an American public at the mercy of insurance companies.
Thanks to Barack Obama, for every person under 65 seeing a net savings of $1 or more, there are 593 people seeing cost increases. A working person under the age of 65 has a 1 in 600 chance of saving money on health insurance today.
And you're steering people into Obamacare? If you're advising healthy Americans under the age of 35 to buy into Obamacare, that borders on malpractice.
We have an emerging new working poor, with over half the people under the age of 45 unable to afford the insurance coverage Obamacare forced them to buy, and are suffering economic hardships NOW.
With major insurers backing out of the Obamacare exchanges, we are seeing consolidation and monopolization. That means fewer choices, higher prices and an American public at the mercy of insurance companies.
Thanks to Barack Obama, for every person under 65 seeing a net savings of $1 or more, there are 593 people seeing cost increases. A working person under the age of 65 has a 1 in 600 chance of saving money on health insurance today.
And you're steering people into Obamacare? If you're advising healthy Americans under the age of 35 to buy into Obamacare, that borders on malpractice.
6
I know a couple in Sumner Washington who hate all things Obama. They purchase an Obama care policy on the exchange, because they could not find other healthcare insurance as affordable.
1
One of the consequences of the ACA was insurers phasing out catastrophic insurance plans. These plans had low premiums, high deductibles, and were designed to prevent financial ruin in the event of an accident. These types of plans are perfect for young, healthy people -- and if they were to be reinstated, I think we'd see higher participation rates among that core group.
But the ACA did not support those plans because of the fascination this country has with so called "preventative medicine". If you are a twenty-something, with no pre-existing conditions and lead a healthy lifestyle, you do not need the level of coverage (and premium expense) that the bronze plans provide. You need a catastrophic plan, but now you can't get one, so more than likely, you'll opt out of health insurance entirely.
All the ACA accomplished was herding people into ever more expensive plans that they may not want nor need. Meanwhile, the insurance companies are rubbing their hands together with glee, whilst crying poverty.
But the ACA did not support those plans because of the fascination this country has with so called "preventative medicine". If you are a twenty-something, with no pre-existing conditions and lead a healthy lifestyle, you do not need the level of coverage (and premium expense) that the bronze plans provide. You need a catastrophic plan, but now you can't get one, so more than likely, you'll opt out of health insurance entirely.
All the ACA accomplished was herding people into ever more expensive plans that they may not want nor need. Meanwhile, the insurance companies are rubbing their hands together with glee, whilst crying poverty.
10
I don't think the PPACA designers were focused on "preventative medicine" but on the premiums they could generate by forcing young, healthy people into the individual markets to keep down the costs of the government subsidies for others. This allowed people like Nancy Pelosi and Harry Reid to claim a lower costs of implementing the PPACA. Of course, this is complete contrast to their attitude about college loans where Elizabeth Warren's fleecing the taxpayer is the current operating mode. One hopes the millennials remember this and take to heart the fear the words "I'm from the government and I'm here to help" should inspire.
1
Sigh.
This is absolute nonsense.
The PPACA not only allows such catastrophic plans, it positively mandates that groups, employers and the Exchanges offer them.
In other words, they're part of every group health care plan. And five seconds of checking would tell you that.
This is absolute nonsense.
The PPACA not only allows such catastrophic plans, it positively mandates that groups, employers and the Exchanges offer them.
In other words, they're part of every group health care plan. And five seconds of checking would tell you that.
An Amercan with preexisting conditions would disagree with you.
"Competition", in health care rarely, lowers cost. Because our system of for profit health care is so complex, and expected to generate large profits, "something has to give". Generally that is access to care, exclusion of existing conditions, cherry picking of insureds, etc.
Since the ACA eliminates the last two, that leaves access to care: limited networks, fewer specialist physicians, higher deductibles, and insurers abandoning an "unprofitable" market if nothing else works.
The ACA was supported by the industry because it anticipated more premium dollars from the currently uninsured, and more spending for care. The act's Individual Mandate provision did not deliver that. Taxing the poor tends not to work.
We're out of magic bullets here. Health care is 30% more expensive in the US than it is in single payer, national health program countries. Do we continue a system of overpriced, heavily rationed, healthcare? The Doctors, Hospitals, Insurance companies, and Pharma, would like to see their comfortable lives continue. As a nation we have to finally decide if health care is a right or a privilege. Currently we are a third world country in that respect.
Since the ACA eliminates the last two, that leaves access to care: limited networks, fewer specialist physicians, higher deductibles, and insurers abandoning an "unprofitable" market if nothing else works.
The ACA was supported by the industry because it anticipated more premium dollars from the currently uninsured, and more spending for care. The act's Individual Mandate provision did not deliver that. Taxing the poor tends not to work.
We're out of magic bullets here. Health care is 30% more expensive in the US than it is in single payer, national health program countries. Do we continue a system of overpriced, heavily rationed, healthcare? The Doctors, Hospitals, Insurance companies, and Pharma, would like to see their comfortable lives continue. As a nation we have to finally decide if health care is a right or a privilege. Currently we are a third world country in that respect.
4
And our astronomic prices are what allow other countries' governments to negotiate reasonable prices for their citizens.
1
It would be interesting to know how much of that 30% cost adder is the result of American Pharmaceuticals and other large healthcare corporations charging substantially more for their goods and services in the US than they do in nationalized healthcare countries.
Obamacare's big flaw is that it tries to achieve the health and financial benefits of universal coverage in the most expensive way possible, by buying overpriced private insurance policies for almost everyone in the country who needs one. (Medicaid expansion is a cheaper way of providing coverage, but Medicaid expansion was only aimed at the poorest group, and because of the Supreme Court, only covers this group in states that chose to expand Medicaid.)
BEcause Obamacare has no public option, and because healthcare in the US is much more expensive than in other advanced countries, the health coverage offered on the exchanges in simply too expensive for most people, even with so-called middle incomes. My wife and I earn slightly above median household income, and even with subsidy must pay premiums of $1,100/month. THese premiums clean us out every month, preventing us from saving much for retirement.
Some might think that subsidies should only go to people who earn below the median, but remember that there is no effort made to keep the policies we must now buy priced at affordable levels. Unlike other major purchases like cars and housing, the market cannot and does not offer a "middle class policy" analogous to a Toyota Camry or a suburban split-level. TOday's policy is priced to provide the coverage you need, and Obamacare rightly did away with the old "pretend" policies.
OBamacare's experiment with private coverage has failed. Bring in single-payor healthcare!
BEcause Obamacare has no public option, and because healthcare in the US is much more expensive than in other advanced countries, the health coverage offered on the exchanges in simply too expensive for most people, even with so-called middle incomes. My wife and I earn slightly above median household income, and even with subsidy must pay premiums of $1,100/month. THese premiums clean us out every month, preventing us from saving much for retirement.
Some might think that subsidies should only go to people who earn below the median, but remember that there is no effort made to keep the policies we must now buy priced at affordable levels. Unlike other major purchases like cars and housing, the market cannot and does not offer a "middle class policy" analogous to a Toyota Camry or a suburban split-level. TOday's policy is priced to provide the coverage you need, and Obamacare rightly did away with the old "pretend" policies.
OBamacare's experiment with private coverage has failed. Bring in single-payor healthcare!
3
Agree generally, but people who praise Medicaid (as opposed to Medicare) have never had any experience with the program. I have a 100% disabled relative who until recently was on Medicaid. (Our beloved governor has issued an edict to throw as many people as possible off the rolls; fortunately she is old enough for Medicare, which picks up the slack. I can only wonder in dismay what happens to other mentally disabled clients who have to figure out the maze of paperwork, forms and regulations, send photocopies of every document they've ever been in the same room with, etc. - only to get their applications lost or rejected for no explicable reason.) And the doctors are no prizes - often bottom-of-the-barrel, who rely on Medicaid patients because anyone who had a choice would go elsewhere. I've seen filthy examining rooms, manned by doctors who were equally grubby; doctors who spoke almost no English; who prescribed vitamins for everything except a broken leg; who were old enough to have known Hippocrates personally and hadn't taken any continuing education since; who didn't seem to have the slightest idea what they were doing. But hey, they accepted Medicaid.
6
You need to talk to somebody who knows what they're doing, because it is illegal to charge you more than about 9% of your annual income.
I have to disagree here. The single-payor system is not what we need. We have already seen how the Fed gets mired in its own web of bureaucracy at the VA and with Medicaid. We just need a public option for people who are unable to afford insurance and people with preexisting conditions. The biggest problems with the ACA are not only are the outrageous premiums, but their deductibles are outrageously high as well. In the end, people are paying top price for minimal coverage.
1
We are kidding ourselves in believing that the Healthcare industry participates in a true free market.
To make it so one must: open the pharmaceutical industry to real competition in a global market: as in the FDA should approve prescription drugs from certain western countries including Canada, Britain, Germany, France etc. to be sold in the US; And that the AMA not control the number of doctors in the country. The Health Insurance industry should provide insurance across state boundaries. Large health providers including Medicare and Medicaid be able to negotiate with pharmaceutical companies for drug pricing based on volume discounts. Make licensing of generic drugs much easier to enable competition world wide. Hospital costs need to be made competitive with clear transparency on all costs associated with medical procedures to patients and not just the insurance companies. Provide a public option that competes with the private Healthcare Insurance companies and may the best thrive. And the list can go on and on.
Unless we make the Healthcare market truly competitive and all pricing becomes transparent, it would be impossible to make any changes work.
To make it so one must: open the pharmaceutical industry to real competition in a global market: as in the FDA should approve prescription drugs from certain western countries including Canada, Britain, Germany, France etc. to be sold in the US; And that the AMA not control the number of doctors in the country. The Health Insurance industry should provide insurance across state boundaries. Large health providers including Medicare and Medicaid be able to negotiate with pharmaceutical companies for drug pricing based on volume discounts. Make licensing of generic drugs much easier to enable competition world wide. Hospital costs need to be made competitive with clear transparency on all costs associated with medical procedures to patients and not just the insurance companies. Provide a public option that competes with the private Healthcare Insurance companies and may the best thrive. And the list can go on and on.
Unless we make the Healthcare market truly competitive and all pricing becomes transparent, it would be impossible to make any changes work.
4
The PPPACA allows building Exchanges across state lines, and put the prices for the top 100 most common procedures at every hospital on line.
Look it up.
Look it up.
Many writers blame the government and point to the utility of a supposedly "efficient" private sector. The mess we are in is due solely to the corruption, collusion and price-fixing among physicians, hospitals, drug companies and insurance companies. If government and Congress had the backbone to end this so-called private market efficiency, a lot of the outrageous pricing would go away.
3
A large problem was created by Congress. Prior to the ACA, the age rating, the amount paid by elderly compared with the young was 6:1 which reflected true costs. Congress intervened making the age rating 3:1 which mean that a 25-year-old is paying 75% too much for his coverage.
One reads in the press that not enough young, healthy people are signing up and this is the reason why. Fix the age rate to reflect true costs and I predict the insurers will see more young, healthy people sign up.
Instead of unfairly treating the young, follow the example of the UK, France, Canada, Ireland, and other developed nations and raise the federal tax from about $1 to a rate exceeding $5 or $7 per pack and use that to pay for the additional health care costs incurred compared with non-smokers. The higher rates will also help people to quit smoking and the young to never start.
In economics terms, by changing the age rate to 3:1 from 6:1 Congress created a market inefficiency while at the same time not addressing the externality of additional health care costs from smoking. The ACA does allow for insurers to charge 50% more for smokers but not all plans have this option and many people claim not to smoke when they do.
Correct the age rating the market conditions of 6:1 and you'll see many more young people sign up for health care.
One reads in the press that not enough young, healthy people are signing up and this is the reason why. Fix the age rate to reflect true costs and I predict the insurers will see more young, healthy people sign up.
Instead of unfairly treating the young, follow the example of the UK, France, Canada, Ireland, and other developed nations and raise the federal tax from about $1 to a rate exceeding $5 or $7 per pack and use that to pay for the additional health care costs incurred compared with non-smokers. The higher rates will also help people to quit smoking and the young to never start.
In economics terms, by changing the age rate to 3:1 from 6:1 Congress created a market inefficiency while at the same time not addressing the externality of additional health care costs from smoking. The ACA does allow for insurers to charge 50% more for smokers but not all plans have this option and many people claim not to smoke when they do.
Correct the age rating the market conditions of 6:1 and you'll see many more young people sign up for health care.
3
Way off buddy! I'm 60. I currently pay $526/month for essentially nothing. Your plan would push my premiums to over $1000/month. Can't afford that.
Secondly, before Obamacare, my policy was underwritten and I had much lower premiums due to my good health and low risk. I lost that advantage.
Thirdly, what you suggest is not how insurance is supposed to work. If it was supposed to cover your individual costs only, that not insurance. It's a time payment plan. Insurance works by spreading out all cost over a very large population, thereby making it affordable for all. All sacrifice a little for the sake of all.
Fourthly, the young already have low premiums and most receive subsidies due to their lower incomes. A potentially subsidized 30 year old that would be paying $100/month is not going to jump in for $50. They spend that on one week of cable TV, or one night at the bar.
Doubling the costs for those of us over 50 isn't a solution. Reducing the take of healthcare from $3 trillion a year to 1.5 would help a lot. Will you cut your income in half to make it work? I didn't think so.
Secondly, before Obamacare, my policy was underwritten and I had much lower premiums due to my good health and low risk. I lost that advantage.
Thirdly, what you suggest is not how insurance is supposed to work. If it was supposed to cover your individual costs only, that not insurance. It's a time payment plan. Insurance works by spreading out all cost over a very large population, thereby making it affordable for all. All sacrifice a little for the sake of all.
Fourthly, the young already have low premiums and most receive subsidies due to their lower incomes. A potentially subsidized 30 year old that would be paying $100/month is not going to jump in for $50. They spend that on one week of cable TV, or one night at the bar.
Doubling the costs for those of us over 50 isn't a solution. Reducing the take of healthcare from $3 trillion a year to 1.5 would help a lot. Will you cut your income in half to make it work? I didn't think so.
2
You're not making sense David.
I am a Black lawyer in Washington DC, and a millennial caught in the shell game, Ponzi scheme called Obamacare.
You can "fix" the age rate any way you wish, it will not "fix" Obamacare. Are you advocating for a truth in lending statement showing me because I am young my insurance rates skyrocketed because I am paying for old people and illegals to get health insurance? What good would that do? If anything it would drive us away from the ACA in larger numbers.
The only way to "correct" Obamacare is to repeal it.
I am not a fan of paying 200% more for less coverage because others are freeloading off of my health and youth.
I am a Black lawyer in Washington DC, and a millennial caught in the shell game, Ponzi scheme called Obamacare.
You can "fix" the age rate any way you wish, it will not "fix" Obamacare. Are you advocating for a truth in lending statement showing me because I am young my insurance rates skyrocketed because I am paying for old people and illegals to get health insurance? What good would that do? If anything it would drive us away from the ACA in larger numbers.
The only way to "correct" Obamacare is to repeal it.
I am not a fan of paying 200% more for less coverage because others are freeloading off of my health and youth.
3
Never fly; too sensible.
1
"Doctors...charge more here than in other countries." As usual, one can lie with the truth. Doctors may charge more in the US, but other countries charge no tuition for medical school. The truth is that most newly minted physicians in the USA carry, what for many, is a mortgage. It must be paid.
The answer is more complicated than the discussion.
The answer is more complicated than the discussion.
10
We desperately need a national single payer system.
I have insurance because of Obamacare after over a decade when insurers wouldn't sell me a policy due to a pre-existing condition, which left me in bankruptcy.
I use epi-pens for allergy and if I wasn't ensured now would be terrified of having to pay hundreds of dollars out of pocket for a single epi pen.
The GOP is keeping us hostage to a system that punishes and bankrupts millions of Americans who can't get adequate insurance coverage - or 19 million Americans who have no coverage at all.
I'm grateful to Obama for getting us this far.
Now humane people must insist demand we go to a national single payer system insuring all Americans. Not to do so is crippling, bankrupting and killing people. We couldn't do this 7 years ago because of the interference of former Senator Joe Lieberman, who was in the pockets of the insurance interests in his state of Connecticut. That a handful of politicians were able to control withholding medical insurance from millions of Americans - something that has damaged this country for decades - was despicable.
We must demand an end to obstruction of national single payer insurance by politicians who are prioritizing insurance company profits over the health and welfare of all Americans.
I have insurance because of Obamacare after over a decade when insurers wouldn't sell me a policy due to a pre-existing condition, which left me in bankruptcy.
I use epi-pens for allergy and if I wasn't ensured now would be terrified of having to pay hundreds of dollars out of pocket for a single epi pen.
The GOP is keeping us hostage to a system that punishes and bankrupts millions of Americans who can't get adequate insurance coverage - or 19 million Americans who have no coverage at all.
I'm grateful to Obama for getting us this far.
Now humane people must insist demand we go to a national single payer system insuring all Americans. Not to do so is crippling, bankrupting and killing people. We couldn't do this 7 years ago because of the interference of former Senator Joe Lieberman, who was in the pockets of the insurance interests in his state of Connecticut. That a handful of politicians were able to control withholding medical insurance from millions of Americans - something that has damaged this country for decades - was despicable.
We must demand an end to obstruction of national single payer insurance by politicians who are prioritizing insurance company profits over the health and welfare of all Americans.
10
The VA Health System is an example of a single-payer, government run healthcare. People die waiting for care in this system. Our current health care system is sick and needs some major surgery, but we have to be very careful about the revisions we make. I for one do not want to die waiting to see a doctor.
4
Once again, another analysis skips over the real problem. Obamacare is not health insurance. It is catastrophic coverage.
I used to have real health insurance. I could go to just about any doctor with a $30 copay. I could go to the ER with a $100 copay. I had a $1000 deductible and maximum out of pocket annual cost of $3000.
Now I pay much more and have insurance that pays for nothing until I spend $6450. Zip! Nada! Oh, but I get a free checkup. I could buy that so called free checkup for $250 and a set of labs on the internet for less than $100. So what happens if the doctor wants to look further? Any additional tests come out of pocket. One test could eat up that deductible. In my case, policies that provide coverage like I used to have would cost about 25% of gross income.
Solution? Don't go to the doctor. This is the era of DIY medicine. Wait until you are really sick.
The reason net healthcare expenditures have not risen much is because these astronomically high deductibles keep people from going to the doctor. We are spending more on premiums, but less on doctor visits because we stay away from the people with the white coats.
Next year, when the premiums skyrocket as predicted, this thing will collapse. We just can't afford to pay 20% or more of gross income on premiums. Most of us simply don't have the money. Analyze that.
I used to have real health insurance. I could go to just about any doctor with a $30 copay. I could go to the ER with a $100 copay. I had a $1000 deductible and maximum out of pocket annual cost of $3000.
Now I pay much more and have insurance that pays for nothing until I spend $6450. Zip! Nada! Oh, but I get a free checkup. I could buy that so called free checkup for $250 and a set of labs on the internet for less than $100. So what happens if the doctor wants to look further? Any additional tests come out of pocket. One test could eat up that deductible. In my case, policies that provide coverage like I used to have would cost about 25% of gross income.
Solution? Don't go to the doctor. This is the era of DIY medicine. Wait until you are really sick.
The reason net healthcare expenditures have not risen much is because these astronomically high deductibles keep people from going to the doctor. We are spending more on premiums, but less on doctor visits because we stay away from the people with the white coats.
Next year, when the premiums skyrocket as predicted, this thing will collapse. We just can't afford to pay 20% or more of gross income on premiums. Most of us simply don't have the money. Analyze that.
17
You've underinsured yourself, and the law doesn't permit costs of 20% of annual income.
Robert, that's my point. I can't afford to insure myself properly. The premiums that will give me the coverage that I want cost $900/month. That's $9600/year. If I make in the lower $50's, that's nearly 20% of my gross income.
How can the law prohibit me paying that much in premiums? It doesn't prohibit me from buying them? There is no lockout on price.
What you have indirectly alluded to is that the law does not work as intended. When you add in the deductibles, many of us could pay over 25% of gross income and that's with a high deductible plan. My total costs could be as high as $12,750 per year. That is over 20% of gross income now. The law does not protect us. It is not working.
How can the law prohibit me paying that much in premiums? It doesn't prohibit me from buying them? There is no lockout on price.
What you have indirectly alluded to is that the law does not work as intended. When you add in the deductibles, many of us could pay over 25% of gross income and that's with a high deductible plan. My total costs could be as high as $12,750 per year. That is over 20% of gross income now. The law does not protect us. It is not working.
3
If Obamacare cost is so onerous, buy a policy outside an exchange.
To all those suggesting replacing the ACA with a so-called public option, nationalizing health insurance, or otherwise having the government take full control of the market, I have only one question:
The government has proven incompetent to regulate the market on a large scale through the ACA; why should we suppose the government would do a better job, if it took over the health insurance industry in its entirety?
In short, the government would not do a better job. In fact, as has been shown over the last five years, it would be an ever-increasingly fast ride downhill, if the government were to get further involved.
Repeal the ACA and allow competition across state lines. That, alone, will do more good than the ACA has done in all of the time it's been implemented.
The government has proven incompetent to regulate the market on a large scale through the ACA; why should we suppose the government would do a better job, if it took over the health insurance industry in its entirety?
In short, the government would not do a better job. In fact, as has been shown over the last five years, it would be an ever-increasingly fast ride downhill, if the government were to get further involved.
Repeal the ACA and allow competition across state lines. That, alone, will do more good than the ACA has done in all of the time it's been implemented.
7
Under a public plan, government would not be regulating the market - the insurance companies. Rather it would be the market. For health care.
And please stop to think, and ask why insurance companies would be excited to cross state lines seeking to sell insurance in those areas where claim histories have been driving out the local insurers.
And please stop to think, and ask why insurance companies would be excited to cross state lines seeking to sell insurance in those areas where claim histories have been driving out the local insurers.
3
Have you ever heard of Medicare? Are you really one of those people who rants "Keep your government hands off my Medicare"?
1
The law allows exchanges across state lines already. As for the notion that The Holy Market will provide, I hope you don't need an EpiPen.
1
The ACA needs to be mended not ended. We need a Democratic congress willing to work with the President. We experimented with a law devised by the Heritage Foundation and first adopted by Mitt. Hillary had some ideas in her health plan and perhaps we can apply some of them.
High deductibles are a major problem since people will not go to doctors when they have small problems that can take care of major problems.
But the ACA is working in Florida even though it has a hostile state government. Florida Blue earned $500 million off the ACA in 2015 and has narrow networks in its Select plans and broad networks in its Option plans. It has no deductible and high deductible plans. My family plan is the broadest most expensive plan with no deductibles but with co-pays and high ones for some drugs and hospitals. That is why Florida has the most people in the US enrolled in ACA plans.
High deductibles are a major problem since people will not go to doctors when they have small problems that can take care of major problems.
But the ACA is working in Florida even though it has a hostile state government. Florida Blue earned $500 million off the ACA in 2015 and has narrow networks in its Select plans and broad networks in its Option plans. It has no deductible and high deductible plans. My family plan is the broadest most expensive plan with no deductibles but with co-pays and high ones for some drugs and hospitals. That is why Florida has the most people in the US enrolled in ACA plans.
2
Anything government tries to run will be less efficient than the private sector. The only true path towards success would be private markets with government regulation and oversight.
3
Absolutely false.
Medicare has a admistrative overhead rate of 2 to 3%. Private healthcare insurance overhead rate is 10 times greater.
Medicare has a admistrative overhead rate of 2 to 3%. Private healthcare insurance overhead rate is 10 times greater.
5
"Anything government tries to run will be less efficient than the private sector. "
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That's just flat out not true. Medicare has been shown time and time again to have far less overhead cost associated with it than any private insurance scheme.
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That's just flat out not true. Medicare has been shown time and time again to have far less overhead cost associated with it than any private insurance scheme.
1
One can write about reducing payments to physicians but unless medical school costs and student debt is lowered, medical graduates won't be able to afford a career in primary care and many who would make good doctors won't be able to afford medical school at all.
8
A great way to handle this would be to have med students take loans as now, but the federal government would pay off a year of loans for every year of medical practice in a high need area. This would prevent the taxpayers paying for 1) people who fail out of medical school, 2) those who go into oversubscribed specialty areas (dermatology?), or 3) those who become just another specialist in an overstocked urban location. And in three years, you'd have a doctor with no loans to worry about, able to go wherever she'd like to be, and a new crop can work off their loans.
1
I am a die hard capitalist and a conservative. I "think" the most pragmatic way is for the "truly" needy or poor, we need to take care of them. The problem is where to draw the line. For instance we do we do about illegal immigrants vs. the working poor who are US citizens? Medicare for these people is the only way to go. The system is set up. Once we decide who qualifies, lets get them enrolled. But....I think this should be a crutch. If they can climb out of poverty too the middle class, should we allow them stay on Medicare? How do we track this? What i don't understand is why people are NOT enrolling in Obamacare if you can qualify for the subsidy? I wish the media would investigate this. 27 Million would make the marketplace improve. Private insures cannot continue to lose money because the marketplace is too small.
2
Very good points. I am a moderate Democrat. I wish both parties would actually pass something to address the problem.
Simple: Republican state governments have refused to expand Medicaid, and have worked to make enrollment as hard as they can.
You wonder why people don't enroll, even though they are eligible.
Firstly, Medicare is only for those aged 65+ and the disabled, so you probably mean Medicaid (for the poor) and/or subsidized health insurance from the exchange.
Medicaid requires recipients to produce proof of income every time it changes - under penalty of law. Poor people have widely fluctuating incomes, so to stay on Medicaid they need to collect documentation and send it to their welfare agency every month. Unless someone is under regular medical care, the time spent collecting, making copies, mailing in changes makes it too complicated to deal with. Also, if you are over 55 and on Medicaid, states can go after your estate assets to recover premium costs - even if you never ever went to the doctor and never sought medical care.
Exchanges don't go after your estate, and you won't go to jail if you don't report your income changes in timely fashion. However, the exchanges require you to know in advance how much you will make during the year - an impossibility for many people. Further, given that your full premium can be $700 or more, if you take the subsidy, but make a mistake, you might be liable to pay back thousands of dollars for premiums - even if you never ever went to the doctor and received absolutely no medical care.
Given the complexity of applying for (and using) the beast called "health insurance", is it a wonder then that people decide to go without?
Firstly, Medicare is only for those aged 65+ and the disabled, so you probably mean Medicaid (for the poor) and/or subsidized health insurance from the exchange.
Medicaid requires recipients to produce proof of income every time it changes - under penalty of law. Poor people have widely fluctuating incomes, so to stay on Medicaid they need to collect documentation and send it to their welfare agency every month. Unless someone is under regular medical care, the time spent collecting, making copies, mailing in changes makes it too complicated to deal with. Also, if you are over 55 and on Medicaid, states can go after your estate assets to recover premium costs - even if you never ever went to the doctor and never sought medical care.
Exchanges don't go after your estate, and you won't go to jail if you don't report your income changes in timely fashion. However, the exchanges require you to know in advance how much you will make during the year - an impossibility for many people. Further, given that your full premium can be $700 or more, if you take the subsidy, but make a mistake, you might be liable to pay back thousands of dollars for premiums - even if you never ever went to the doctor and received absolutely no medical care.
Given the complexity of applying for (and using) the beast called "health insurance", is it a wonder then that people decide to go without?
1
I manage the purchase of insurance for 7 employees at a small non-profit preschool. Every year it is the same thing. The cost of plans go up and I have to pick a lesser plan to cover us. Last year I switched us on to the Marketplace to receive the tax credit but in the end, the tax credit doesn't cover the cost of the increases and the tax credit is only available to small business' for 2 years...after that we're on our own.
The only avenue I have to control cost is to pick lesser plans. Which means employees must pay more of their own health care costs not at all commensurate with any cost of living increase they receive in pay. Or I could just fire everyone over 30 including myself!
I always applauded Obama's efforts in creating the ACA but without some way of controlling costs built in I cannot see how it will succeed. For-profit insurance companies will not accept lowering CEO pay and stockholder profits to accommodate a fair system. The only option is to create real competition through an optional national health care program. With a real fair choice for people to turn to, the major insurers will have to really compete to stay in the game.
The only avenue I have to control cost is to pick lesser plans. Which means employees must pay more of their own health care costs not at all commensurate with any cost of living increase they receive in pay. Or I could just fire everyone over 30 including myself!
I always applauded Obama's efforts in creating the ACA but without some way of controlling costs built in I cannot see how it will succeed. For-profit insurance companies will not accept lowering CEO pay and stockholder profits to accommodate a fair system. The only option is to create real competition through an optional national health care program. With a real fair choice for people to turn to, the major insurers will have to really compete to stay in the game.
8
Mandatory national healthcare.
A major reason that insurance companies charge more here is because the hospitals must cover everybody but not everybody buys insurance. So those of us who do have insurance are paying for those who don't. It's called cost shifting and should be illegal but it isn't.
I was standing to pay my bill at my doctor's for a checkup. It cost $150 but my insurance carrier would pay all but ten dollars. A person in the next checkout was doing the same thing for the same checkup. Her collector said "You don't have insurance so that will be $50." I found a new doctor after that, but I suspect that all of them do it.
I was standing to pay my bill at my doctor's for a checkup. It cost $150 but my insurance carrier would pay all but ten dollars. A person in the next checkout was doing the same thing for the same checkup. Her collector said "You don't have insurance so that will be $50." I found a new doctor after that, but I suspect that all of them do it.
3
Lots of doctor's offices charge less for cash up front on uninsured patients. There is a lot of overhead expense involved with billing insurance, carrying balances, prior authorization of procedures, etc. which is not an issue for private pay patients.
3
My dentist has a plan where if you pay $400 a year, you get two cleanings/checkups for each family member, plus she'll handle any emergencies at no extra cost. It doesn't cover everything (preventive extractions, bridges, crowns, implants, etc); just basic family dentistry like fillings, xrays.
1
Obamacare Marketplaces Are in Trouble. What Can Be Do?
Scratch it.
Copy the German system, tested, refined and improved since 1883.
Scratch it.
Copy the German system, tested, refined and improved since 1883.
11
It will be interesting to watch the German system in action if they end up with large numbers of low wage or no wage immigrants with great medical needs for extended lengths of time.
2
Other countries, Britain, France, Scandanavia, israel to whom we send billions of $'s, etc. all have well working plans. Are we that backward a nation, that Ill-educated that we cannot learn from them, even to copy- crib in school terms.
10
In Scnadanavia, coverage stops at age 80.
In the EU, diabetics with renal failure don't get dialysis past age 50.
And in the US, we continue to subsidize world health care on the entire planet via Obamacare's desire to ignore Big Pharma. If we demand to pay no more than 125% for a drug in europe here at home, 2 things would happen- our drug prices would go down immediately, and the EU would bankrupt.
In the EU, diabetics with renal failure don't get dialysis past age 50.
And in the US, we continue to subsidize world health care on the entire planet via Obamacare's desire to ignore Big Pharma. If we demand to pay no more than 125% for a drug in europe here at home, 2 things would happen- our drug prices would go down immediately, and the EU would bankrupt.
3
Apparently we are that backward.
"In Scandinavia health coverage stops at age 80"--where ever did you get this loony idea? Absolutely untrue. Health coverage is available to every legal resident of Sweden, for example, and there is no age limit.
What I see is, that the free market, private enterprise system is inappropriate as a way of providing health care - just as it is recognized as inappropriate in many other areas. I wouldn't go as far as to say our health insurance system is totally dysfunctional - but it is pretty close. We have a lot of smart people in the insurance business making a living trying to avoid paying for other peoples' health care - and yet, we end up paying more than anybody else in the world - if we were in an imaginary system where you get to pick the best way of doing something, we could choose any of the countries doing so much better than we are, and simply copy their system. But we don't have that kind of free choice...
113
I find myself wondering the same thing -- why don't we just model our system after a successful one in another country. I will say though that the problem is mostly the providers, not the insurers. Read Steven Brills' articles on this topic -- very enlightening.
I have given up on our Republican legislators working for the good of the country. All they are interested in is what benefits them.
Call it 'Medicare for All' call it Singlepayer, call it good for ALL citizens of the US. For profit business, the greedy version allowed by law in this country, does not belong in our health management. We'd be a healthy and more productive nation with the assurance that our physical and financial health was not at RISK every single day. This obscene scheme must stop!
5
Universal Health Care for All with tight government regulation of pricing for all providers and suppliers is the only answer. I nearly gagged today when learned that the purveyor of EpiPen is going to come out with a generic version. What a joke. They will still make billions of $$$ off the misery of others. The patent should be taken away from them and given to a government agency to be manufactured and sold at cost plus 1% to actually save lives instead of allowing BIG Wall Street-controlled pharma to profit from death.
4
So your answer is for the government to steal a patent? Really?
1
The solution is and was so simple: allow people to sign up only when they
decide they need insurance.
How do we pay for this? Simple: this is where government can come in.
People who already have insurance will be registered with the government.
They will be exempt from what I write next.
If a person decides they need insurance NOW they will be put on
a special list by the government. They will be required to remain on this
list, and keep paying a somewhat raised rate, for long enough
that the plans are financially sound. In other words, the people who
need expensive care and are cured will pay for the treatment of those
who need expensive care and die before paying "their fair share".
decide they need insurance.
How do we pay for this? Simple: this is where government can come in.
People who already have insurance will be registered with the government.
They will be exempt from what I write next.
If a person decides they need insurance NOW they will be put on
a special list by the government. They will be required to remain on this
list, and keep paying a somewhat raised rate, for long enough
that the plans are financially sound. In other words, the people who
need expensive care and are cured will pay for the treatment of those
who need expensive care and die before paying "their fair share".
3
Single payer. Very simple.
9
Single payer.
Can't happen.
It's illegal.
And unconstitutional until Obamacare is repealed.
Really liberals. What's wrong with you?
Can't happen.
It's illegal.
And unconstitutional until Obamacare is repealed.
Really liberals. What's wrong with you?
3
Never supported this ridiculous law. Own my own business and bought top notch coverage through it. Then Obamacare came along and threw me off my plan. I have to now buy through the exchange, and the coverage is terrible. So now if Obamacare goes belly up, I can end up with no coverage at all because if I can't buy coverage through my company, then I can't afford it. What a joke.
7
To everyone suggesting "Medicare for all", please stop.
The only reason Medicare appears to be working reasonably well is because you have the entire working population paying the medical bills of a smaller subset of the population: retired people. How sustainable will that be if we now put everyone into Medicare?
Older folks, I have a message for you. Do not be fooled by these neo-communists who lie about how great Medicare for all will be. Medicare for all necessarily requires a decrease in the quality of care for you.
The only reason Medicare appears to be working reasonably well is because you have the entire working population paying the medical bills of a smaller subset of the population: retired people. How sustainable will that be if we now put everyone into Medicare?
Older folks, I have a message for you. Do not be fooled by these neo-communists who lie about how great Medicare for all will be. Medicare for all necessarily requires a decrease in the quality of care for you.
4
Medicare pays private hospitals, doctors for services. Nationalize the whole works.
No more billionaire CEOs.
No more billionaire CEOs.
1
True. That is why Medicaid exists.
There are no solutions only improvement of care can make a difference as well as more healthy people!
Nationalize it.
2
The first thing that must be done is to punish the people who did this to us, the people who told us we had to pass the bill to find out what was in it, the people who told us costs would decline by 2500 per family, the people who falsely claimed they were bending the cost curve down, the people who falsely assured us that if we liked our plans we could keep them, that if we liked our doctors we could keep them too, the people who ignored, belittled, slandered, and attacked those of us who skeptical and who accurately predicted all of the terrible things that would happen if this terrible law were law were passed.
They gave us such a wonderful product that they had to threaten us with penalties and taxes if we didn't buy it, and even then people decided they would rather take the punishment that buy this piece of garbage.
They gave us such a wonderful product that they had to threaten us with penalties and taxes if we didn't buy it, and even then people decided they would rather take the punishment that buy this piece of garbage.
4
What can be done ?
Well the obvious is single payer and the next best thing is a public option. The backdoor trojan is there in the ACA ( any state can set up single payer if they want to ) I believe Vermont was close.
Just like gay rights progressed through the states, single payer ( once established ) will get us to the promised land.
-- Or we could all get up off our duffs and vote in a democratic congress to enact our will .
Just an idea...
Well the obvious is single payer and the next best thing is a public option. The backdoor trojan is there in the ACA ( any state can set up single payer if they want to ) I believe Vermont was close.
Just like gay rights progressed through the states, single payer ( once established ) will get us to the promised land.
-- Or we could all get up off our duffs and vote in a democratic congress to enact our will .
Just an idea...
5
Helthcare costs rise because of two reasons
1) there are too many intermediaries all of which need their own profit margins
2) folks who are insured knowing that their costs are covered go to medical facilities for the most mundane reasons.
In my opinion in order to control healthcare costs the solution Is
1) adopt a single payer system
OR
2) healthcare insurance should be only for catastrophic costs. Visits to the doctors office for ordinary ailments such as common colds, vaccinations, should not be covered under insurance. Also regulation need to be put in place where cost of services should be prominently displayed in the Doctor's office so customers know what costs they are incurring and avoid getting sticker shocks after they have opted in for getting treated.
the advantage of option 2 is that because people are paying out of pocket they would be more conscious of their spending. This would lead to decrease in anti-biotics and pain-killer prescriptions and eventusally lead to a healthier addiction free nation
1) there are too many intermediaries all of which need their own profit margins
2) folks who are insured knowing that their costs are covered go to medical facilities for the most mundane reasons.
In my opinion in order to control healthcare costs the solution Is
1) adopt a single payer system
OR
2) healthcare insurance should be only for catastrophic costs. Visits to the doctors office for ordinary ailments such as common colds, vaccinations, should not be covered under insurance. Also regulation need to be put in place where cost of services should be prominently displayed in the Doctor's office so customers know what costs they are incurring and avoid getting sticker shocks after they have opted in for getting treated.
the advantage of option 2 is that because people are paying out of pocket they would be more conscious of their spending. This would lead to decrease in anti-biotics and pain-killer prescriptions and eventusally lead to a healthier addiction free nation
2
For a lot of us, Option 2 is already going on, through high-deductible, low(er) premium plans, and I do think it is having the effect you described.
Or you have a nation who never goes to the doctor until a small treatable issue becomes catastrophic (and expensive).
2
if it is a small treatable issue then in most likelihood the patient would be able to cover the cost of it . There is no need to have a healthcare plan with its 400% overheads
2
It was obvious from the start that you need to allow a more than 3:1 spread in premiums between young and old. The cost of a 60 year old (woman or man) is way more than 3X the cost of a 25 year old male - so you won't get a lot of young people in the system unless you allow a more reasonable spread, like 6 to 1.
1
What can be done? Single payer health care.
4
The only way to fix Obamacare is to destroy the private corporate system. If the government changes the rules for corporate health care to make it unattractive and force people to move into Obamacare, then maybe they can keep Obamacare going. But it will be better than what we have now because the government will be running it :)
2
Numerous commentators have advocated "Medicare for All." Medicare doesn't look like the typical health insurance plan that most people have. They probably don't know that Medicare penalizes people that have saved during their working careers and have retirement income beyond Social Security by increasing their Part B and D premium costs. Further, I suspect they're not on Medicare and aren't not familiar with Medicare's esoteric and archaic rules. They probably never heard of Benefit Periods, Benefit Period coinsurance, and how the coinsurance payments increase the longer a patient is in a Benefit Period. Most certainly, they're not familiar with the Lifetime Reserve Days and the fact that Medicare coverage can end once a patient's Lifetime Reserve Days are exhausted and the patient is on their own after that.
4
Well I'm on a Medicare Advantage plan and I don't think any of that applies to me. The main thing I notice is how inexpensive it is, I'm saving a bundle over what I had to pay in the individual insurance market.
I also know that Medicare is, in general, quite popular. I am deeply skeptical about your honesty.
I also know that Medicare is, in general, quite popular. I am deeply skeptical about your honesty.
2
There is no particular reason for someone to know these details. I receive Medicare, I am subject to some of these additional premiums. The total with drug coverage comes to less than $500 per month. My wife is no longer working but not Medicare eligible has an ACA plan that cost $1060 per month. Prior to that she had group insurance for $630 per month and an HCA that covered the deductible.
The best feature of Medicare compared to all ACA plans we looked at except 2, was that it offered out of state coverage. There were a great many ACA plans, but they only covered you in your state of residence. That is hardly acceptable in NJ- get ill at a Broadway show or whatever and you are uninsured.
The best feature of Medicare compared to all ACA plans we looked at except 2, was that it offered out of state coverage. There were a great many ACA plans, but they only covered you in your state of residence. That is hardly acceptable in NJ- get ill at a Broadway show or whatever and you are uninsured.
Mr. Toner, you're free to be skeptical but I'm not being dishonest. I suggest you check the Medicare website (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/.... There you will find a table on Pages 5 and 6 which shows for 2016:
Inpatient Hospital Deductible
1st 60 Day: $1,288
61st - 90th Day: $322 per day
60 (91st - 150th day) Lifetime Reserve Days Coinsurance: $644 per day
Further, Attachment A (page 18) of the same document has a table showing premiums vs income.
Inpatient Hospital Deductible
1st 60 Day: $1,288
61st - 90th Day: $322 per day
60 (91st - 150th day) Lifetime Reserve Days Coinsurance: $644 per day
Further, Attachment A (page 18) of the same document has a table showing premiums vs income.
In Canada an epi pen cost $80. In the US we get fleeced at an 8 to 1 margin. Doesn't anyone remember when George H W Bush gave the drug companies free reign? He made it ILLEGAL to seek lower drug prices. Here we are.
25
Dump it. Replace it with Medicare for all and the people that have pre-existing conditions should still be covered. And as far as this country affording it - we could if we didn't constantly go to war and feed the military industrial complex. It's not rocket science but apparently those war-mongering clowns in DC think it is. It's time this country took a giant leap into the 21st century.
15
Amercans cannot afford private healthcare.
UnitedHealth Group provided CEO William McGuire with a severance package worth $1.7 billion in 2006.
Nationalize the whole thing.
UnitedHealth Group provided CEO William McGuire with a severance package worth $1.7 billion in 2006.
Nationalize the whole thing.
139
Whatever eventually replaces Obamacare certainly won't provide for allowing denial of coverage for pre-existing conditions or the possibility that one's coverage may become exhausted in a time of need. This new way of thinking is also a big part of the triumph of Obamacare.
5
We just need to get the insurance companies out of the health care business. Health care should not be a for-profit enterprise. Insurance companies are nothing but parasites taking 20%. They add nothing of value.
84
Blue cross and others are not for profit organizations. Next excuse!
1
Not for profit doesn't mean that you can't make money. Next alibi.
1
I wish I could recommend your comment 100 times. Not only are they parasites, they are so inefficient as to be laughable as businesses. If they didn't have a choke hold on the market they would fold.
The American health care system's devotion to capitalist principle is dooming our efforts to support universal care.
We support numerous CEOs and executives in drug and insurance companies with multimillion dollar salaries (sometimes hundreds of millions of dollars) whose only goal seems to blew their own profits.Even hospitals pay numerous executives multimillion dollar salaries, while simultaneous sending out letters begging for charitable donations, yet finding ways to give little or no charitable care.
On the consumer side, people are reluctant to pay thousands of dollars a year for medical "insurance" that offer little or no insurance. Every plan on these exchanges has deductibles running typically to $5000 annually. For all intents and purposes, you are still paying all your own medical costs unless you have a catastrophic illness. So of course, people play the odds, hope they don't get terribly ill and refuse to buy insurance until they get sick. If they do get sick, they try to pay for insurance for the briefest period possible.
Caregivers are caught in a vise as they try to render care and get reasonable fees from insurance companies. Hospitals press their staffs to work harder for less.
Admit that private incentives are not doing the job. Go to a public option, Medicare for All, and be done with it. Human nature leads to gaming the system on the side of the users of health care and those that run the system.
Or maybe we can change human nature? Not likely!
We support numerous CEOs and executives in drug and insurance companies with multimillion dollar salaries (sometimes hundreds of millions of dollars) whose only goal seems to blew their own profits.Even hospitals pay numerous executives multimillion dollar salaries, while simultaneous sending out letters begging for charitable donations, yet finding ways to give little or no charitable care.
On the consumer side, people are reluctant to pay thousands of dollars a year for medical "insurance" that offer little or no insurance. Every plan on these exchanges has deductibles running typically to $5000 annually. For all intents and purposes, you are still paying all your own medical costs unless you have a catastrophic illness. So of course, people play the odds, hope they don't get terribly ill and refuse to buy insurance until they get sick. If they do get sick, they try to pay for insurance for the briefest period possible.
Caregivers are caught in a vise as they try to render care and get reasonable fees from insurance companies. Hospitals press their staffs to work harder for less.
Admit that private incentives are not doing the job. Go to a public option, Medicare for All, and be done with it. Human nature leads to gaming the system on the side of the users of health care and those that run the system.
Or maybe we can change human nature? Not likely!
42
Many thoughtful comments here reflecting varying degrees of understanding about this complex issue. Nowhere, however, is there any mention of:
increasing the costs for those who engage in risky behavior, such as smoking;
addressing the insane numbers of people who claim to be 'disabled' for nebulous reasons and investigating the doctors who sign the certifications (not only layering on more costs but taking people out of the workforce who simply don't feel like working--and this is NOT a comment on those poor souls who really are infirm and who deserve our help);
the obesity epidemic, etc.
The writer who suggested a flat rate for every procedure forgets that people are individuals. S/he also forgets that insurance companies set rates, doctors don't set rates. Performing an appendectomy on a trim and muscular person is a different procedure than performing that same surgery on a person who is has complications, whether from obesity or smoking or circulatory issues or or or. And let's not forget: many countries with single=payer systems treat lung cancer with morphine. Be careful what you wish for.
increasing the costs for those who engage in risky behavior, such as smoking;
addressing the insane numbers of people who claim to be 'disabled' for nebulous reasons and investigating the doctors who sign the certifications (not only layering on more costs but taking people out of the workforce who simply don't feel like working--and this is NOT a comment on those poor souls who really are infirm and who deserve our help);
the obesity epidemic, etc.
The writer who suggested a flat rate for every procedure forgets that people are individuals. S/he also forgets that insurance companies set rates, doctors don't set rates. Performing an appendectomy on a trim and muscular person is a different procedure than performing that same surgery on a person who is has complications, whether from obesity or smoking or circulatory issues or or or. And let's not forget: many countries with single=payer systems treat lung cancer with morphine. Be careful what you wish for.
3
How's about you name even one of the "many countries with single-payer systems" which "treat lung cancer with morphine."
I believe that is a total lie. Maybe you should spend less time being lied to by the likes of Limbaugh.
I believe that is a total lie. Maybe you should spend less time being lied to by the likes of Limbaugh.
1
The problem is not impossible if we accept the notion that every citizen should have access to proper health care----without profit-generating bureaucracy draining billions of dollars away from the actual delivery of health care services. We must end for-profit health insurance in the United States once and for all. We must join the rest of the civilized world with a single payer plan which covers every citizen-----the plan that Obamacare should have been.
25
In manufacturing, risks of product, delivery, quality, pricing, and financing are inside the same entity. Integrate the delivery and financing of health care, with appropriate market controls in place, and let's see how the integration of risk and reward works.
1
In my eyes, The fundamental flaw inherent to the ACA begins and ends with how the marketplace law was engineered at the very get go. And that would be the separation of employer based coverage from "individual" 'marketplace premium coverage. What you have essentially created is a monster problem of political divide right off the get-go. Those who already are comfortable living with low or no premium plans through their employers being pitted against those seeking 'marketplace' plans and, of course vice versa; someone always thinking or believing someone else- is getting a better deal. A terrifically cynical plan that only puts everyone and everybody- at odds with each other- and in the meantime, the financially rapacious Mylans of the nation take advantage of the fact no one is paying attention to regulatory concerns. Oy.
What needs to happen is a nearly complete overhaul of the medical/industrial insurance industry sucking at the teat of the government voucher system that allows them to play extremely self-serving financial games with their unprotected 'marketplace' customers/patients'. The playing field as it stands right now is unnervingly unequal. The time is now to end this untenable employer vs. individual medical cat-fight and finally bring Medicare for All to the table. Start slowly, by initiating the plans at age 50 and work down. We've already wasted too much time on the currently punitive and unsustainable model.
What needs to happen is a nearly complete overhaul of the medical/industrial insurance industry sucking at the teat of the government voucher system that allows them to play extremely self-serving financial games with their unprotected 'marketplace' customers/patients'. The playing field as it stands right now is unnervingly unequal. The time is now to end this untenable employer vs. individual medical cat-fight and finally bring Medicare for All to the table. Start slowly, by initiating the plans at age 50 and work down. We've already wasted too much time on the currently punitive and unsustainable model.
13
Or how no Republican voted for it. There was a reason and now we see it.
2
Yes, we should have had a public option. Hopefully, some how and some way this will happen if Secretary Clinton is elected. And, yes, the exorbitant costs of hospital care and prescription drugs border on the amoral. But keep in mind that along with the above, health insurance companies are for-profit. These are all big business, and long gone are the days when the central concern was the health and welfare of the public. What is most interesting - and questionable - is why for the last six years has there been no "complaints" from the insurance companies who took part in the ACA? The more competition they had with each other, the more opportunity they had to increase their enrollments. Perhaps, I am wrong, but I can not help but think that this being an election year is propelling corporate-run health insurance companies to put the knife to Obamacare. After all, with a Republican president, just imagine how much profit said companies will be able to pass onto to their CEO's and their investors. The very thing that the President wanted to stop is the very thing that these vultures want back again. It is a game for them in which they, the powerful, must win.
3
How embarrassing to have a government that is so deeply in the pockets the health care industry. I have lived in England and received medical care there. It was so easy. How can health care possibly be affordable here when it has to support a titanic insurance industry, an opportunistic malpractice industry, and a pharmaceutical industry obligated to maximize shareholder profit. And there is little evidence that Clinton will be anything more than a pansy to all these industries. Trump would be a wild card. But, good or bad, there would be change.
14
It is especially pathetic that US lawmakers, and indeed the public at large, is incapable of looking to other countries that have achieved universal coverage, better health care outcomes, AND lower costs than the US. Call it American exceptionalism, xenophobia, or just plain stupidity, but it has the potential for completing the dismantling of the web that binds us together as a civilized nation.
115
This is one reason so many turned out this year in support of change (Trump & Sanders)
It is the only area where Trump seems tolerable - healthcare for all - unfortunately like all his other positions there is no substance or detail...
It is the only area where Trump seems tolerable - healthcare for all - unfortunately like all his other positions there is no substance or detail...
2
As many readers have already said, a government run, single-payer "Medicare for All" is the only way to go. What is missing in most commentary is the other side of the equation -- the costs of being a doctor. If we accept as a society that medical care is not an option in modern society then why do we as a society tolerate the high cost of medical education? This education should be completely (or almost completely) paid for by society for the best and the brightest (as it is in most Western countries) and malpractice insurance should also be managed as a federal insurance system (we are already insuring bank deposits this way). This would also go a long way towards pulling cost out of the system. This way, doctors can charge less for their services.
22
We pay $1,900 a month for our family of three, carry $5,000 deductibles for each person and are getting double digit premium increases. At 5% of income -- the maximum you should pay on these premiums -- our policy makes sense only if we make more than $450,000 a year. A paltry 0.7% of U.S. households make this much. Without the increases. With the increases, the number of people for whom these policies prove in is no more than half a percent.
These data show that no healthcare plan works in the U.S. today.
These data show that no healthcare plan works in the U.S. today.
26
Here is a plan for you. No insurance and stay healthy. Save that money and pay cash.
2
Obamacare mandated that health insurers sell their product in a market accessible to all, through the exchanges.
But no law can mandate a buyer to purchase a product they cannot afford even with a tax penalty if you don't buy.
Insurance plans on the exchanges are too pricey. And deductibles in most plans are wildly expensive.
Small businesses and minimum wage earners cannot afford this kind of health insurance, no matter how well intended.
But no law can mandate a buyer to purchase a product they cannot afford even with a tax penalty if you don't buy.
Insurance plans on the exchanges are too pricey. And deductibles in most plans are wildly expensive.
Small businesses and minimum wage earners cannot afford this kind of health insurance, no matter how well intended.
19
So now we're going to have even more plans with small networks and third-rate care? Great.
There are many things we could do to improve ACA. Remove the cap on charges to older people like me, so that younger people, who aren't likely to become ill, don't skip insurance. Remove some of the add-ons in the plans, e.g., children's dental care -- this should absolutely be provided but it shouldn't be provided by ACA purchasers alone. Increase fees for those who don't buy insurance to a level sufficient to provide Medicaid coverage, and let them buy into that program at an honest price -- they're going to be treated anyway if they get sick. Allow insurers to vet people who upgrade to a costlier plan, or who have dropped out of the program, to prevent the insurance hopping that is destroying the better plans. Allow a public option. And best of all, replace the parasitic, inefficient private plans with Medicare for All.
There are many things we could do to improve ACA. Remove the cap on charges to older people like me, so that younger people, who aren't likely to become ill, don't skip insurance. Remove some of the add-ons in the plans, e.g., children's dental care -- this should absolutely be provided but it shouldn't be provided by ACA purchasers alone. Increase fees for those who don't buy insurance to a level sufficient to provide Medicaid coverage, and let them buy into that program at an honest price -- they're going to be treated anyway if they get sick. Allow insurers to vet people who upgrade to a costlier plan, or who have dropped out of the program, to prevent the insurance hopping that is destroying the better plans. Allow a public option. And best of all, replace the parasitic, inefficient private plans with Medicare for All.
3
Remove the cap on charges to older people like me so that health insurance becomes every bit as unavailable (completely unaffordable) to the individual as it was pre-ACA.
1
People are calling for a 'public option', with the implicit assumption that a public plan will force everyone to accept less money and thus solve the problems.
Here are a few problems with that
1. Increasingly the new middle class are nurses, physical therapists, health care techs, nurse practitioners, and physician assistants. Any cut in reimbursement is going to impact them greatly, as will their tax rates and ability to make a decent living for their families
2. In other 'public option' health systems (ie Canada), the system has other perks. For instance
a) medical training is paid for by the government... ie by taxes on the population. There is no medical school debt
b) malpractice is marginalized both in scope and damages. There is a study that stated only ~4% of US health costs are directly related to litigation. I won't disagree - but that is just the cost of counsel and settlements. The cost of premiums for malpractice and the amount of tests ordered in defense of a potential lawsuit are tremendous. And those tests - often blood work and more often scans, do not increase the revenue for the ordering provider 1 cent unless he/she also owns a radiology practice (very rare).
c) Even in Canada the predominant payment model is.... fee for service. Please, look it up if you do not believe me.
In short, if you want to force a public option and lower reimbursement rates on a system with none of the perks. I do not think you will get the results you are expecting.
Here are a few problems with that
1. Increasingly the new middle class are nurses, physical therapists, health care techs, nurse practitioners, and physician assistants. Any cut in reimbursement is going to impact them greatly, as will their tax rates and ability to make a decent living for their families
2. In other 'public option' health systems (ie Canada), the system has other perks. For instance
a) medical training is paid for by the government... ie by taxes on the population. There is no medical school debt
b) malpractice is marginalized both in scope and damages. There is a study that stated only ~4% of US health costs are directly related to litigation. I won't disagree - but that is just the cost of counsel and settlements. The cost of premiums for malpractice and the amount of tests ordered in defense of a potential lawsuit are tremendous. And those tests - often blood work and more often scans, do not increase the revenue for the ordering provider 1 cent unless he/she also owns a radiology practice (very rare).
c) Even in Canada the predominant payment model is.... fee for service. Please, look it up if you do not believe me.
In short, if you want to force a public option and lower reimbursement rates on a system with none of the perks. I do not think you will get the results you are expecting.
13
2)b) is wrong:
States that have instituted "reforms" that have substantially reduced the number of malpractice suits have not reduced the cost of health nor the frequency of tests and treatments. Defensive medicine is a myth. In fact, in a letter to Senator Hatch, the CBO wrote that an ideal system of tort reform would not lower costs by any more than 0.5%, 0.3% of which would be due to less "defensive medicine,"
References: page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, and http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf,
Here is the relevant paragraph from the letter to Senator Hatch:
"CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services."
States that have instituted "reforms" that have substantially reduced the number of malpractice suits have not reduced the cost of health nor the frequency of tests and treatments. Defensive medicine is a myth. In fact, in a letter to Senator Hatch, the CBO wrote that an ideal system of tort reform would not lower costs by any more than 0.5%, 0.3% of which would be due to less "defensive medicine,"
References: page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, and http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf,
Here is the relevant paragraph from the letter to Senator Hatch:
"CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services."
4
Defensive medicine is not a myth. I routinely see tests with 1-3% probability of being positive (inpatient EKGs for mild CP, CT scan for pulmonary embolism, CT scans for head trauma in a true loss of conscousness for > 2 minute situation) being ordered. With vocal family at bedside and a real path through litigation to affect a provider's whole life. Our frequency of imaging follow up after cancer is much higher than Europe's, and part of that is protecting against missing a recurrence. Part of that is that the population of the US would not accept the watch and wait approach of many Europeans.
Please, unless you are a provider, you have no idea what you are talking about in regards to defensive medicine.
You cannot just reduce the risk. A single big lawsuit can ruin your entire life and a career that took a decade to even begin. You have to have structured boundaries and limits, and a true health court. You took the risk of me losing my career from 5% to 4%? Yea, no thanks, I'm going to order the test to make sure I am 99% sure instead of 95%. Which is in no way modeled by the CBO and not understood at all by people outside the system.
But it is parroted quite often.
Please, unless you are a provider, you have no idea what you are talking about in regards to defensive medicine.
You cannot just reduce the risk. A single big lawsuit can ruin your entire life and a career that took a decade to even begin. You have to have structured boundaries and limits, and a true health court. You took the risk of me losing my career from 5% to 4%? Yea, no thanks, I'm going to order the test to make sure I am 99% sure instead of 95%. Which is in no way modeled by the CBO and not understood at all by people outside the system.
But it is parroted quite often.
10
Is our health system designed exclusively for nurses and practitioners to have a decent salaries? I am surprised that doesn"t apply to other industries. Automation leads to cutting of workforce, leaving thousand without jobs, however I haven't heard a peep to stop spread of automation. Somehow, these workers are suposed to figure out it on their own, and yet we should worry about health worker"s salary. Why not let market to decide how much these health workers are worth. Cut the fees and see how many of them will stay. If there will be shortage, you can always increase the fees
1
It's funny, I don't see anyone comments here in favor of ObamaCare.
11
None of the suggested solutions sound as if they're likely to help much.
4
Describe Obamacare in 2016 in five words or less:
I. Told. You. So.
I. Told. You. So.
38
With respect, what would you recommend for people with pre-existing conditions who making $50K / year and are trying to keep it together in this gig economy?
I'm paying $570 / mo with a $1300 deductible.
I'm paying $570 / mo with a $1300 deductible.
2
DCBarrister: Describe the GOP obstructionism in 5 words or less:
We like to obstruct.
We like to obstruct.
Part of the solution lies in economic growth: let people assume the burden of their own premiums. Only the Federal Reserve has addressed this. A warring two-party system that refuses to compromise is bad for citizens.
And those that think they will get the 1% to pay the bill are mistaken. Such attempts fall short and serve only to tighten the vice on middle class families.
And those that think they will get the 1% to pay the bill are mistaken. Such attempts fall short and serve only to tighten the vice on middle class families.
4
Bernie Sanders proposed Medicare for All. He came close
to winning the Democratic nomination. Could
such a program be introduced all at once? Well,
it might be brought into being over a number of years,
maybe five to ten years, while insurance based coverage
continued: first babies to ten-
year-olds plus 62- to 52-year-olds; then age 11 to 20 plus 31 to 41;
then 20 to 30, and the age inclusion would be complete,
putting the entire population under Medicare. I'm just
thinking, but such a day could be dawning.
to winning the Democratic nomination. Could
such a program be introduced all at once? Well,
it might be brought into being over a number of years,
maybe five to ten years, while insurance based coverage
continued: first babies to ten-
year-olds plus 62- to 52-year-olds; then age 11 to 20 plus 31 to 41;
then 20 to 30, and the age inclusion would be complete,
putting the entire population under Medicare. I'm just
thinking, but such a day could be dawning.
7
Healthy people don't sign up because the exchange rules are designed for stagnant lifestyles with few changes - but many people don't live that way. Young people often have no idea at the beginning of the year how much they will make by the end of the year. My adult daughter would work two or three different part- and full-time jobs over the course of the year, some as independent contractor, others as an employee. Did she know how much she'd wind up making? Not a chance.
Family situations change, despite the best laid plans. If your teenager gets a summer job, or doesn't get one, your family income prediction mistakes can send you into a paperwork swamp. Then what happens when the adolescent lands a good job in the middle of the year, files his own taxes, and is no longer your dependent - retroactively?
Luck changes. What if your penny stock doubles, or you win a couple grand in the lottery, at the casino, or at bingo? What if your roof leaks, and you need to withdraw from your IRA? You are expected to predict the roof leak's impact on your taxable income at the beginning of the year?!
Absent a crystal ball, it's no wonder healthy people are afraid to sign up. They are afraid of the tax penalty, but they are also afraid of making a prediction mistake that can wind up costing them paperwork and thousands of dollars in reimbursements. Obamacare bureaucrats just don't understand life.
Family situations change, despite the best laid plans. If your teenager gets a summer job, or doesn't get one, your family income prediction mistakes can send you into a paperwork swamp. Then what happens when the adolescent lands a good job in the middle of the year, files his own taxes, and is no longer your dependent - retroactively?
Luck changes. What if your penny stock doubles, or you win a couple grand in the lottery, at the casino, or at bingo? What if your roof leaks, and you need to withdraw from your IRA? You are expected to predict the roof leak's impact on your taxable income at the beginning of the year?!
Absent a crystal ball, it's no wonder healthy people are afraid to sign up. They are afraid of the tax penalty, but they are also afraid of making a prediction mistake that can wind up costing them paperwork and thousands of dollars in reimbursements. Obamacare bureaucrats just don't understand life.
10
It goes without saying that a program like ObamaCare, depending on the greedy souls of the private health insurance companies, is bound to turn out to be a mess and ultimately a failure. We already have a single payer in many areas, with more to come next year. Why not go to a single government payer, NOW.
6
80% of Americans did not want Obamacare but the Democrat controlled Senate rammed it through on Christmas Eve late in the evening like the Grinch. Now Obamacare is crumbling and the media says "what shall we do?"
12
Good morning, Pete. Please get the correct facts on the current level of support of the ACA.
5
Pete, I don't know how you handle your health insurance premiums.
We were buying in the open market @ $950 / month per person. So almost $2000 / month, after taxes. Much more than the mortgage.
So now we're paying about $600 / month each, with $1300 deductibles. Each. We can't get hired because we're over 50 so we're piecing it together in the gig economy. We have pre-existing conditions.
So what would you recommend? Thanks!
We were buying in the open market @ $950 / month per person. So almost $2000 / month, after taxes. Much more than the mortgage.
So now we're paying about $600 / month each, with $1300 deductibles. Each. We can't get hired because we're over 50 so we're piecing it together in the gig economy. We have pre-existing conditions.
So what would you recommend? Thanks!
6
Yeah, 1. Up to at least 2009, Americans overwhelmingly supported a single payer system such as Medicare for All.
"Between 2003 to 2009, 17 opinion polls showed public support for a single-payer system.[25] These polls are from sources such as CNN,[26] AP-Yahoo,[27][28] Quinnipiac,[29] New York Times/CBS News Poll,[30][31] Washington Post/ABC News Poll, [32] Kaiser Family Foundation[33] and the Civil Society Institute. [34]
In October 2003, a Washington Post poll found that 62% supported "a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers."[35]"
2. All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
3. Obama made the decision to take single payer off the table from the get go. Whether this decision was made to appease the insurance industry, to make large contributors happy, because he saw it as a political win, or it is the best he thought he could do, is irrelevant.
It was the wrong decision.
It has left us with a complicated system that is too easy to attack
"Between 2003 to 2009, 17 opinion polls showed public support for a single-payer system.[25] These polls are from sources such as CNN,[26] AP-Yahoo,[27][28] Quinnipiac,[29] New York Times/CBS News Poll,[30][31] Washington Post/ABC News Poll, [32] Kaiser Family Foundation[33] and the Civil Society Institute. [34]
In October 2003, a Washington Post poll found that 62% supported "a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers."[35]"
2. All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
3. Obama made the decision to take single payer off the table from the get go. Whether this decision was made to appease the insurance industry, to make large contributors happy, because he saw it as a political win, or it is the best he thought he could do, is irrelevant.
It was the wrong decision.
It has left us with a complicated system that is too easy to attack
133
now that youve tried everything and its failed, try socilaised medicine
or isnt that good enough for th exceptional ones ?
3
Obamacare in trouble? Who would have thought?
"You have to pass the bill to find out what's in it"
"If you like your doctor you can keep your doctor"
"If you like your plan you can keep your plan"
"It will save the average family $2500 a year"
Any detractors from these lies were accused of RACISM because a black President either said them or was for them.
You see how the ol' race card is more than a little worn out?
"You have to pass the bill to find out what's in it"
"If you like your doctor you can keep your doctor"
"If you like your plan you can keep your plan"
"It will save the average family $2500 a year"
Any detractors from these lies were accused of RACISM because a black President either said them or was for them.
You see how the ol' race card is more than a little worn out?
16
Says a commenter that just brought race into the equation. Go figure.
4
The problem is that Obamacare is suffering from parasites.
Consider:
Operating overhead for Medicare = 3%
Overhead for private medical insurance = 30% (after all this is strictly a financial industry, and not health care)
The time has come to rid ourselves of these parasites and implement MEDICARE FOR ALL.
Consider:
Operating overhead for Medicare = 3%
Overhead for private medical insurance = 30% (after all this is strictly a financial industry, and not health care)
The time has come to rid ourselves of these parasites and implement MEDICARE FOR ALL.
48
First, the reason Medicare has such a low overhead is they piggyback on various other government agencies such as SSA and IRS. Second, as I wrote earlier, if proponents of Medicare for ALL really understood Medicare for All, they'd almost certain to be dumbfounded by the esoteric and archaic rules. Do they realize that a person can exhaust their Medicare benefits if that person is sick long enough? I suggest people do some research on Benefit Periods, the escalating coinsurance costs the longer a person is sick, and, most importantly, Lifetime Reserve Days.
5
That could be fixed. You remember there was lifetime spending cap in most insurances. It was cancelled by Obamacare.
Medicare has no checks or controls at all. If you set up a medical billing company, and bill $100 million with valid SS numbers, they will pay you. They may come along to check a couple years later, but that gives you plenty of time to flee to Brazil.
That's why their administrative costs are 3%!
That's why their administrative costs are 3%!
1
The real solution is obvious: the creation of universal healthcare, funded by taxes. Everyone needs healthcare, and everyone needs to contribute. People with more disposable income, like myself, need to contribute more.
Unfortunately, half of the US believes they have no duty to support America beyond waving a flag and shouting about how America is better than your country. Those people are fine with letting poor people get sick and lose what little they have in bankruptcy. They whine and wring their hands about the ACA, and do nothing to fix it beyond trying to repeal it so they can get out of contributing even that much to the country.
These people are un-American. They do not believe in a truly United States. They believe in a country that exists only to serve them and their interests.
Unfortunately, half of the US believes they have no duty to support America beyond waving a flag and shouting about how America is better than your country. Those people are fine with letting poor people get sick and lose what little they have in bankruptcy. They whine and wring their hands about the ACA, and do nothing to fix it beyond trying to repeal it so they can get out of contributing even that much to the country.
These people are un-American. They do not believe in a truly United States. They believe in a country that exists only to serve them and their interests.
20
Because of the way Obamacare was written (and more importantly the insurance company lawyers who wrote it) there is no legal way to create universal healthcare without ending Obamacare and repealing the ACA completely.
Obama liberals sitting around in a haze wishing and hoping for single payer are exhibiting the ignorance that Jonathan Gruber and Barack Obama laughed about in those private WH meetings when Obamacare was being written.
Obama liberals sitting around in a haze wishing and hoping for single payer are exhibiting the ignorance that Jonathan Gruber and Barack Obama laughed about in those private WH meetings when Obamacare was being written.
4
"The real solution is obvious: the creation of universal healthcare, funded by taxes."
Spoken like a typical government worshiping "progressive" who never saw a tax that they did not want to impose or increase. Even the government loving NYTs has said that "government is always inefficient and usually corrupt" which should come as no surprise since anything that involves politics is always inefficient and corrupt, so why would anyone want more inefficient and corrupt government?
Spoken like a typical government worshiping "progressive" who never saw a tax that they did not want to impose or increase. Even the government loving NYTs has said that "government is always inefficient and usually corrupt" which should come as no surprise since anything that involves politics is always inefficient and corrupt, so why would anyone want more inefficient and corrupt government?
3
Many commenters decry the decline of rational and respectful dialogue among persons with opposing views in the current climate, I wouldn't be surprised if you have made such obsdervations yourself. But claiming that those who disagree with your favored solution "are fine with letting poor people get sick" doesn't help.
1. No, European countries don't all have single payer. Except for England, they have mixed systems. And higher taxes, rationing, and healthier people.
2. No, you cannot simply hand everybody in the country Medicare. And Medicare comes with premiums, co-pays and co-insurance, various restrictions, and decades of payments before you use it.
3. No, you cannot simply throw out the employer-based system.
4. No, shouting hey presto! does not make the politics go away.
5. No, repealing Obamacare will not bring about a happy land of free markets, bunnies, and candy.
i recommend jumping on kff.org and reading up on the PPACA a little. Oh, and by the way--The Upshot has done a wonderful job of reporting on it, warts and all. Beautiful work.
2. No, you cannot simply hand everybody in the country Medicare. And Medicare comes with premiums, co-pays and co-insurance, various restrictions, and decades of payments before you use it.
3. No, you cannot simply throw out the employer-based system.
4. No, shouting hey presto! does not make the politics go away.
5. No, repealing Obamacare will not bring about a happy land of free markets, bunnies, and candy.
i recommend jumping on kff.org and reading up on the PPACA a little. Oh, and by the way--The Upshot has done a wonderful job of reporting on it, warts and all. Beautiful work.
8
"European countries don't all have single payer. Except for England, they have mixed systems. And higher taxes, rationing, and healthier people."
And they also rely on the US for the bulk of their defense so they have more money to spend for other things.
And they also rely on the US for the bulk of their defense so they have more money to spend for other things.
4
Almost all of these are wrong or misleading. The UK also allows people to buy private insurance on top of the NHS. As for single payer, it depends on your definition. The fact is that ALL members of the OECD have a universal, government run system. Among European countries, only Switzerland, The Netherlands & Germany make any significant use of direct private insurance & in all of these countries, it is severely regulated by the government. In Switzerland which uses private insurance the most, the government writes a basic policy which all companies must offer unchanged & can make NO profit on it. For serious illness, The Netherlands has government insurance while short term care is run like Switzerland. In Germany, if you make enough money, you can opt out of the government system, but only about 10% do.
The bottom line is how much countries spend per person on health care. Since money is fungible, it is irrelevant how it is paid taxes, or premiums:
Amount spent on health care in 2013 in PPP dollars (which take cost of living into account):
US - 8713
OECD average - 3453
UK - 3251
France - 4124
Germany - 4810
Canada - 4351
Australia - 3868
Italy - 3077
Israel - 2428
Japan - 3713
Denmark - 4552
And so on.
You can find more data at
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
The savings in Medicare for All are so great we could do away with co-pays, deductible. etc.
As for the rest of your points, I say, "Why not?"
The bottom line is how much countries spend per person on health care. Since money is fungible, it is irrelevant how it is paid taxes, or premiums:
Amount spent on health care in 2013 in PPP dollars (which take cost of living into account):
US - 8713
OECD average - 3453
UK - 3251
France - 4124
Germany - 4810
Canada - 4351
Australia - 3868
Italy - 3077
Israel - 2428
Japan - 3713
Denmark - 4552
And so on.
You can find more data at
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
The savings in Medicare for All are so great we could do away with co-pays, deductible. etc.
As for the rest of your points, I say, "Why not?"
4
@Charles W.
Spot on...
Spot on...
1
Wait, Krugman says that everything is ok.
17
We would be better off if ditched the ACA, VA care, Medicare and other government controlled systems and gave each person a national card that allowed them to buy private insurance that meets their needs within reason.
3
I am a resident of NYC. Having recently joined the ranks of unemployed, I tried to look into the healthcare options outside of just joining my husbands' policy. What I encountered was a nightmare of ROBO calls from the 'exchanges' who front-end the insurance companies. 19 calls in one day!
why can't there be websites that allow you to put in your relevant information and compare policies side by side, while manipulating things like deductible, co-pay and other variables?
why can't there be websites that allow you to put in your relevant information and compare policies side by side, while manipulating things like deductible, co-pay and other variables?
2
????
Go to healthcare.gov, click Get Coverage, and pick your state from the dropdown. Then enter your zip and all the available plans are populated.
Go to healthcare.gov, click Get Coverage, and pick your state from the dropdown. Then enter your zip and all the available plans are populated.
2
If your husband is earning more than $50K per year, you are not going to qualify for any subsidies.
You may as well go on his plan as it will be cheaper.
You may as well go on his plan as it will be cheaper.
1
Jules,
It's different in NY. You are immediately re-directed to the NY site, which is complex and has all these 'middlemen' - it's really a drag. Check for yourself - it's no where near as simple as CA, and I haven't a clue why
debby
It's different in NY. You are immediately re-directed to the NY site, which is complex and has all these 'middlemen' - it's really a drag. Check for yourself - it's no where near as simple as CA, and I haven't a clue why
debby
(Disclosure: I am a liberal democrat.) Obamacare is a bad idea poorly executed. It was created as a 'let's make sure to keep the health insurance industry happy so that they don't oppose the plan' plan and of course the business people who designed the program in 2010 are now bailing out of their plan several years later. So much for involving industry representatives in public policy, at least for health insurance. So a bad idea.
Poorly executed? Yes. Can we all remember the computer system crashes and the infamous 'you can keep your doctor if you want'?
What to do? Expand the Child Health Improvement Program and move Medicare down in age to age 50 first with a multi year plan to move it down to all adults.
Why Americans get so sick, pay so much for their sicknesses, and refuse to figure out ways to live better and healthier lives is a great mystery, isn't it?
Poorly executed? Yes. Can we all remember the computer system crashes and the infamous 'you can keep your doctor if you want'?
What to do? Expand the Child Health Improvement Program and move Medicare down in age to age 50 first with a multi year plan to move it down to all adults.
Why Americans get so sick, pay so much for their sicknesses, and refuse to figure out ways to live better and healthier lives is a great mystery, isn't it?
3
The plan is collapsing in Utah, down to two providers from four.
6
Noting will be done until after the election and Hillary has it locked up so it is up to her to fix it, but so far she does not have a workable plan. This is looking like another Venezuela. Great prices but no product.
2
Ted Kennedy wanted to expand Medicare to everyone. The insurers are dropping out because they don't see an existential threat to their business model anymore. If that were on the table insurers would be fighting to be in every state to maintain their businesses. Aetna's dropping out was not about costs, but about a power play against the government. They know with the GOP in congress they don't need to play. The Co-ops failed because the GOP congress didn't fund them with the money that they were supposed to get under the law.
I hope it is obvious now even to Obama Kool-Aid drinkers that Obamacare is a structural disaster and is beyond repair. It must be junked immediately and replaced with the more reasonable Wyden-Bennett plan originally proposed in 2008, but foolishly rejected by the drunk-on-power Democratic congress.
7
You ask: What can be done? It's time this country comes to the realization that health care is not a commodity. It's something that is impossible for the market to be in charge of. We need to move to a single-payer system, just like the rest of the developed world (and even countries that aren't considered developed).
That's what can be done ... and needs to.
That's what can be done ... and needs to.
6
We have 100 million people on Medicare and Medicaid and therefore one of the largest single payer systems in the world.
4
"We have 100 million people on Medicare and Medicaid and therefore one of the largest single payer systems in the world."
-------
Right, and those seem to work pretty well. So why is it so hard to convince people that 320 million should be covered in the same way?
That's what can be done.
-------
Right, and those seem to work pretty well. So why is it so hard to convince people that 320 million should be covered in the same way?
That's what can be done.
A few random thoughts. First, this was designed so the young would subsidize the old(a familiar refrain). No surprise that the young and healthy are opting out. Next, the individual market is a small portion of the total market. The NYT does not have enough info. on what is happening in the employer market. Cost of medical treatment and medicines is the real issue. You can buy drugs much cheaper in Canada, for example, which is silly. Our tort system is absurd. There are likely many other possibilities for cost control. Big picture for the individual marketplace, if you try to get the poorer young people to subsidize the wealthier old people, if you make it easy for people to only buy insurance when they know they will need medical care, you will have a problem.
6
Actually, the system was not designed for that purpose. It was designed to transfer money from taxpayers to those receiving subsidies. There is a limit on the age based cost differential but that isn't the major source driving the costs up.
2
The answer is to ban profits from health care as all other major industrialized countries have done.
Please review this New York Times blog from 2009:
http://prescriptions.blogs.nytimes.com/2009/09/15/health-care-abroad-que...
Please review this New York Times blog from 2009:
http://prescriptions.blogs.nytimes.com/2009/09/15/health-care-abroad-que...
8
The fatal flaw of Obamacare is that it didn't truly address the cost side of the equation.
More equal access to still-outrageous costs just leads to a bankrupcy of the system, which is what we are seeing.
8
Go further than simply adding a public option. Government production of vaccines, epi-pens, insulin and its deliver system, as well as other basic and widely used medicine isn't going to bankrupt Big Pharma, an entity that clearly doesn't want to be bothered with anything that doesn't provide immoral profit margins, would be a good start.
1
The obvious solution is universal healthcare. Unfortunately, both the Democrats and Republicans are owned by the vast lobbying groups of the healthcare industry. Both parties are at fault for the mess that Obamacare is.
Until we get to universal healthcare, about starting with increasing the age children can stay on their parents insurance beyond 26. Maybe, consider doing the reverse and letting parents on to their adult children's employer based policy.
Require all providers of healthcare to publish the prices for their services. I have multiple places I can get a radiology scan if needed. I should be able to easily find out how much each one will cost me.
The solutions are out there if we ever get a government that works for "the people".
Until we get to universal healthcare, about starting with increasing the age children can stay on their parents insurance beyond 26. Maybe, consider doing the reverse and letting parents on to their adult children's employer based policy.
Require all providers of healthcare to publish the prices for their services. I have multiple places I can get a radiology scan if needed. I should be able to easily find out how much each one will cost me.
The solutions are out there if we ever get a government that works for "the people".
6
First, there are still far too many free riders on the system - people who are currently healthy and can wait to buy insurance until after they get sick. The penalties for not having insurance are not high enough yet to push people to purchase insurance so it is left to the rest of us (yes I buy insurance on the individual market) to subsidize them for waiting and then, when they do get insurance after becoming sick, instantly cost the pool even more. Raise the penalties!
Second, we have a great example this week that the health care free market does not control prices - Mylan's outrageous but perfectly legal increase in the price of EpiPen. Even with their announcement today that they will introduce an identical generic version at $300 for 2 (a blatant admission that the list price is based on nothing more than greed), that price is three times higher than 2007 and the list price is 6X higher. While some readers hate the idea of the government regulating pharmaceutical prices, EpiPens purchased by insurance companies raise everyone's premiums for no additional health benefit and those purchased by Medicare or Medicaid are basically allowing Mylan to raise everyone's taxes, which they pocket. Monopolistic life-saving emergency medications like EpiPens are NOT sensitive to free market forces - regulate the price!
Second, we have a great example this week that the health care free market does not control prices - Mylan's outrageous but perfectly legal increase in the price of EpiPen. Even with their announcement today that they will introduce an identical generic version at $300 for 2 (a blatant admission that the list price is based on nothing more than greed), that price is three times higher than 2007 and the list price is 6X higher. While some readers hate the idea of the government regulating pharmaceutical prices, EpiPens purchased by insurance companies raise everyone's premiums for no additional health benefit and those purchased by Medicare or Medicaid are basically allowing Mylan to raise everyone's taxes, which they pocket. Monopolistic life-saving emergency medications like EpiPens are NOT sensitive to free market forces - regulate the price!
13
The price of an EpiPen makes no difference to your insurer. If they don't like the price, they simply remove your drug from their formulary or declare your procedure "experimental," therefore not covered. This is the "system" that mj thinks we should be forced to support by being fined into insolvency?
2
Repeal and replace with "Medicare fro All".
So, next year, with the exception of cannot be denied coverage for a pre-existing condition, no life time caps on coverage and children can remain on their parent's policy until they are 26, we are back to having virtual monopolies in some states. Actually more monopolies, then there were before Obamacare. Also, premiums are raising by double digits for both Obamacare and employer insurance. And, drug compnaies are now charging more than the market can bear by hiking prices many times fold to get bigger profits. As fro bankruptcies, related to health care, they are rising.
Obamacare never took care of the cost of health care. The free market has become a gouge market. And more and more the health care industry is creating a model that is unsustainable.
Until there are price controls put in place, health care costs will spiral more and more out of control.
Private insurers are dropping out to the point there may be only two or three insurers left; with parts of the country with no access to insurance.
Let's face it, Obamacare is quickly heading for failure. Neither Trump, Clinton, Congress, the Democrats or the Republicans are willing to enact the laws to rein in costs or to extend Medicare to all US citizens. No politician is willing to be brave enough to fix this train wreck.
So, next year, with the exception of cannot be denied coverage for a pre-existing condition, no life time caps on coverage and children can remain on their parent's policy until they are 26, we are back to having virtual monopolies in some states. Actually more monopolies, then there were before Obamacare. Also, premiums are raising by double digits for both Obamacare and employer insurance. And, drug compnaies are now charging more than the market can bear by hiking prices many times fold to get bigger profits. As fro bankruptcies, related to health care, they are rising.
Obamacare never took care of the cost of health care. The free market has become a gouge market. And more and more the health care industry is creating a model that is unsustainable.
Until there are price controls put in place, health care costs will spiral more and more out of control.
Private insurers are dropping out to the point there may be only two or three insurers left; with parts of the country with no access to insurance.
Let's face it, Obamacare is quickly heading for failure. Neither Trump, Clinton, Congress, the Democrats or the Republicans are willing to enact the laws to rein in costs or to extend Medicare to all US citizens. No politician is willing to be brave enough to fix this train wreck.
10
As long as we allow for profit health care, we will never reach the goal of healthcare for all, via a fair, affordable price.
Profit is the only driving force at this point, and there is currently no solutions. Congress will allow the system to fail, make its call for more campaign contributions for allowing to fail and then look for someone to blame, no solutions, just blame
What a mess
Profit is the only driving force at this point, and there is currently no solutions. Congress will allow the system to fail, make its call for more campaign contributions for allowing to fail and then look for someone to blame, no solutions, just blame
What a mess
2
Shall we pattern it after the VA system or the post office?
4
To the government worshiping "progressives" profit is a dirty word. In their ideal world everyone would work for their great god government or at least a non-profit entity but never for an evil for-profit corporation. Just like int the old Soviet Union and we all know how well that worked out.
3
I assume that you have health insurance from your employer so you have limited data on what consultants, or other 1099-type workers are dealing with.
The cutoff for receiving subsidies is ridiculously low, at least in NY State. The fact that we, the patients, have to worry about being able to see physicians or physical therapists, or purchasing prescriptions we need because of how things are being run makes the entire process of getting health care, unless we really need it, a burden. We have the worst healthcare system in the world. It's too easy to fall between the chasms, to be bilked, overpay, have a claim denied or lost, to go bankrupt because of the cost of premiums, copays, etc. combined, or to receive the wrong care because of a complete lack of communication between providers no matter how hard the patient tries.
When we are sick we should not have to bring along anyone to make sure that the doctor(s) get it right. We should not need to hire patient advocates to sort out our bills. We should not have to worry, each time we need care, that we'll liable for more than we can afford or, if we have no job, that we cannot get care at all because we made too much prior to that to get subsidies to help us pay for insurance.
Our wealthcare system does not work for us whether it's the private market or the public market. Insurers keep on finding ways to shift the costs to the patients. Pharmaceutical companies act as if patients can afford anything as long as they have insurance or they, the pharmaceutical company offer a coupon. Instead of health insurance why not have a single payor universal access system?
When we are sick we should not have to bring along anyone to make sure that the doctor(s) get it right. We should not need to hire patient advocates to sort out our bills. We should not have to worry, each time we need care, that we'll liable for more than we can afford or, if we have no job, that we cannot get care at all because we made too much prior to that to get subsidies to help us pay for insurance.
Our wealthcare system does not work for us whether it's the private market or the public market. Insurers keep on finding ways to shift the costs to the patients. Pharmaceutical companies act as if patients can afford anything as long as they have insurance or they, the pharmaceutical company offer a coupon. Instead of health insurance why not have a single payor universal access system?
2
For the longest time liberals, including our president, claimed that the exchanges weren’t in trouble at all, and that all was hunky-dory with ObamaCare: they maintained this illusion even as the problems now becoming critical had long been evident, and had been foreseen by Republicans from the beginning. Now, some are finally admitting the problems, but remain unwilling to acknowledge the cause.
ObamaCare just doesn’t work. And mere Band-Aids won’t fix it.
To make such a program even marginally viable, choice inevitably must be squeezed out of the equation: if government provides it or controls it, there can BE no choice. “Choice” was never its objective, which was in fact to provide minimal coverage to everyone regardless of the sacrifices that compelled most to suffer. Sacrifices such as stratospheric premiums, deductibles and co-pays that make ACA-related policies equivalent to paying retail for healthcare for millions who earn just too much to have their healthcare costs subsidized away. A public health option won’t solve the problem of non-viable exchanges: insurers can’t compete with it, would exit provision of basic healthcare in droves, leaving government the only one standing. That would leave almost all Americans not on Medicare or with a job that provides it with NO choice at all.
ObamaCare just doesn’t work. And mere Band-Aids won’t fix it.
To make such a program even marginally viable, choice inevitably must be squeezed out of the equation: if government provides it or controls it, there can BE no choice. “Choice” was never its objective, which was in fact to provide minimal coverage to everyone regardless of the sacrifices that compelled most to suffer. Sacrifices such as stratospheric premiums, deductibles and co-pays that make ACA-related policies equivalent to paying retail for healthcare for millions who earn just too much to have their healthcare costs subsidized away. A public health option won’t solve the problem of non-viable exchanges: insurers can’t compete with it, would exit provision of basic healthcare in droves, leaving government the only one standing. That would leave almost all Americans not on Medicare or with a job that provides it with NO choice at all.
7
Controlling costs by starving providers has been tried for years. How’s that working? Well, how many doctors have ceased accepting Medicaid patients? Medicare patients? Is it more or less likely that those that continue to are the most competent or the least competent? And costs keep rising unsustainably anyway. In the end, we’ll be left with programs that have no competent doctors to provide services and the need to pay retail for EVERYTHING. How is that likely to serve the interests of those targeted as the beneficiaries of ObamaCare?
The market is too small? And the solution is to artificially make employer-provided insurance less attractive? Employer-provided insurance is the only vector for healthcare insurance that WORKS and appears sustainable. Let’s by all means cannibalize it to shore-up a program that’s failing even by the admission of its supporters.
Time to scrap ObamaCare and go back to the drawing-board. But, in the end, you cannot have universal free healthcare without it being the most expensive component of a nation’s expenditures, without it eliminating “choice”, without it being quite basic in extent and quality, and without foregoing pretty much every OTHER priority for public funds. Just look at Europe.
The market is too small? And the solution is to artificially make employer-provided insurance less attractive? Employer-provided insurance is the only vector for healthcare insurance that WORKS and appears sustainable. Let’s by all means cannibalize it to shore-up a program that’s failing even by the admission of its supporters.
Time to scrap ObamaCare and go back to the drawing-board. But, in the end, you cannot have universal free healthcare without it being the most expensive component of a nation’s expenditures, without it eliminating “choice”, without it being quite basic in extent and quality, and without foregoing pretty much every OTHER priority for public funds. Just look at Europe.
7
It's okay that you don't know what you're talking about, but your refusal to learn is a real problem.
But prove me wrong: pick one provision, any provision, of the PPACA and explain it.
Bet you can't.
But prove me wrong: pick one provision, any provision, of the PPACA and explain it.
Bet you can't.
1
The GOP has actively engaged in disrupting and destroying the mechanisms that address the issues described in this article. Any new system is going to have growing pains; there were mechanisms in place to protect the businesses that entered into the insurance pools from the unknowns and instability in the new markets. These mechanisms were gutted by the GOP.
The GOP wants health care for the 1%. The rest of us can just get by and depend on the kindness of strangers. If you are like D. Trump, you want people having to unload their homes due to medical expense induced bankruptcies. Besides, Darwin stated it best, on the superior really survive, the rest of us do not really matter.
If you want the health care system to work, vote out the Republicans in Congress and get people in there that want to make the concept of healthcare for everyone a reality.
The GOP wants health care for the 1%. The rest of us can just get by and depend on the kindness of strangers. If you are like D. Trump, you want people having to unload their homes due to medical expense induced bankruptcies. Besides, Darwin stated it best, on the superior really survive, the rest of us do not really matter.
If you want the health care system to work, vote out the Republicans in Congress and get people in there that want to make the concept of healthcare for everyone a reality.
1
We need a single payer policy that will bring prices down with strict price controls on medical care and pharmaceutical drugs. Why don't we take our lessons from other developed nations who experience both lower overall healthcare costs and better health outcomes. We are worse on both. A good place to start would be to lower the age of Medicare eligibility, especially given the high rates of unemployment and disability insurance use among those in their 50's. I suspect that they turn to disability insurance because they cannot afford health insurance and cannot find work. It becomes their only option. Then, offer comprehensive insurance to all others while continually lowering the Medicare eligibility age until it covers everyone. Businesses will be more competitive without the drag of health insurance and Americans will be healthier. Of course, taxes will be higher but who do you think pays for all that medical care for the uninsured at present?
3
This is NOT 'rocket science' folks. We must first disavow the insurance companies business model 'for profit' and replace them using the Canadian model . Then , beat up on 'Big Pharma' enough to bring down drug prices. We should disconnect the anachronistic connection between employment and healthcare, relieving employers of this burden. The care providers must change compensation for doctors and nurses to salaried positions while pursuing Tort reform to enable MD's to be relieved of the high malpractice premium costs. After that we will witness a happy bunch of productive people who are enjoying the many jobs which this will create.
3
Alan, one of the reasons patients sue is because they need more medical care and our current system of linking employment to health insurance deprives them of the care they need if they lose their job because they can no longer work due to whatever problems they have because of the medical errors. Tort reform is not the issue. The issue is the accessibility of health care to all who need it. If you are crippled as a result of inadequate treatment, the wrong treatment, or a doctor who should not be practicing any longer, caps on settlements won't help you once the money you win runs out. You'll continue to need care. However, unless you are willing to have bake sales or start a go fund me project you won't be able to get the care you need.
If we changed how we pay for medical school and medical care we wouldn't need tort reform because patients wouldn't need to sue for money to receive the care they need. Then the only suing would be for egregious malpractice.
If we changed how we pay for medical school and medical care we wouldn't need tort reform because patients wouldn't need to sue for money to receive the care they need. Then the only suing would be for egregious malpractice.
So just like the state of the economy has been spun (it has been a weak recovery) so all that bragging about how many uninsured are now covered was misleading as it mostly represented people signing up for free medicaid and 27 million people still don't have insurance. What happened to all those healthy young people that were supposed to give the insurance companies big profits? Healthy young people don't buy health insurance it was just spin.
So all those dire predictions about what was wrong with Obamacare were true as was the conventional wisdom that you don't pass such major far reaching legislation on a straight party-line vote. Now even if there was afix the votes are not there to amend the law - at least not under that great legislative leader Barack Obama.
So all those dire predictions about what was wrong with Obamacare were true as was the conventional wisdom that you don't pass such major far reaching legislation on a straight party-line vote. Now even if there was afix the votes are not there to amend the law - at least not under that great legislative leader Barack Obama.
10
I don't understand why your are so gleeful about something that is a great fear for so many of us.
I take it you have insurance at a price that you can handle and I'm happy for you.
But please try to comprehend how hard it is for many to find good paying, steady work. I receive no subsidies and have to come up with $600 / month as well make payments on a $1300 annual deductible.
Most people cannot afford that.
I take it you have insurance at a price that you can handle and I'm happy for you.
But please try to comprehend how hard it is for many to find good paying, steady work. I receive no subsidies and have to come up with $600 / month as well make payments on a $1300 annual deductible.
Most people cannot afford that.
#DickeyFuller
I am on Medicare and I voted for Obama the first time around to get a good healthcare law because my youngest daughter has a chronic and expensive illness. Right now she is stuck in a low paying job because it comes with insurance. If she must buy her own her deductible would be consumed her first treatment and the premium would still be beyond her means.
I am not gleeful, I am angry that Obama is so feckless. Instead of being statesmanlike and getting bipartisan support for a workable law. Obama treated the whole project like a political contest as if he was still a Chicago ward politician. I guess that is why the Obama White House was staffed with so many political operatives. It is also why Obamacare was h only achievement - and now that's turned to ashes.
I am on Medicare and I voted for Obama the first time around to get a good healthcare law because my youngest daughter has a chronic and expensive illness. Right now she is stuck in a low paying job because it comes with insurance. If she must buy her own her deductible would be consumed her first treatment and the premium would still be beyond her means.
I am not gleeful, I am angry that Obama is so feckless. Instead of being statesmanlike and getting bipartisan support for a workable law. Obama treated the whole project like a political contest as if he was still a Chicago ward politician. I guess that is why the Obama White House was staffed with so many political operatives. It is also why Obamacare was h only achievement - and now that's turned to ashes.
3
getting bipartisan support for a workable law.
But Michael, the Repubs vowed to block every single thing he tried to do -- and they did.
The president was so conciliatory to the Repubs that he, in essence, proposed the Heritage Foundation's plan! He proposed RomneyCare from Massachusetts! He gave them_exactly_what they wanted and they still shot it down.
So be mad. But realize that the Congressional Republicans are responsible for where we are now. :-)
But Michael, the Repubs vowed to block every single thing he tried to do -- and they did.
The president was so conciliatory to the Repubs that he, in essence, proposed the Heritage Foundation's plan! He proposed RomneyCare from Massachusetts! He gave them_exactly_what they wanted and they still shot it down.
So be mad. But realize that the Congressional Republicans are responsible for where we are now. :-)
The model for Obamacare originally came from a conservative think tank. I think an important lesson here is that, a conservative idea for "reform," by encouraging competition, is not working. A Republican Congress or even a Congress with one house in Republican control, will not implement any of these fixes, preferring to see the system fail than help it become viable. Until we start solving problems instead of trying to fit solutions to ideologies, we will continue to face these situations, and people will suffer as a result.
4
The Republican House has passed 14 Obamacare fixes which were signed into law since taking over in 2011. 8 of these bills were sponsored by Republicans.
Apparently Republicans are indeed willing to implement fixes that the President is willing to sign into law.
Apparently Republicans are indeed willing to implement fixes that the President is willing to sign into law.
3
Obamacare requires us to support for-profit insurance, which are not market-driven and have no incentive to serve their customers.
For healthy people, it's cheaper to self-insure and be a medical tourist for major surgery. With narrower networks, people can't even get in to see their doctors let alone get timely access to specialists. Why bother?
Before Obamacare, I got affordable coverage with a big deductible. It didn't cover childbirth, "preventive" tests or annual exams. It was just fine for big-ticket care and I could choose my doctor and hospital. This type of policy makes sense for those who are healthy, regardless of age. And it's gone.
As others pointed out, there is huge waste in the system. The worst: annual physicals on asymptomatic, healthy adults, including procedures that have no demonstrated value for this population (such as cardiograms). Physical therapists demand a minimum of 12 sessions and doublebook. An orthopedic facility asks everyone to get an x-ray before seeing a doctor (it's up to the patient to point out that x-rays don't make sense for soft tissue injuries).
The best solution is also the least likely to happen. Read David Goldhill's book, Catastrophic Care: How American Health Care Killed My Father.
For healthy people, it's cheaper to self-insure and be a medical tourist for major surgery. With narrower networks, people can't even get in to see their doctors let alone get timely access to specialists. Why bother?
Before Obamacare, I got affordable coverage with a big deductible. It didn't cover childbirth, "preventive" tests or annual exams. It was just fine for big-ticket care and I could choose my doctor and hospital. This type of policy makes sense for those who are healthy, regardless of age. And it's gone.
As others pointed out, there is huge waste in the system. The worst: annual physicals on asymptomatic, healthy adults, including procedures that have no demonstrated value for this population (such as cardiograms). Physical therapists demand a minimum of 12 sessions and doublebook. An orthopedic facility asks everyone to get an x-ray before seeing a doctor (it's up to the patient to point out that x-rays don't make sense for soft tissue injuries).
The best solution is also the least likely to happen. Read David Goldhill's book, Catastrophic Care: How American Health Care Killed My Father.
12
See this here? This here is half the problem.
First, insurance that doesn't cover pregnancy is fine, right up to when you get pregnant. Or I should say it's fine for an INDIVIDUAL, until you happen to notice that all insurance depends on the idea of spreading risk across a large number of people.
Second, it is idiotic to argue that nobody healthy needs an annual physical. Older people do; kids do. They're called checkups for a reason. And it is well beyond idiotic to attack the PPACA for encouraging checkups, which it does, for crying out loud, because checkups are the way you catch problems before they become expensive.
Third--could we just stop pretending that we're all doctors? I worked in hospitals for more than years, am far more eddicated than most, have soent more than a decade working on medical insurance matters--and I am no more aualified to decide when I need an x-ray than the man in the moon.
In the first place, yes, Virginia, x-rays can at times show "soft tissue," injuries. For pete's sake, they're done all the time when pneumonia or CHF is suspected. They're done to show tracheal deviation, and...they're dine all the time.
In the second, an orthopod orders a film to make sure you don't have a greenstick break, or some kind of underlying bone disease, or even an infective process.
The flip side of this? People demanding expensive drugs, procedures and surgeries that they don't need, because they Just Know They Do.
First, insurance that doesn't cover pregnancy is fine, right up to when you get pregnant. Or I should say it's fine for an INDIVIDUAL, until you happen to notice that all insurance depends on the idea of spreading risk across a large number of people.
Second, it is idiotic to argue that nobody healthy needs an annual physical. Older people do; kids do. They're called checkups for a reason. And it is well beyond idiotic to attack the PPACA for encouraging checkups, which it does, for crying out loud, because checkups are the way you catch problems before they become expensive.
Third--could we just stop pretending that we're all doctors? I worked in hospitals for more than years, am far more eddicated than most, have soent more than a decade working on medical insurance matters--and I am no more aualified to decide when I need an x-ray than the man in the moon.
In the first place, yes, Virginia, x-rays can at times show "soft tissue," injuries. For pete's sake, they're done all the time when pneumonia or CHF is suspected. They're done to show tracheal deviation, and...they're dine all the time.
In the second, an orthopod orders a film to make sure you don't have a greenstick break, or some kind of underlying bone disease, or even an infective process.
The flip side of this? People demanding expensive drugs, procedures and surgeries that they don't need, because they Just Know They Do.
1
This article is laughable... four tactical problems of a plan that is at best a minor improvement over the bad old days.
Canada figured it out. So did western Europe. Why are we so stupid as to continue to believe that health care costs are driven by market forces. Our unquestioning adoration of "free markets" is making millionaires out of insurance and pharma CEOs while patients suffer. It is a stain on the richest nation in the world.
Canada figured it out. So did western Europe. Why are we so stupid as to continue to believe that health care costs are driven by market forces. Our unquestioning adoration of "free markets" is making millionaires out of insurance and pharma CEOs while patients suffer. It is a stain on the richest nation in the world.
104
It ain't a free market!
Making millionaires out of insurance and pharma CEO'...." was the goal of Obamacare. Well, more exactly making multimillionaires out of already millionaires. It became apparent as soon as the plan was announced and showed "If you like your current health care plan you can keep it" to be, well, not exactly accurate, and put a lie to the words "free market" when the American people were threatened with fines in they did not sign up. So much for the Land of the Free (choice). The plan was rushed into law without much other thought. Does anyone really think it does not stink to high hell? Obama bent over backwards to placate the insurance companies. I understood it as soon as i looked at it, but then again, i don't spend ten percent of my time playing golf.
2
@Mark - Maybe you should take a look at the number of doctors in the top 1% - its about half of them. They are the largest occupational group in the top 1%, followed by lawyers.
1
The formula was to be preserve the free market, which translates to the political power of entrenched interests such as Big Pharma, Physicians, Insurers and Hospitals. These are not eleemosynary organizations and as such the first principle is profit to shareholders, executives and members of professional organizations.
The original amount of tax penalty for the healthy who do not pay into the fund in the form of signing up was sharply reduced to make it more palatable to legislators, which meant that that it was a prudent decision for this healthy (low cost) group to wait until they were sick. So the model of viability was distorted before the program was launched.
Of course it is failing as it tried to provide an expensive service to all, without the requisite political will to tax the public, the only way it ultimately can be done.
AlRodbell.com
The original amount of tax penalty for the healthy who do not pay into the fund in the form of signing up was sharply reduced to make it more palatable to legislators, which meant that that it was a prudent decision for this healthy (low cost) group to wait until they were sick. So the model of viability was distorted before the program was launched.
Of course it is failing as it tried to provide an expensive service to all, without the requisite political will to tax the public, the only way it ultimately can be done.
AlRodbell.com
4
Preserve the "free market"!
eleemosynary = charitable
2
The ACA's many pitfalls are coming home to roost. To put it bluntly, the concessions to private insurers were too big, and the penalties for patient noncompliance--an annual fine of a couple hundred versus a year of premiums-- too enticing.
Because all these loopholes and perverse incentives, the ACA was doomed to fail. For universal health insurance to succeed, everybody must be covered: healthy along with the sick.
I see no way to "fix" the ACA. Returning to the GOP way-- survival of the richest--isn't the answer either. The only answer is universal coverage by opening up Medicare for all. Universal from birth--no more opt-ins or Opt-outs based on your health. Where insurance companies used to cherry pick, the ACA holdouts are doing the same things for themselves.
It games the system and leaves the sickest and the government holding the bag. And it's patently unfair for the people who need care the most.
Because all these loopholes and perverse incentives, the ACA was doomed to fail. For universal health insurance to succeed, everybody must be covered: healthy along with the sick.
I see no way to "fix" the ACA. Returning to the GOP way-- survival of the richest--isn't the answer either. The only answer is universal coverage by opening up Medicare for all. Universal from birth--no more opt-ins or Opt-outs based on your health. Where insurance companies used to cherry pick, the ACA holdouts are doing the same things for themselves.
It games the system and leaves the sickest and the government holding the bag. And it's patently unfair for the people who need care the most.
58
well said, Ms. McMorrow. We need single-payer, don't we?
1
The politicians don't dare do it because the taxes required would be too high. Even the most liberal Democrats realize the voters would hang them from lampposts if they taxed everyone an additional 30%, starting with the first dollar of income. And that would only pay for current spending.....
1
Health care funding is very lousy insurance business. Insurance is a viable business only when the insured party doesn't want to experience the insured loss and has the ability to prevent it.
6
Medicare seems to work across the country. Yes, you need a supplemental plan, or even to opt out entirely and go with an Advantage plan to make it work. Yes, it fails to cover basic vision or dental care, so you need to purchase separate coverage for those medically necessary services. Yes, the dreaded donut hole, while being slowly phased out, is still present and still affects prescription choices. Yes, being on Medicare means you're not eligible for those coupons and programs that drug manufacturers offer. And yes, there appears to be a law preventing Medicare from negotiating lower prices on drugs.
But even with all of those issues, and I'm sure there are others, Medicare works. The question is why this model isn't simply adopted to cover the rest of the country's adult population.
I will also add that I think the big insurers are skewing their numbers by refusing to pool their customers. They're maintaining puddles instead--a puddle of the healthier people with employer-based coverage and a separate puddle for the sicker ACA customers. Forcing them to combine those into one risk pool for cost calculation purposes might improve the numbers overall, and outcomes on our end.
Lastly, why the administration didn't write in penalties for insurers who withdraw from the system, unless they go out of business completely, needs to be explained.
But even with all of those issues, and I'm sure there are others, Medicare works. The question is why this model isn't simply adopted to cover the rest of the country's adult population.
I will also add that I think the big insurers are skewing their numbers by refusing to pool their customers. They're maintaining puddles instead--a puddle of the healthier people with employer-based coverage and a separate puddle for the sicker ACA customers. Forcing them to combine those into one risk pool for cost calculation purposes might improve the numbers overall, and outcomes on our end.
Lastly, why the administration didn't write in penalties for insurers who withdraw from the system, unless they go out of business completely, needs to be explained.
15
I'm amazed at the comments about Medicare for All being the solution. Have its proponents ever looked at Medicare in detail? There are rules about benefit periods, coinsurance per benefit period. 60 day waits to start new benefit period, rapidly increasing coinsurance for benefit periods extending beyond 60 days, and, of course, the limited number of Lifetime Reserve Days. If you're sick long enough that you run out Lifetime Reserve Days, Medicare stops paying and you're on your own. Even the extra cost Medigap policies don't extend coverage much beyond these limits. Personally, when I reach 65, I may look at retaining individual insurance with its fixed yearly deductible and full coverage beyond the deductible limit and more importantly, no lifetime limits so I won't be subject to these esoteric and archaic rules as long as I pay my premium each month.
3
"...Medicare works. The question is why this model isn't simply adopted to cover the rest of the country's adult population."
Easy answer to your question -- the rest of the country's adult population is paying for Medicare without getting any benefits. This is what makes Medicare work -- millions of people are paying into it without being able to use it (that would be everyone who is under the age of 65 and employed). Because of this large pool of people paying into system but getting NOTHING from it, the smaller number of people who actually get Medicare benefits do not have to pay all that much for them.
If you cover the entire population by Medicare, where will you get the large pool of people paying into the system but getting no benefits from it? You can't. That means that all the costs of “Medicare for everyone” will have to be covered by the people covered by Medicare -- and thus those costs will be MUCH higher than they are for today's Medicare beneficiaries.
Easy answer to your question -- the rest of the country's adult population is paying for Medicare without getting any benefits. This is what makes Medicare work -- millions of people are paying into it without being able to use it (that would be everyone who is under the age of 65 and employed). Because of this large pool of people paying into system but getting NOTHING from it, the smaller number of people who actually get Medicare benefits do not have to pay all that much for them.
If you cover the entire population by Medicare, where will you get the large pool of people paying into the system but getting no benefits from it? You can't. That means that all the costs of “Medicare for everyone” will have to be covered by the people covered by Medicare -- and thus those costs will be MUCH higher than they are for today's Medicare beneficiaries.
3
@Skeptical - You hit it. Everyone working is paying 2.9% of their salary for Medicare, or 3.8% if that make over $250K. They get in return - nothing!
1
Why is a public option "hard to make work in practice?" Canada, Japan, and all of Western Europe seem to have no trouble making such an option work--at lower costs than what the US government bears now.
48
"Why is a public option 'hard to make work in practice?" Congress
Overcome that problem and the rest should relatively easy. Except for the billions in lobbying against it by the medical establishment.
And OMG ain't that socialism??!!??
May I suggest either getting very rich, move or just don't get sick.
Overcome that problem and the rest should relatively easy. Except for the billions in lobbying against it by the medical establishment.
And OMG ain't that socialism??!!??
May I suggest either getting very rich, move or just don't get sick.
Maybe the US is just ruled by car thieves and other stripes of crooks.
I suspect that the author means "hard to make work in practice, given current American political and economic conditions." Of course, Western Europe, Canada and Japan have working systems. But most of the European countries began their systems right after WWII, when health care -- and everything else -- was in ruins. Those countries had the luxury of building from nothing, and with support for providing care at reasonable costs. In 2016, to make a National Health Service with real cost limits, one would have to figure out how to move millions of workers from private insurance and ancillary medical jobs to something else; pay for medical student debt already accumulated by practitioners now on lower incomes; provide much higher subsidies for medical school training going forward; and a host of other nettlesome issues. All the while, we have to figure this out as the current industry comes to Washington with boatloads of cash, urging legislators not to upset the cart. Converting a sector that occupies 18-19% of the economy to something that is half that size -- i.e. comparable to European systems -- is incredibly disruptive. Recognizing that we need to change is the easy part; making it happen, once we have passed the tipping point, is extraordinarily difficult.
1
The notion that market forces can be applied to health care delivery was never anything more than wishful thinking. A free market depends on several things that are not present in the health care market: symmetry of information between buyer and seller, the ability for either party to walk away from the transaction ("I'll just wait for the price of that emergency triple bypass to drop," said no one ever), equivalent products to choose from ...
No, competition was never the answer. The answer is what it always has been: a national healthcare program, funded by payroll taxes, that covers every man, woman, and child in the country, with the primary motivation being to provide for a healthy populace, rather that to provide profits for investors. We need to grow up and recognize that health care is not a commodity to be traded, but a necessity that should be provided as part of the social contract.
No, competition was never the answer. The answer is what it always has been: a national healthcare program, funded by payroll taxes, that covers every man, woman, and child in the country, with the primary motivation being to provide for a healthy populace, rather that to provide profits for investors. We need to grow up and recognize that health care is not a commodity to be traded, but a necessity that should be provided as part of the social contract.
336
So well said. Free markets don't work under all circumstances, and healthcare is manifestly one of them. It ain't working, people. It is never going to. We need a single-payer system.
2
We also need to grow up and recognize that rationing will occur, that 90 year olds should not be getting hip transplants and everyone will not get everything they want, because it is 'free'.
4
I agree with your analysis about asymmetrical information. If I may add, moral hazard and free riders prevent this market from functioning properly. And this is an excellent example of a prisoner's dilemma, where everyone acting in a self-interested way will make all participants worse off.
1
One correction, about half of Americans who purchase health insurance in the individual market get no subsidy. Here's a link to a chart detailing their numbers: http://healthpolicyandmarket.blogspot.com/
Surprisingly, in many states more are off-exchange then on. With steep increases next year many of these people, who are likely healthier, are going to drop coverage.
Why do I say this? Because I am one of them and every month when it comes time to pay my $604 premium and I have not used medical care I wonder why I do it.
If we turn the market into Medicaid with super narrow networks, I would drop my insurance and move to short term coverage or fixed indemnity. I would never, never pay $600 for Medicaid type coverage. In fact, I wouldn't pay $300 per month for Medicaid.
I do think that changing requirements for covered benefits would be a huge help. It never made any sense to me that childbirth and well child visits up to age 5 were deemed "essential benefits" for those long past their childbearing years and for men (noticeably absent from the exchanges) rather than an add-on to a policy. The same goes for dental and vision for my non-existent children. All should be add-ons to individual insurance plans.
it's not just young people we need in the market, it's also older, healthy people because we let insurers charge them 3x what they charge younger Americans and they use far less care then the current average exchange enrollee.
Surprisingly, in many states more are off-exchange then on. With steep increases next year many of these people, who are likely healthier, are going to drop coverage.
Why do I say this? Because I am one of them and every month when it comes time to pay my $604 premium and I have not used medical care I wonder why I do it.
If we turn the market into Medicaid with super narrow networks, I would drop my insurance and move to short term coverage or fixed indemnity. I would never, never pay $600 for Medicaid type coverage. In fact, I wouldn't pay $300 per month for Medicaid.
I do think that changing requirements for covered benefits would be a huge help. It never made any sense to me that childbirth and well child visits up to age 5 were deemed "essential benefits" for those long past their childbearing years and for men (noticeably absent from the exchanges) rather than an add-on to a policy. The same goes for dental and vision for my non-existent children. All should be add-ons to individual insurance plans.
it's not just young people we need in the market, it's also older, healthy people because we let insurers charge them 3x what they charge younger Americans and they use far less care then the current average exchange enrollee.
6
The federal government is a very large workforce, and last I knew, had many plans to choose from. Some offer childbirth and child care coverage, some don't some are for healthier people, some for sicker people. I'm not exactly sure how that manages to make a profit for those companies, but it appears to. Not sure why the whole of the US can't participate in that marketplace.
2
That was John Kerry's proposed plan when he ran against George W Bush in 2004. And, it was a good, simple solution to the problem. One giant risk pool - that's why it works with the option of offering subsidies to those who could not afford to pay and/or expanding Medicaid.
So simple and so much better than the ACA mess. Much as I supported it's passage initially, at this point I think we have to throw it out and start all over. At most, leave the Medicaid expansion - the rest of it is a mess and it will never work.
The ACA is like a 3-legged stool that has already lost 2 of its legs. Good riddance, and let's start over and do it right this time.
So simple and so much better than the ACA mess. Much as I supported it's passage initially, at this point I think we have to throw it out and start all over. At most, leave the Medicaid expansion - the rest of it is a mess and it will never work.
The ACA is like a 3-legged stool that has already lost 2 of its legs. Good riddance, and let's start over and do it right this time.
1
Given the greed of highly paid insurance executives and their boards, the only thing that really makes sense is single payer, Medicare for all, with the insurance industry handling the supplemental policies, as it does now. I have the impression Hillary Clinton intends to move in this direction, but as usual she hasn't been very clear about the nature and pace of change to a single payer system. One way to start the ball rolling is a nationwide public option; another, not mutually exclusive, is to institute a pay in Medicare option for anyone over fifty and a mandate for Medicare to negotiate drug prices.
In the band aid category, the proposal to "reinsure" catastrophic costs makes sense for both patient and insurance companies (a legitimate gripe about an ACA which they helped design).
In the band aid category, the proposal to "reinsure" catastrophic costs makes sense for both patient and insurance companies (a legitimate gripe about an ACA which they helped design).
7
No other country on this planet leaves its citizans to be fleeced by rapacious drug companies like the land of the free and home of the brave.
2
Before we look at solutions, we should take a broader look at the major problems that exist. They do not happen to be confined to the ACA exchanges.
Premiums are unaffordable. Deductibles and other cost sharing are unaffordable. Provider choice is disrupted when it is necessary to change networks. Segregated risk pools distribute risk unevenly, and risk adjustment has been gamed by the private insurers. These problems stem from fragmentation and from dysfunctional responses on the part of the insurers.
One risk pool for everyone, funded equitably based on ability to pay, would correct these problems. Administered pricing would slow the growth in health care costs to sustainable levels. Resource allocation can be improved to ensure access for everyone. This, of course, is what a single payer system would do.
They say that single payer is not feasible here, only in other countries. Yet how can we consider that it is feasible to continue on a path that perpetuates inequity, disruptive care, and non-sustainable health care inflation? That tortures the concept of feasibility.
Premiums are unaffordable. Deductibles and other cost sharing are unaffordable. Provider choice is disrupted when it is necessary to change networks. Segregated risk pools distribute risk unevenly, and risk adjustment has been gamed by the private insurers. These problems stem from fragmentation and from dysfunctional responses on the part of the insurers.
One risk pool for everyone, funded equitably based on ability to pay, would correct these problems. Administered pricing would slow the growth in health care costs to sustainable levels. Resource allocation can be improved to ensure access for everyone. This, of course, is what a single payer system would do.
They say that single payer is not feasible here, only in other countries. Yet how can we consider that it is feasible to continue on a path that perpetuates inequity, disruptive care, and non-sustainable health care inflation? That tortures the concept of feasibility.
16
"One risk pool for everyone, funded equitably based on ability to pay, would correct these problems."
...funded equitably based on the ability to pay....
So, do you want to fund it equitable or based on the ability to pay? Because those are two VERY different things.
If you want "one risk pool for everyone" then making everyone pay the same exact amount (the same number of dollars) is already a huge help for those who present higher risk. (Because normally, as you ought to know, riskier customer pay more for insurance -- for example, single males under 25 pay more for car insurance, people who had lots of speeding tickets pay more for car insurance, etc). Everyone pays the same amount would be "treating people equitably" and also being nice to those who are in higher risk groups.
But making health insurance premiums "based on the ability to pay" is not equitable. There is good evidence based on demographic and other data that this would be equivalent to making low-risk groups pay MORE for health insurance than the high-risk groups. No insurance system on the world operates that way -- and it should be clear why.
And before you ask, the publicly-funded healthcare systems in European countries are not insurance systems, and they do not claim to be insurance. They are income redistribution systems – it just so happens that “income redistribution” is not seen as evil in many European countries.
...funded equitably based on the ability to pay....
So, do you want to fund it equitable or based on the ability to pay? Because those are two VERY different things.
If you want "one risk pool for everyone" then making everyone pay the same exact amount (the same number of dollars) is already a huge help for those who present higher risk. (Because normally, as you ought to know, riskier customer pay more for insurance -- for example, single males under 25 pay more for car insurance, people who had lots of speeding tickets pay more for car insurance, etc). Everyone pays the same amount would be "treating people equitably" and also being nice to those who are in higher risk groups.
But making health insurance premiums "based on the ability to pay" is not equitable. There is good evidence based on demographic and other data that this would be equivalent to making low-risk groups pay MORE for health insurance than the high-risk groups. No insurance system on the world operates that way -- and it should be clear why.
And before you ask, the publicly-funded healthcare systems in European countries are not insurance systems, and they do not claim to be insurance. They are income redistribution systems – it just so happens that “income redistribution” is not seen as evil in many European countries.
4
When even those of us who are employed can no longer afford high premiums for essentially catastrophic coverage, the whole market will have collapsed.
1
This is what happens when the government tries to force major policies without the public's consent. Consider that voters have never approved of Obamacare, Obama's transgender policy, or Obama's immigration policy. No wonder the US Supreme Court keeps ruling against him - Obama was elected president and not dictator. Let the people decide.
21
Congress approved the ACA and it was signed by the president--just like the Constitution indicates federal laws are supposed to be passed. Are you suggesting all federal laws should be subjected to national referendums?
8
You might have worked better if Congress actually represented their constitutes instead of the insurance and Pharma. Give it a rest.
1
Well as part of the "public", I applaud Obama for caring about those that didn't have insurance, taking that first step for change, a system that isn't working. Not sure what public you are referring to, maybe "Faux News" that misleads everyone, but those that now have health insurance sure have welcomed it. Isn't that in the millions?
2
Conservative business leaders have done everything, they can think of, to assist obstructionist Congress members to throw wrenches into the works. If Congress would get behind universal health care, give a damn about their constituency (which is actually ALL Americans,) these problems could be resolved. But ACA is a program promoted by President Obama, so it must be eliminated, not fixed.
6
Even if there were no Obama, the thought of covering 11 million illegal immigrants at a minimum would probably be a show stopper.
3
These are almost verbatim, the predictions that conservatives and most economists made about the ACA.
Then there was the Times, disingenuously suggesting prices were falling a few years ago, because they WERE falling briefly in NY. But rising everywhere else. The rising everywhere else part, was not reported.
As predicted, more government control and regulation creates monopolies and oligopolies. It does not favor competition, it crushes it. You are getting what you asked for.
Then there was the Times, disingenuously suggesting prices were falling a few years ago, because they WERE falling briefly in NY. But rising everywhere else. The rising everywhere else part, was not reported.
As predicted, more government control and regulation creates monopolies and oligopolies. It does not favor competition, it crushes it. You are getting what you asked for.
28
I'm perplexed, yes it is true, the merger and trade commission did help create the giant hospitals, and drug companies (by giving the ok to the mergers) that creating the monopolies and there by wiping out most of the competition in the Republican designed ACA plan that the New York Times reported on. What exactly is your point?
Time for a public option!
6
And we are surprised? The insurance industry wrote the ACA. What did you expect? We need a single-payer system.
214
Not so. The Pelosi/Reid Congress wrote and passed the ACA, without a single Republican vote.
2
Kate, while any comment bashing the insurance industry is sure to get plenty of "likes", your comment actually doesn't make any sense. The insurance industry is losing lots of money on the exchanges. That's party of the problem, and it's why insurers are dropping out. If the insurance industry actually did write the ACA (it didn't), we actually should be surprised at this outcome.
Nor, contrary to your comment, is a single-payer system the only, or even necessarily the best way, to achieve universal coverage. Other countries, like the Netherlands and Switzerland, successful rely on private insurers. The difference is they also have a real mandate (not a toothless one like in Obamacare) to get the young and healthy in the system.
Bashing evil insurance companies is easy. Coming up with policy that works is complicated.
Nor, contrary to your comment, is a single-payer system the only, or even necessarily the best way, to achieve universal coverage. Other countries, like the Netherlands and Switzerland, successful rely on private insurers. The difference is they also have a real mandate (not a toothless one like in Obamacare) to get the young and healthy in the system.
Bashing evil insurance companies is easy. Coming up with policy that works is complicated.
3
If insurance companies "wrote" the legislation, why are they all losing money in the and leaving the exchanges?
1
What needs to be done? Starting a national health plan like Canada, which is the model for the world.
The rest of the civilized world has figured it out, except us.
The worst thing to go back to is the old republican de facto criminal plan of be rich and/or don't get sick and/or don't have a bad life event and help HMO/General meds execs become billionaires at the expense of sick Americans.
The rest of the civilized world has figured it out, except us.
The worst thing to go back to is the old republican de facto criminal plan of be rich and/or don't get sick and/or don't have a bad life event and help HMO/General meds execs become billionaires at the expense of sick Americans.
7
The ACA has helped millions, no doubt; however, its flaws and its haters both make the best argument for single payer.
Your move, Secretary - er, I mean President - Clinton.
Your move, Secretary - er, I mean President - Clinton.
3
Yea, Clinton is not beholding to anyone. Pay no attention to man behind the curtain of the Clinton Foundation.
3
A healthy person, who buys an insurance but only goes to a doctor for the annual wellness check-up a year, will be fine doing it every other year. That is a very good candidate for Obama-insurance. But how do you keep as many people as healthy as that?
2
There are lots of healthy people in this country. Unfortunately, the PPACA's individual market place is skewed toward the sick. This isn't amazing as people that work tend to healthier overall and most don't give up a piece of their benefit package. Just like employer based plans, the PPACA individual market place depends on healthy individuals to offset the cost of the sick. However, just because a person isn't in an employer plan is no reason to force them to pay exorbitant costs to cover the PPACA sick. The risk pools need to be wider and maybe everyone should be in the same one. Personally, from what I've read of the Swiss and German systems, I'd like to see that sort of system implemented instead of the mongrel system we got with Obamacare.
2
Yeah so socialized medicine is the norm in almost every First World country. It is NOT hard to make work in practice, we just have stupid citizens and politicians who don't know anything about anything.
6
Make private insurance illegal, make private medical care illegal, for everyone, and everyone will have the best medical care, same goes for education (secondary and higher), and housing
1
You must be a "progressive" who wants to make everyone, everywhere the slaves of your inefficient and corrupt great god government.
5
Elect a Congress Clinton can work with if she gets in office. Dems in Congress helped GW Bush fix some systemic problems in his signature Medicare Part D drug program.
The GOP in Congress has not lifted a finger to fix the normal problems that arise once any large-scale legislation is enacted. In fact the GOP has done everything to it can to make Obamacare fail.
So get to the polls in November and fire the do-nothing GOP majority in Congress. That will be a huge step toward helping Obamacare get the critical fixes it needs.
The GOP in Congress has not lifted a finger to fix the normal problems that arise once any large-scale legislation is enacted. In fact the GOP has done everything to it can to make Obamacare fail.
So get to the polls in November and fire the do-nothing GOP majority in Congress. That will be a huge step toward helping Obamacare get the critical fixes it needs.
2
How about a real public option or better yet single payer plan for all. The greed in our healthcare system must be stopped.
5
Yep-I'm one of those individuals who doesn't qualify for a subsidy. I'm simply not going to pay $700/month for a plan with a$6K annual deductible. Going back to being uninsured next year unless something changes. Thanks Republicans for doing everything in your power to put health insurance out of reach!
7
Um... no!
No Republicans voted for ACA. Nice try, but your party owns this mess.
No Republicans voted for ACA. Nice try, but your party owns this mess.
4
The problem with the health insurance market is that it is even a market in the first place.
Forget the public option.That's a cop-out. We need true single-payer health care, a/k/a Medicare for All. Financed through a progressive tax, no co-pays or deductibles, universal coverage from cradle to grave, none of those opt-outs allowed in Red States where hatred of the poor is both a managerial strategy and a cultish dogma.
Obamacare is all about protecting big business and fostering competition for profit and making a handful of insurance and pharmaceutical moguls even more obscenely rich. Some 30 million people are still uninsured, while millions more are under-insured. Even those lucky enough to have insurance constantly have to shop around, prove their incomes, their addresses, their existence - and who still can't afford to visit a doctor or hospital when they get sick.
The idea is you shouldn't and/or mustn't use your plan, and that way the neoliberal bean counters can brag about medical costs going down. It's "best practices" and efficiency and the bottom line over the actual health and the actual care of people.
It's a big, fat scam and a monumental rip-off.
So enough of making our human rights and our well-being subservient to endless economic growth. It's time to join the rest of the civilized world.
If we can afford trillion-dollar wars and negative effective tax rates for predatory oligarchs like Donald Trump, we can certainly afford universal health care.
Forget the public option.That's a cop-out. We need true single-payer health care, a/k/a Medicare for All. Financed through a progressive tax, no co-pays or deductibles, universal coverage from cradle to grave, none of those opt-outs allowed in Red States where hatred of the poor is both a managerial strategy and a cultish dogma.
Obamacare is all about protecting big business and fostering competition for profit and making a handful of insurance and pharmaceutical moguls even more obscenely rich. Some 30 million people are still uninsured, while millions more are under-insured. Even those lucky enough to have insurance constantly have to shop around, prove their incomes, their addresses, their existence - and who still can't afford to visit a doctor or hospital when they get sick.
The idea is you shouldn't and/or mustn't use your plan, and that way the neoliberal bean counters can brag about medical costs going down. It's "best practices" and efficiency and the bottom line over the actual health and the actual care of people.
It's a big, fat scam and a monumental rip-off.
So enough of making our human rights and our well-being subservient to endless economic growth. It's time to join the rest of the civilized world.
If we can afford trillion-dollar wars and negative effective tax rates for predatory oligarchs like Donald Trump, we can certainly afford universal health care.
184
Karen: totally not an expert so maybe I'm not getting what you mean by "forget the public option". My understanding is that Germany's Gesetzliche Krankenversicherung (and several other Euro plans) is/are exactly that, a public option. Citizen's are free to have private health insurance if they want it, but once you opt out of the government "sickness fund" it's very difficult to get back in. Last I heard, about 91% percent of the population are in the government scheme, which because of its large number of participants, can provide very strict cost controls. From what I read, insurers in this country were not particularly adverse to ACA (it's fiercest opponents were pharma and device manufacturers), but they are diametrically opposed to a public option, which they perceive would eventually garner such large market share that they would be put out of business. At least that's my understanding
2
Glenn,
Our political leaders began their opaque negotiations last time with the public option, when they should have demanded single payer right from the get-go. So the bill was whittled down and whittled down to the current "product".
My point is, why start from a position of weakness and compromise? Why were single payer advocates, like Physicians For a National Health Program, barred from all the legislative discussions?
Our political leaders began their opaque negotiations last time with the public option, when they should have demanded single payer right from the get-go. So the bill was whittled down and whittled down to the current "product".
My point is, why start from a position of weakness and compromise? Why were single payer advocates, like Physicians For a National Health Program, barred from all the legislative discussions?
2
We can "afford" million dollar wars? We can't.
1
I sincerely hope some states/regions have every insurer back out of the individual marketplace leaving the consumer with no choices at all. Maybe that will be a wake up call to how much this law has failed and how unprofitable it is to provide individual plans. Without any company to provide insurance, that leaves only the government to pick up the burden and look itself in the mirror.
4
There is no mention of the cost providers have to deal with all the different prices with all the different insurance plans. Accountants in some hospitals are more numerous than healthcare professionals. We could save lots of money if there was one price for everyone for each procedure.
8
Why is health insurance so tied to employment? We are still stuck in the model of insuring people through their employers. Might have been the solution in a post WWII manufacturing world, but we've stuck with it and created behemoth insurance companies that pass along unfettered increases in health care costs to consumers. Why should health insurance continue to be an "employee" benefit? Is there really a good reason for it in today's world?
12
Obamacare is the opposite of what the country needs, which is to control the exorbitant costs of medical tests and procedures in the US. A series of excellent NYT articles over the past few years identified costs as the central problem in US health care, but the problem has been widely ignored. Obamacare is a gift to the health care and insurance industries, to be paid for by working middle class Americans who don't qualify for taxpayer subsidies. Obamacare basically perpetuates the problem of costs, and thus is unsustainable without long-term damage to the productive economy of our country.
95
Pay to physicians accounts for @ 8% of total dollars spent on health care/insurance..
1
Obamacare is a gift to Big Pharma also. The government must control drug prices.
4
so you think the government is going to be able to mandate these costs? The medical industry is "for profit" so they will continue to reap the benefits any way possible to prevent less profits. Look at CEO salaries. They sure aren't choosing to do it on their own nor do they care about the patients, those that can't afford it.
At least Obamacare gave Americans health insurance for those that were not provided before because the medical industry focuses on profit, not care. Our system isn't working while the rest of the world has insurance with better costs, better care and services. America is the only country whose healthcare isn't working. So obvious. And a reason for continuing costs? More Americans are now coming forward whose medical care had to be ignored because they had no choice. Preventative care and meds could have lessened their problem had they been able to afford it. Pity those that went bankrupt. As an auditor for a bank at one time, I personally witnessed the fact many lost what they had due to healthcare costs, a serious illness. Time for single payer option.
At least Obamacare gave Americans health insurance for those that were not provided before because the medical industry focuses on profit, not care. Our system isn't working while the rest of the world has insurance with better costs, better care and services. America is the only country whose healthcare isn't working. So obvious. And a reason for continuing costs? More Americans are now coming forward whose medical care had to be ignored because they had no choice. Preventative care and meds could have lessened their problem had they been able to afford it. Pity those that went bankrupt. As an auditor for a bank at one time, I personally witnessed the fact many lost what they had due to healthcare costs, a serious illness. Time for single payer option.
The exchanges were first proposed by the Nixon administration, as part of a larger healthcare policy more liberal than Obamacare. Democrats like Ted Kennedy opposed it, favoring single payer instead.
Democrats today should still oppose anything that relies on private insurance companies in the end, because there is no evidence of it ever working anywhere in the world.
This just shows how successful Republican strategy has been the last 50 years - they have democrats fighting tooth and nail to hold onto and improve a plan dems themselves hated in the 70s
Democrats today should still oppose anything that relies on private insurance companies in the end, because there is no evidence of it ever working anywhere in the world.
This just shows how successful Republican strategy has been the last 50 years - they have democrats fighting tooth and nail to hold onto and improve a plan dems themselves hated in the 70s
12
I think France has supplemental insurance companies. You can purchase something beyond the government offerings if you choose.
2
We told you so: Whenever the government wants something to happen, the numbers in the estimates miraculously support its expectations. To anyone else old enough to remember Vietnam--seems like old times, doesn't it? The simple fact is that the United States does not have sufficient GDP to support universal health care, a military that polices the planet and service on the debt we incurred earlier on in our national addiction to profligacy. Something will have to give.
23
Actually, the main cause of our lack of fund is 'payments to or on behalf of individuals'. This is 72% of the 2016 Federal budget. It includes Social Security, Medicare, Medicaid, and all the other welfare programs.
Defense is only 15%, interest on the national debt 6%, and actually running the government 7%.
Defense is only 15%, interest on the national debt 6%, and actually running the government 7%.
1
Alan Behr - What needs to "give" in the United States' budget is "a military that polices the planet." The other thing that needs to go is the health insurance industry. We can have Single Payer, and it will be cheaper all around, with better outcomes. Just check out the countries that have it.
Bernie Sanders was right.
Bernie Sanders was right.
3
The countries that have the kind of health care we envy -- Canada, Australia, Europe, Scandinavia -- much, much higher taxes and huge VATs on every purchase. In Sweden, the VAT is 28%. Imagine paying 28% on EVERYTHING you purchase! even a stick of gum!
They also have few military expenses as WE PROVIDE THEIR DEFENSE and have for over 70 years.
Put those two things together. If we are willing to pay the taxes, and cut our military spending, we too can have single payer or any other health care we wish.
They also have few military expenses as WE PROVIDE THEIR DEFENSE and have for over 70 years.
Put those two things together. If we are willing to pay the taxes, and cut our military spending, we too can have single payer or any other health care we wish.
So at the end of the day, Obamacare is based on the idea that competition is good, but tries to prevent insurers from competing on all significant dimensions except the one that the government is better at anyway. We shouldn’t be surprised when insurance policies get worse (in terms of the benefits they actually provide) and health care costs continue to rise.
If we take as our starting premise that everyone should be able to afford decent health care—something that literally everyone agrees with—then the most obvious solution is single payer or one of its close cousins, such as we see in every other advanced economy in the world. But … markets! Not just Republicans, but also most Democrats are convinced that markets must be better, because of something they learned in Economics 101. Health care is one of the best examples of economism—the outsized influence that the competitive market model has had on public policy, even in areas where its lessons patently don’t apply.
If we take as our starting premise that everyone should be able to afford decent health care—something that literally everyone agrees with—then the most obvious solution is single payer or one of its close cousins, such as we see in every other advanced economy in the world. But … markets! Not just Republicans, but also most Democrats are convinced that markets must be better, because of something they learned in Economics 101. Health care is one of the best examples of economism—the outsized influence that the competitive market model has had on public policy, even in areas where its lessons patently don’t apply.
15
Can someone explain how many people are affected? The closest I could find in the article is: "But 17 percent of people eligible for this market might have no choice of carrier next year." (Note to editor: "this market" lacks a clear antecedent.). Presumably this means 17% of people who buy their own insurance, but how many people is that? Most people get insurance through their employer, or Medicare or Medicaid, leaving how many on their own? If 20% of the population are on their own, then .17 x .20 = .034. In other words barely 3% of the population is affected by this problem.
4
Not addressed at all is the skyrocketing cost of going to the doctor after paying the exorbitant premium that covers nothing. $6K in premiums and $6K in deductibles is a terrible deal. I am beginning to think that I should self insure. I would have almost $60K in a savings account if I had put that money in a bank instead of handing it over to a health insurance predator since the advent of Ocare. And only briefly touched on in the piece is the litany of ridiculous coverage required of single, childless adults. I pay $10 a month in a separate premium for pediatric dental care insurance even though I don't have children. What's up with that? And why am I paying for pregnancy care when I will never need it? The coverage mandates are absurd. You want to have a brood of no-necked monsters? Pay for them yourself.
37
Well I am paying 24 grand a year and we have incurred 1 million yep 1 million in medical bills. So if i was self insured what would I be ? Dead or bankrupt. No thanks even the nurse said she was self insured she should not better. You don't know what the future holds.
2
I can't think of a another market segment in our country that shouldn't exist than healthcare. Free market healthcare will never work because of the way all market places work here. Consolidation alone assures no real competitive pricing. Political contributions to law-makers governing healthcare market rules alone proves it isn't a free market, rather a market to the highest bidder. Market price controls - none. It's time to admit that treatment for profit is a scandalous failure.
48
Perhaps we need a mixed system.
The default position would be a "public option" which would offer very basic care, but protect against catastrophic bills. This would be paid by a percentage tax on all income from all sources, starting with $1.
A person could opt out of this by getting private insurance, and the government would then pay the private insurer the expected costs that it would have incurred under the public option to keep the costs down.
The default position would be a "public option" which would offer very basic care, but protect against catastrophic bills. This would be paid by a percentage tax on all income from all sources, starting with $1.
A person could opt out of this by getting private insurance, and the government would then pay the private insurer the expected costs that it would have incurred under the public option to keep the costs down.
13
That would depend on what percentage the tax is, wouldn't it? If it was 2%, people would go for it, but if it was 30%, they wouldn't.
2
Expand and increase the tax subsidies, with a corresponding limit on deductibles. Then, stiffen and enforce the penalties.
Much of the problem is, of course, attributable to the unwillingness of the Red States to expand Medicaid under the Affordable Care Act, for purely political reasons. This failure forced many poor less healthy people into the marketplaces to purchase insurance if they did not qualify for the affordability exemption. Their choice, even with the tax subsidies, was limited to the least expensive high-deductible policies offered in their states. Some exercised this choice, while others balked and stayed out of the marketplace. After all, the penalties were weak and they could always get coverage later . . . This reality is often overlooked.
Much of the problem is, of course, attributable to the unwillingness of the Red States to expand Medicaid under the Affordable Care Act, for purely political reasons. This failure forced many poor less healthy people into the marketplaces to purchase insurance if they did not qualify for the affordability exemption. Their choice, even with the tax subsidies, was limited to the least expensive high-deductible policies offered in their states. Some exercised this choice, while others balked and stayed out of the marketplace. After all, the penalties were weak and they could always get coverage later . . . This reality is often overlooked.
4
Well of course, it is the states' prerogative to not expand Medicaid. Also, why do you assume that the only reason for not expanding is political? Via cost sharing, their is cost to the states, albeit small at first.
1
The article itself confirms that the recommended "fixes" are not feasible. The real problems of Obamacare cannot be fixed and are also present on a much grander scale as the article suggested. It's an allusion that universal health care can be provided on the basis of a private insurance industry alone. It took European countries decades to implement a universal insurance system which enforces that virtually everyone who works pays into the system on an employer based withholding system. It's just a fact that in every quality health insurance system the young and healthy must carry the sick and old. If the young and healthy can opt out, the system will fail. Among other things, that, and any "public option" would require aggressively curtailing illegal off the books employment at every level. I don't see that there is widespread support for this in this country. Obamacare will slowly peter out and that's will be it, folks. No need for a big republican unwind here.
11
When Aetna decides to spend $44,000,000 as compensation for the top 5 executives, United Healthcare hands over $205,000,000 to one CEO for his annual wage, it must be challenging to figure out how to continue to pay for the care of sick insureds. 'Covered Lives' in the business. Used to be able to get away with dropping the sick from a plan. Declining to pay for 'pre-existing conditions' only vaguely related to current illness. There's still the option to drop any physicians caring for costly patients from the network. But, all in all, it's tough to run a Cadillac compensation plan for the small group enrolled in the private insurance executives club, hand out 20% - 30% of premiums to brokers, make a decent return for investors, and ......... what was that last brief? Oh yeah..... pay the people who actually provide care to the people who pay premiums. It's a tough one.
299
As long as Republicans control one house of Congress, none of these "adjustments" to the ACA will occur unless maybe they pertain to rectifying the mispricing of ObamaCare policies wrt risk. Health insurance companies would favor such a "right sizing" of risk ratios endemic to the ACA law. This in turn could induce some companies to give the ObamaCare exchanges another chance. This might also induce younger and healthier persons to sign up for policies because the premiums are not so biased against them.
2
Young people think they are going to live forever until they become old people.
2
American medical care is in trouble for two reasons. First, our medical people charge about twice what their peers in other countries charge. Second, well over half of our medical procedures are either useless or harmful to the patient. Other countries refuse to pay for these things, an approach called Evidence Based Medicine. My 25 years as a statistician in health care confirms these points.
The only organization with the strength to force medical people to accept a huge pay cut is the Federal government. This means that single payer is necessary. Obamacare, like Romneycare its predecessor, is a barely disguised payoff to the insurance companies for contributions (bribes).
To see the story of Obama rejecting Evidence Based Medicine read Wall St Journal reporter Ron Suskind's book Confidence Men. To see what we should do watch Comedy Party Platform on YouTube (2 min 9 sec). Thanks. [email protected]
The only organization with the strength to force medical people to accept a huge pay cut is the Federal government. This means that single payer is necessary. Obamacare, like Romneycare its predecessor, is a barely disguised payoff to the insurance companies for contributions (bribes).
To see the story of Obama rejecting Evidence Based Medicine read Wall St Journal reporter Ron Suskind's book Confidence Men. To see what we should do watch Comedy Party Platform on YouTube (2 min 9 sec). Thanks. [email protected]
58
Vermont, home of Socialist Sanders, just rejected "single-payer" as financially bankrupting.
Thinking "single-payer" could be approved nationwide would be like thinking Nancy Pelosi knows something about balancing budgets. Absurd, on its face.
Thinking "single-payer" could be approved nationwide would be like thinking Nancy Pelosi knows something about balancing budgets. Absurd, on its face.
The underlying premise of Obamacare was flawed. It was health insurance reform, which required cooperation of for profit insurers, as opposed to health care reform, which is what our system is need of. Which leads to the inevitable question: why must the government guarantee that insurance companies profit? The question isn't who's going to pay, but should be: why is it so expensive?
142
It is 'so expensive' because American doctors,and health care staff and hospitals are paid far more than anywhere else in the world for comparable services, and, American pharmaceutical companies charge far more there than anywhere else in the world for comparable drugs. None of this was properly considered by the Obamacare act.
7
This seems as good a time as any to ask the question - why is it we're happy with the job President Obama has done? I think we're happy with it because we agree with him, or he with us. He seems to hold the same views we have. But he's not our philosopher or spokesman, the job of an Executive is to Execute. With the Affordable Care Act, as well as the number of guns in the country, the condition of the Middle East, environmental policy, our national debt (a synonym for our children's hopes - remember hope?), the strength of our allies, racial harmony or any other area of concern, regardless of his intentions, regardless of how we admire his comportment and his family, exactly what has he successfully DONE? Certainly not provide us affordable health care. I like him. He's dignified, and that matters. By any other measure he's failed.
3
@Max - You've got that right. Orthopedic surgeon in Germany - 90,000 Euros. Orthopedic surgeon in US - $410,000.
4
This article wholly fails to address the major cause of the problem. The law was based upon the assumption that with a mandate, younger and healthier people would buy into the pool and offset the cost of insuring older, sicker patients. (The "death spiral"). This has not happened, at least to the degree necessary to have a stable market.
Two steps that would help to address this death spiral would be: (1) increase the penalty for those who decline insurance, to a figure approaching or equalling the cost of insurance, or (2) strictly enforcing the mandate by attaching wages or assets of those who opt out.
But this would be a massively unpopular on a political basis, so it will never happen. Many of those who criticized the law did so on this basis, as this is a matter of simple math, but were criticized as wanting to have people die in the streets, etc.
Two steps that would help to address this death spiral would be: (1) increase the penalty for those who decline insurance, to a figure approaching or equalling the cost of insurance, or (2) strictly enforcing the mandate by attaching wages or assets of those who opt out.
But this would be a massively unpopular on a political basis, so it will never happen. Many of those who criticized the law did so on this basis, as this is a matter of simple math, but were criticized as wanting to have people die in the streets, etc.
20
With only a half dozen major insurers left this is becoming an oligopolistic market that won't control costs in a normal market-based way. That is why the Federal government should lift Medicare age caps in areas only served by 1 or 2 insurers, to preserve that competition.
14
Obama promised universal health care coverage and didn't deliver it with Obamacare. That is the real problem, not the nuances of the law. If we addressed that problem, the others would largely disappear.
8
Obamacare never promised universal coverage. Where did you ever get this notion from? Rush? FOX?
2
Obama promised it during the 2008 primary campaign, according to the New York Times.
1
Just to be specific. in 2008, Obama claimed his plan provided universal coverage. Hillary accused Obama of leaving 15 million people uninsured. As the article notes, there are now 27 million Americans who don't have insurance.
1
Two modifications to Obamacare would do a lot to hold down premium costs and to ensure participation of insurers so adequate choice prevails.
First, make all young adults (ages 18-34) eligible for a subsidized Bronze plan on the exchanges that costs them no more than $75 per month. Second, apply the maximum penalty allowed under Obamacare (the greater of the full premium for a Bronze plan or $2,087) to young adults who do no enroll in an exchange.
Insurers are allowed to sell qualified health plans both on the exchanges and directly via their sales forces and websites. So, they can withdraw from exchanges and continue to sell Obama-like plans directly. The two changes about would make their direct offerings uncompetitive, because most of the younger, healthier, less expensive enrollees would buy through the exchanges. If insurers wanted to sell individual policies, they would be forced to offer them via the exchanges and they could set premiums lower because there would be many more young people enrolled.
First, make all young adults (ages 18-34) eligible for a subsidized Bronze plan on the exchanges that costs them no more than $75 per month. Second, apply the maximum penalty allowed under Obamacare (the greater of the full premium for a Bronze plan or $2,087) to young adults who do no enroll in an exchange.
Insurers are allowed to sell qualified health plans both on the exchanges and directly via their sales forces and websites. So, they can withdraw from exchanges and continue to sell Obama-like plans directly. The two changes about would make their direct offerings uncompetitive, because most of the younger, healthier, less expensive enrollees would buy through the exchanges. If insurers wanted to sell individual policies, they would be forced to offer them via the exchanges and they could set premiums lower because there would be many more young people enrolled.
5
The subsidized bronze plan for all young adults is a good idea. It seems to me that if 25 million people or so are still uninsured, there is plenty of room for improvement on how to connect the people who need affordable, good-quality insurance with insurance plans that are affordable and actually cover healthcare needs.
3
Would any of those 25 million uninsured be illegal immigrants? I can't see the country agreeing to paying upfront for them, even as we pay more through emergency room care.
2
A lot of the problem is that the plans themselves are not affordable. Right before Obama Care, I had a policy that ran $120 a month, with a $3500 deductible. That was affordable. Post Obama Care, that grew to $420+ a month, $5500 deductible. That is not affordable for me. I don't qualify for a subsidy. Luckily, I got a new job with employer paid care. But the math- I would have gone from 10% of my income to healthcare to 21% of my income going to healthcare. At a time when everything else is getting more expenses and wages are stagnant.
10
An insurance market will never work if I can go out and buy insurance because I know I need an operation, keep the insurance for six months and then turn it off. Until this is fixed there is no way insurance companies can make money. It is economics 101, plain and simple.
68
Health care should not be a for profit business. Open a taco bell for that
5
I don't know where you're getting your info from, but it just doesn't work that way. You have to have a "qualifying event" to sign up outside the ordinary enrollment periods (at the start of the year), at which point you commit to a full year of coverage. After that, if you drop your insurance, you're subject to a penalty. Also, I'm not aware of any surgical procedure that doesn't involve a significant degree of pre- and post- follow-up w/ a doctor -- that's no one-time event.
Part of the problem is that the penalties are (relative to the cost of insurance) incredibly small. The other problem is that the high-deductible policies offered actually provide very little in the way of insurance, meaning that almost all costs are actually incurred out of pocket (absent some catastrophic event). No one has much incentive to get insurance that provides very little in the way of real coverage.
Part of the problem is that the penalties are (relative to the cost of insurance) incredibly small. The other problem is that the high-deductible policies offered actually provide very little in the way of insurance, meaning that almost all costs are actually incurred out of pocket (absent some catastrophic event). No one has much incentive to get insurance that provides very little in the way of real coverage.
8
The only hope is across the board government price regulation, similar to Medicare parts A and B, for all medical services provided to individuals and families regardless of how/where they buy their policies. Further, Medicare D must be revised immediately, as the government's inability to by prescription medications in bulk from pharmaceutical companies is unfairly putting patients' fiscal and physical lives in harms way.
The healthcare industry has shown us time and time again that they put profit above human life. They cannot be trusted to self govern. Insurers, healthcare providers, medical device and pharmaceutical companies must be carefully regulated as is the case in almost every other civilized nation in world. The black sludge that is "medical price transparency" is strangling our citizens, and cannot and should not be tolerated.
Last but certainly not least, our politicians have to stop accepting bribes from big pharma and medical device companies. Their lobbyists spend billions annually to "persuade" our politicians. Wolves in the hen house are costing Americans their lives.
The healthcare industry has shown us time and time again that they put profit above human life. They cannot be trusted to self govern. Insurers, healthcare providers, medical device and pharmaceutical companies must be carefully regulated as is the case in almost every other civilized nation in world. The black sludge that is "medical price transparency" is strangling our citizens, and cannot and should not be tolerated.
Last but certainly not least, our politicians have to stop accepting bribes from big pharma and medical device companies. Their lobbyists spend billions annually to "persuade" our politicians. Wolves in the hen house are costing Americans their lives.
234
Can we agree to call 'health care providers' physicians and not pretend that their remuneration for the care they provide is not already regulated and limited by insurance plans, employers, government employees? Physician payment accounts for 8% of health care dollar payments.
3
I often see this type of comment on articles about healthcare costs and while pharmaceutical companies and costs are easy targets, and with companies like Mylan extorting patients in need, simply because they can, they make convenient boogey men for consumers. But the ugly truth is that the price controls and regulation will ultimately have to expand to doctors, nurses, and other healthcare workers, as well as the hospitals where they work. The fee for service model, which only promotes wasteful and excessive testing and procedures has to be replaced with models that reward outcomes rather than the number of procedures or visits.
The real *policies* incorporated into the ACA were merely a band-aid, and that band-aid is starting to come undone.
The real *policies* incorporated into the ACA were merely a band-aid, and that band-aid is starting to come undone.
3
No industry can self regulate. Not one.
5