The future of healthcare in the US?

As in, what about that campaign promise Trump made to "repeal and replace" the ACA....which Republicans loved because they'd tried unsuccessfully to repeal it over 50 times? I'm still waiting for the "replacement" ideas. No, it's not enough to say It'll be totally great, fantastic, people will love it, trust me!" :rolleyes:

It's a given that a single payer NHS is dead in the water, as is a Medicare-for-all type system, and the latest expansions of state Medicaid will likely be undone, too. My guess is congress will undo/void the individual mandate, which will make the whole thing implode. But they'll still use the private insurance model to mean "healthcare", which will mean we'll go back to millions of uninsured people (who use ERs for healthcare), and millions of under-insured who'll have to declare medical bankruptcy (after their first disease or accident). And none of that will help reduce or contain the costs of medical care.

Any predictions or policy preferences you'd like to see moving forward?

Also, in advance of anyone suggesting "Health Savings Accounts" are a good alternative.....I'd like them to explain where they got that idea. And how a HSA can even begin to pay for chronic diseases or catastrophic events that can cost millions of dollars in just a few weeks?

I bought a policy though the federal market place.....because that was the only way to get health insurance as a retired/unemployed person before Medicare eligibility. I didn't qualify for tax credits either, which meant I'd paid the insurance company full price. But they notified me that they'd be exiting the federal MarketPlace (Obamacare) by the end of December.

Think about what that means. Yeah, I was in the group whose premiums would double. But I was among the group that was formerly uninsured. Fortunately, I knew about the "loophole" that said if buying health insurance on the federal marketplace exceeded 8% of net income, it meant an exemption from any tax fine. The problem was finding health insurance outside the federal exchange.....when the ACA made that possible in the first place.

Trying not to underestimate the way a decision will lean to the right one way or another and trying to get to the thinking behind decisions is what I rely on to posit my assumptions about the future. In this case it is pretty clear that the thinking behind the decisions is, do poor people die cheaper under ACA or do poor people die cheaper without insurance? Pretty morbid but a buck's a buck and the less people to spend it on the better. Didn't the right rail against death panels some time ago. Polar reversal coming sometime soon. Or stipends I guess???

Contrary to the idea of "American Exceptionalism", we're not so different from every other nation trying to navigate in the 21st century. :( What makes it even more difficult in the US, when it comes to healthcare, is that we haven't really decided if it's part of "The Commons" as a public good, or part of individual "Life and Liberty".....and what to do in the meantime, while legislators fight about Constitutional interpretations.

Yeah, I remember the Republican "death panels". Those same people talked about trading a chicken for a doctor's visit. :picard:

The idea behind HSAs and deregulation is the concept of the informed patient consumer who will 'shop' for better prices. LASIC was typically not covered under insurance and so providers had to compete for costumers with price and we saw the price go down. Right now price shopping is virtually non-existent and when price shopping is virtually non-existent there is no incentive to come up with more efficient and cost reducing methods.

Poor people can't shop.

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Originally Posted by Being

Poor people can't shop.

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But they do benefit along with everyone else when prices go down.

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Originally Posted by Lewkowski

But they do benefit along with everyone else when prices go down.

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I can tell you there is a group of people for who healthcare is too expensive at any price. And that group is surprisingly big.

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Originally Posted by Lewkowski

The idea behind HSAs and deregulation is the concept of the informed patient consumer who will 'shop' for better prices. LASIC was typically not covered under insurance and so providers had to compete for costumers with price and we saw the price go down. Right now price shopping is virtually non-existent and when price shopping is virtually non-existent there is no incentive to come up with more efficient and cost reducing methods.

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But medical care isn't like any other consumer product or service. It's not like shopping for a big screen TV, comparing prices between Walmart and Amazon, and if you have to pick it up at the store or they have free shipping. Even your LASIK comparison is rather lame, because it's not a medically necessary surgical procedure. :rolleyes:

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Originally Posted by Hazir

I can tell you there is a group of people for who healthcare is too expensive at any price. And that group is surprisingly big.

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Agreed. And that group has only grown over the years....as the full-time work force with employer-subsidized health benefits has shrunk. Politicians used to fight about "entitlement programs" for elders and seniors, SS and Medicare. But now they'll have to address the *entire* medical/pharmaceutical industry that's become unaffordable for most people, even with gov't subsidies for private insurance (Obamacare).

Tangent: anyone watching cable TV knows it's largely funded by the pharmaceutical industry, because almost every commercial ad is about a drug for heartburn, constipation, skin conditions, diabetes, or erectile dysfunction.

I'd like to see the insurance industry explain how their costs are necessary, just as I'd like to see how the the pharmaceutical industry explains the costs of marketing...that could be better spent on R & D.

You might just be watching shows and networks whose demos tend to align with older demographics that consume more drugs than the youngins watching those internet videos.

There's some propaganda floating around, that it's the Federal Government (aka Obamacare and its regulations) that's keeping people from accessing affordable, comprehensive healthcare. In reality, it's the insurance industry that's the fly in the ointment. Obamacare was the first real attempt at regulating the insurance industry.

Trump announced an inter-state competitive model, with Rand Paul as a libertarian supporter. Big fucking deal. What they didn't mention is that states won't be required to accept that insurance from low-cost insurers, leaving people with paid policies that put them in service limbo, or outright medical bankruptcy. The very reasons Obamacare was instituted in the first place.....

IMHO, the for profit health insurance model, especially as implemented in the US, is a bad idea.

I agree. I've said for a long time that health insurance is not health care.

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Originally Posted by EyeKhan

IMHO, the for profit health insurance model, especially as implemented in the US, is a bad idea.

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Market distortions have created a monstrosity that is the worst of both worlds. Almost no one competes on price for medical treatment now and that is the only thing that can realistically bend the cost curve (outside of mandated lower prices by government fiat which would be awful). Tying your health insurance to your employment has proven to be one of the worst ideas of all time.

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Originally Posted by Lewkowski

Market distortions have created a monstrosity that is the worst of both worlds. Almost no one competes on price for medical treatment now and that is the only thing that can realistically bend the cost curve (outside of mandated lower prices by government fiat which would be awful). Tying your health insurance to your employment has proven to be one of the worst ideas of all time.

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I agree that linking health insurance to employment turned out to be a horrible idea. But maybe 'the worst idea of all time' was linking health CARE to health INSURANCE in the first place. Or maybe it was buying into the idea that health/medicine is just like any other industry where freeee market competition forces apply? As if sick or injured people would "shop around" for best prices during a crisis or emergency....like they do when their car breaks down. :picard:

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Originally Posted by EyeKhan

IMHO, the for profit health insurance model, especially as implemented in the US, is a bad idea.

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Is there another kind of insurance? Choobs, do remember coverage and insurance are not the same thing. Insurance is a type of coverage.

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Originally Posted by LittleFuzzy

Is there another kind of insurance? Choobs, do remember coverage and insurance are not the same thing. Insurance is a type of coverage.

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And health insurance isn't health care.....

For all the cries to "Repeal and Replace Obamacare", there are few replacement models. Personally speaking, I applied for, and was granted an exemption to the ACA requirements, because it meant paying more than 10% of my income for health insurance, and I didn't qualify for federal subsidies. (Plus, my state didn't participate in the federal exchanges.) So I have a crappy 80/20 major medical policy that's basically temporary hospital insurance, when most medical care is provided on an out-patient basis. But I pay the premiums on the outside chance that I'll have a catastrophic event requiring in-patient care. I know most hospitals charge different rates for out-of-network policies, so I'm probably screwed. And my deductible is $5,000. But that's what Trump, speaker Ryan, and the Republicans call "choice"

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Originally Posted by GGT

I agree that linking health insurance to employment turned out to be a horrible idea. But maybe 'the worst idea of all time' was linking health CARE to health INSURANCE in the first place. Or maybe it was buying into the idea that health/medicine is just like any other industry where freeee market competition forces apply? As if sick or injured people would "shop around" for best prices during a crisis or emergency....like they do when their car breaks down. :picard:

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Actually a lot of medicine isn't a crisis situation at all.

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Originally Posted by Lewkowski

Actually a lot of medicine isn't a crisis situation at all.

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But is it affordable OOP?

For example, you might not call a child's ear infection a crisis, but it's certainly an urgent medical need. And who can afford to pay for after-hours immediate care without insurance, or a federal subsidy?

And what 'principle' gives you space to imply that one child's ear infection matters more than the next? Their parents' insurance status, their ability to pay cash OOP?

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Originally Posted by GGT

But is it affordable OOP?

For example, you might not call a child's ear infection a crisis, but it's certainly an urgent medical need. And who can afford to pay for after-hours immediate care without insurance, or a federal subsidy?

And what 'principle' gives you space to imply that one child's ear infection matters more than the next? Their parents' insurance status, their ability to pay cash OOP?

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By not competing on price you doom society to keep spending ever escalating amounts of money.

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Originally Posted by Lewkowski

By not competing on price you doom society to keep spending ever escalating amounts of money.

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Who is going to "compete" for people with high-cost medical conditions? The insurance industry? hahaha