ACA at risk?

[SecondCor521]

I think you'll agree there's more to a functional market than that. Consumers have to be able to make a rational estimate of the quality and availability of the services from the various sellers (very hard right now with health care.). They need information to even choose which services to buy (easy if it is "replace my knee joint," harder if it is "eliminate my cancer "). Competition based on best value is also always hampered if time is limited.
I do think that increasing transparency on available options, their cost, and better info on expected outcomes would help lower the cost of health care if patients also were price sensitive. But for a market and pricing signals to work well, they all have to be present.
The issue of how these costs are to be paid is also inter-related.
I'd guess even people with a lot of money would be disinclined to spend it on extreme one-in-a-million end-of-life treatments if it means they'll be spending money that their spouse and kids need. But if unknown others are paying, they'd likely be willing to turn on the money tap and roll the dice If the docs and medical providers make more as a result, I can see some perverse incentives regarding information flow.

I was arguing for the minimal conditions that I thought were necessary to generate competitive downward pressure on price in a market, not what the necessary conditions were for a functional market. I was also mostly disagreeing with the argument of the previous poster that because life is very valuable (which I agree it is) that doctors don't compete on price (which they don't, but I don't think it is for that reason). Supercars and large mansions are extremely expensive (even more than an average Joe's life according to the highway design folks), and yet there is a functioning market for those items.

Time limitations (that are sometimes there and sometimes aren't, to varying degrees) and the fact that health care is complex do indeed make it harder to shop around.

I think your "inter-related" sentence is key. IMO, there are things (government policies, insurance+job interrelations, and maybe some things in the prescription drug part of the market) that interfere with those price signals and the customer's interest in seeking the information.

My understanding is we do spend a lot on end-of-life care in the US. Partly because we don't like to give up - Americans are a generally optimistic lot - but also because usually someone else is paying. If a kidney transplant to save Great Aunt Edna is $100K and government or insurance is paying, then go ahead. If the four grandkids have to write $25K checks, maybe we think she lived a long good life but it's time to let nature and old age take its course.

I like your ideas about transparency and more information.

 

[ziggy29]

And........

The price of hamburgers would not be a secret! [emoji23] [emoji23] [emoji23]

And would be the same for everyone, not 10x more expensive for people without "burger insurance".

 

[joeea]

For a country that claims to put so much value on human life, what is the excuse for having 28m people or so without any healthcare insurance, let alone affordable?

Politics.

Not much of an excuse, I know. More like an explanation.

 

[NW-Bound]

I read a study that shows for cancer patients, the survival rate is higher in the US than in other Western countries.

The result did not surprise me, considering how much money we spend on cancer treatment.

But among people with coverage, do they want to give up their unlimited benefits to divert some care to the people without coverage?

Do terminal patients want to give up one month of lingering on with the most expensive drugs, in order for another person to have 10 more years?

 

[Cut-Throat]

Well, I don't think the system we have is quite as free market as I described. If it were more like buying hamburgers, we would not have:

1. A significant issue with hamburger malpractice.
2. Tax deductible cheese.
3. Any connection between Burger King and your job.
4. Having to go to the McDonalds network.
5. Monthly hamburger premiums and copays and coinsurance and deductibles.
6. Hamburgercare and Hamburgeraid.
7. People working at Wendy's who take care of the back office billing and insurance claims.
8. etc.

(Yes, hamburgers are simpler and cheaper than medical care. I know.)

Well, on these points we agree... But if you are saying that a Health Care for Profit Model will work well...... We will agree to disagree.

 

[SecondCor521]

Well, on these points we agree... But if you are saying that a Health Care for Profit Model will work well...... We will agree to disagree.

I think it would and I've tried to articulate why. But I also readily concede that we won't see it in the US in my lifetime, and the momentum is towards more socialized medicine. I think that approach has some advantages but also is problematic for a number of reasons which won't become apparent until after we adopt it.

I think reasonable people can disagree and still be friends.

 

[24601NoMore]

I think the FIRST thing we need to do is top trying to undo the existing ACA JUST because someone we did not like created it.

From my own perspective, undoing the ACA has ZERO to do with undoing it just because someone we did not like created it. (Agreed, BTW but that's not the issue).

It has EVERYTHING to do with the fact that HC (unless you are subsidized) has jumped to $15-20K in premiums plus $7K PER PERSON deductibles (ie: useless, unless you have a life threatening illness or injury).

Pre-ACA, we did not have $7K PP deductibles (in most cases) and premiums were far more reasonable.

THAT is the issue. I don't care one whit who created it, and if a (R) created it, I'd feel precisely the same way. Because, who has $20K - 30K/year to spend on HC as a pretty much mandatory expense? That's insane. My MORTGAGE was not $20-30K / year!! Go try to absorb THAT in your ER budget..

 

[24601NoMore]

But I also readily concede that we won't see it in the US in my lifetime, and the momentum is towards more socialized medicine.

Socialized medicine scares the bajeebus out of me. Do you seriously want the life or death of your very loved ones to be subject to some bureaucrat's decision? Because that's precisely what socialized medicine is.

If you doubt that, take a look at what's happened in the UK. Very long wait times to see a provider. Frequently denied treatments.."he/she is too old..let's give them 'comfort' in the end of their life..(via some hard drugs).."

God help us if that ever comes to the US.

 

[SecondCor521]

Socialized medicine scares the bajeebus out of me. Do you seriously want the life or death of your very loved ones to be subject to some bureaucrat's decision? Because that's precisely what socialized medicine is.

If you doubt that, take a look at what's happened in the UK. Very long wait times to see a provider. Frequently denied treatments.."he/she is too old"..

God help us if that ever comes to the US.

I would hope it would be clear by my posts on this thread that I don't, but I'm guessing your question was more rhetorical than directed at me.

But as you note, we'll have much longer delays and bureaucratic health decisions, as well as lower quality care on average, and probably fewer medical advances over time. But we'll be able to blame the government at least, so we'll have that going for us.

I'm not sure why you think it isn't coming here. It is. My dad - now a retired physician - saw it coming 30 years ago. I've been watching it come over my lifetime. I don't see much that can stop it at this point.

 

[ShokWaveRider]

Socialized medicine scares the bajeebus out of me.

Call it what it is "Universal Healthcare" and you will love it!

 

[gwraigty]

Yep. If the entire ACA is thrown out, even those happy with their employer plans may find a return to lifetime benefit caps, and no more insuring children to age 26 -- only until 18 unless they are full time students, which was the pre-ACA norm.

I don't know how many people who think the loss of the ACA is no big deal to them because they have employer insurance has stopped to think about these things. Even if you don't have a Marketplace policy, a lot of these changes could ripple back into employer plans.

+1

 

[24601NoMore]

I would hope it would be clear by my posts on this thread that I don't, but I'm guessing your question was more rhetorical than directed at me.

Right..purely rhetorical, and not directly in response to a particular post / poster.

 

[Cut-Throat]

Call it what it is "Universal Healthcare" and you will love it!

Or call it Medicare, and no one wants to give that up!

 

[SecondCor521]

I also wanted to say thank you to everyone on this thread for the civil conversation. So many of these kinds of threads get closed, but this one has survived and I appreciate it.

 

[CardsFan]

I also wanted to say thank you to everyone on this thread for the civil conversation. So many of these kinds of threads get closed, but this one has survived and I appreciate it.

+1

This a thread I expected to meet an early doom (Porky), but most posters have kept it civil and interesting.

With a company subsidized retiree insurance plan, I don't have a dog in this fight, but I still find it interesting.

 

[travelover]

.........With a company subsidized retiree insurance plan, I don't have a dog in this fight, but I still find it interesting.

I'm not so sure . If the ACA goes down and we revert to the previous laws, my understanding is that all health insurance policies will be affected in terms of lifetime caps, mandatory covered services and how long kids can stay on plan, as a few examples.

 

[Cut-Throat]

THAT is the issue. I don't care one whit who created it, and if a (R) created it, I'd feel precisely the same way. Because, who has $20K - 30K/year to spend on HC as a pretty much mandatory expense? That's insane. My MORTGAGE was not $20-30K / year!! Go try to absorb THAT in your ER budget..

Health Care Costs were skyrocketing well before the ACA.... The ACA did not create the high costs, it was put into place BECAUSE of the High Costs.... Which created the huge numbers of people that were uninsured.


The ACA could not stop the escalating costs, but were not the cause of them...

 

[ivinsfan]

+1

This a thread I expected to meet an early doom (Porky), but most posters have kept it civil and interesting.

With a company subsidized retiree insurance plan, I don't have a dog in this fight, but I still find it interesting.

Well technically since everyone needs Healthcare everyone has a dog in the fight. If all the interests.. consumers, insurance companies, government, health providers, could adopt this attitude something good might happen. I won't be holding my breath over that one...

 

[BeachOrCity]

Doctors and nurses don’t need financial incentives to do a good job but rather are motivated by aims of patient care and job.

Ummm not really. Maybe some doctors but not all and not even close.

One of the biggest obstacles to reform and lowering costs is specialists and their various ancillary businesses and the huge billings and profits they earn

 

[Brat]

If the ACA is killed LOTS of folks will learn what they lost, not just those using ACA policies.

 

[jimandthom]

If the ACA is killed LOTS of folks will learn what they lost, not just those using ACA policies.

Co-worker and her hubs absolutely resented ACA when it first came out, along with many other governmental policies.

She had a daughter who tried to be born at least 4 months early. Mom spent rest of her term in the hospital, little girl spent an additional 3-4 months after mom was discharged.

Multiple surgeries, frequent infections/hospitalizations, Cerebal Palsy, couldn't hold her head up until past age 2, couldn't crawl until 3, leg braces, special Ed and rehab programs in home and after/during school, you name it she has received the care.

Mom and dad don't object any longer to ACA, paying prop. taxes that support various developmental education/rehab activites. Now readily admits that ACA saved this little ones life and prevented them from bankruptcy.

 

[24601NoMore]

Health Care Costs were skyrocketing well before the ACA....

Agreed up to that point, but the ACA absolutely increased premium and deductible costs (massively, and there are nearly endless examples of people's HC premiums doubling, tripling (or more) to the point they can't begin to afford the premiums, let alone the big deductibles). That's partly because the insurance companies now need to cover everybody, have no limits on coverage, plans now need to be consistent in coverage regardless of a person's need (ie: my plan covers pregnancy for a mid 50 yo man), etc.

I'm not saying those things are necessarily wrong (except perhaps the equal coverage for things people don't need), but absolutely were a big part of the (massive) premium and deductible increases when the ACA got created..

From my perspective, I'd much rather the .gov continue to provide subsidies for those who truly cannot afford HC, and let those of us who wish to purchase policies on the open market - even across state lines - do so. And those policies should not IMHO be forced to "have" certain things (pregnancy coverage for a mid 50 yo male or a 60+ yo female, for instance) in them, but let the people CHOOSE their policy coverage.

I'd expect that a large part of the reason we can't get something like that passed is the .gov wants too much control over people, and there's nothing as controlling as HC. But it's as American as apple pie to let people choose to buy what they want to buy, politics aside.

 

[CardsFan]

I'm not so sure . If the ACA goes down and we revert to the previous laws, my understanding is that all health insurance policies will be affected in terms of lifetime caps, mandatory covered services and how long kids can stay on plan, as a few examples.

Well technically since everyone needs Healthcare everyone has a dog in the fight. If all the interests.. consumers, insurance companies, government, health providers, could adopt this attitude something good might happen. I won't be holding my breath over that one...

Fair points, we all are affected in some way.

 

[joeea]

Or call it Medicare, and no one wants to give that up!

Oh Medicare is terrible!

Who seriously wants the life or death of your very loved ones to be subject to some bureaucrat's decision? And all those very long wait times to see a provider. Frequently denied treatments.."he/she is too old..let's give them 'comfort' in the end of their life..(via some hard drugs).."?

Simply awful.

 

[Beststash]

Oh Medicare is terrible!

Who seriously wants the life or death of your very loved ones to be subject to some bureaucrat's decision? And all those very long wait times to see a provider. Frequently denied treatments.."he/she is too old..let's give them 'comfort' in the end of their life..(via some hard drugs).."?

Simply awful.

I assume sarcasm or maybe your not on Medicare yet?