Affordable Health Care Discussion.

[Cerb]

Righto, I'm going to try and be a good OP and not start by presenting my views on the affordable health care act.

I want an open and frank discussion on whether people are just looking at the situation as they want to see it. I think almost everyone accepts the necessity of health care in the United States changing.

I'd like to see both fact and opinion on this topic, but I want everyone to be prepared (myself included) for opinions to receive a broadside of facts. I then would like people to really consider the facts as best they can.

One factor that I will freely admit to is that this is a politicized discussion. It shouldn't be of course but it is. People need to consider that when they respond (myself included).

Some elements to consider / questions.
How easy has it ben for people to participate?
Are the costs lower for people on average?
Have citizens just given up trying to get involved in the program?
Has the plan and its implementation impacted your job or health care?
Would you rather pay the fine for the first year than be enrolled?
Thoughts on healthcare.gov?

Have a go at it. I'll try and keep my rants limited to stuff I can use as an external source rather than just my own opinion, which I recognize I rely on too much.

[Alterrum]

Ok, this is coming from an European uneducated about the daily lives of Americans. Apologies for any grave mistakes or if I offend someone.

www.nytimes.com/2013/10/28/opinion/krugman-the-big-kludge.html?ref=paulkrugman

I kind of agree with him, that the Afoordable Care Act is currently a clumsy half-solution. It would be simpler to make the move towards a single-payer system (which costs less per capita), but in the current state of politics in the US that would be hard to achieve. 

As much as I know, the Affordable Care Act has increased costs for upper-middle class and wealthy Americans, while lowering it for the poorer Americans (correct me about this if I'm wrong). Considering the high level of economic inequality, I don't think this effect is a bad thing, although more of the costs could have landed on the very rich. The complexity of enrolling and problems with websites is just something that needs to be fixed and results from a lack of prior experience dealing with this.

I'm not following US happenings in that much detail, so could someone here also describe the Republicans' alternative to tackling the healthcare problem? 

Also waiting to see people's answers to Cerb's questions. 

[The Republike]

I am an American who agrees with much of the conservative, right-wing argument. From my perspective I think the Affordable Health Care Act is a terrible idea. I don't like Government control in my day to day life, so I think as much business  as we can in this country should be privatized. When the whole of an industry is private, it allows the population decide what the changes within the industry need to be. Without this, the government can alter the industry to what they see fit and do long-term damage to society and the economy. Also, when we look at the changes this act is going to make from a logical viewpoint, it is going to make getting health care more expensive for a majority of Americans. Insurance companies are just that, companies, so they are out not only to help people, but to more importantly make money doing it. Knowing this, when the government steps in and tells them they can't deny people with preexisting conditions access health care, and furthermore can't charge them a great deal more, prices will go up for everyone. Why will prices go up? Because if a person in their mid fifties who has been smoking a pack a day for thirty years and drinking three bottles of beer every night since before they were legally able to and a person in their mid twenties who runs marathons and triathlons go in to an insurance agency and apply for health insurance, the company pre-affordable health care would charge the latter a great deal less than the former. Now, as affordable health care goes into affect, the companies are forced to give similar rates to both stereotypical sets of people, for the same coverage, even though the healthier person will most definitely not need nearly as much back from the insurance company as the older drunk. The company will have to make up the loss some how, so it will not just lower the higher price by small increments, it will probably also inflate the lower prices.    

[Mal]

Before I answer this, I want everyone to know that I voted for President Obama three times. The '08 primary and both elections (he's really been in office that long?).

Anyway, I also thought the ACA was deeply flawed. I DO believe that in a country that has accomplished so much in its realtively short history, we should have some type of basic health care available to all of our citizens. And the term citizens means natural born or naturalized. As I understand it, except in emergency cases, unless you're a citizen of countries where there is national health insurance (England, Canada), you cannot get health care unless you pay out of pocket. If I'm wrong on this, my apologies.

To answer Cerb's questions:

How easy has it ben for people to participate?

From what I've been able to ascertain, it has been rather difficult, because of the flaws in healthcare.gov and other technical issues.

Are the costs lower for people on average?

I think it's too early to answer that since the Act has only been implemented for about a month.

Have citizens just given up trying to get involved in the program?

Again, I'd need to see some polling data, but I do understand that reports on the web site's flaws are deterring people from trying.

Has the plan and its implementation impacted your job or health care?

I'm a Federal employee so it hasn't had any effect. My premiums have gone up every year since I first started out as a Postal employee in '94. And they're going up on schedule in January. And since we haven't had a raise since 2010, this is basically a pay cut.

Would you rather pay the fine for the first year than be enrolled?

I can't really answer that. See my response to the previous question.

Thoughts on healthcare.gov?

See my previous responses. I think I already answered it.

[Ardreas]

It's a nice idea, wanting all the people to have health care. But making it reality in a way that doesn't create a great deal of pain for most people is not something this administration has succeeded at.

I work full time at a company that has always provided healthcare and dental to its employees. It's been great so far, but now my company is dropping health care coverage for everyone. Why? Because the requirement for companies that employ more than 15 full-time workers to provide health coverage is gone. Now that the marketplace is supposed to be there for people to get individual healthcare, the company figures it can save money by not offering coverage for us anymore. And really, I can't blame them. It makes sense from a profit perspective. But damn if it isn't a big pain I have to deal with now. I've always had healthcare through my employer, and now it's expiring the end of the year. I have to go on the exchange to find a new plan. But joy of joys, the exchange site isn't working. And unless they get it up and running smoothly by next month, I may very well be out of healthcare completely when my current coverage drops.

Thanks Obama.

[Echolilia]

To me, the single biggest step forward (bundled with a few others, quite a few steps back, and a lot of side-shuffling) in the Affordable Care Act is that it lays the groundwork for individual states to set up a single payer system.

[progutopia]

Health care should be delivered through a publicly funded health care system, which should be free at the point of use with most services provided by private entities. The government should assure the quality of care through federal standards. The government should not participate in day-to-day care or collect any information about an individual's health, which should remain confidential between a person and their physician. It can be cost-effective because of the administrative simplicity. Each doctor can handle the insurance claim against the government insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private insurance should be a minimal part of the overall health care system.

Competitive practices such as advertising would kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs could be paid through funding from income taxes. There should be no deductibles on basic health care and co-pays can be extremely low or non-existent. A health card could be issued by the Department of Health to each individual who enrolls for the program and everyone would receive the same level of care. There would be no need for a variety of plans because virtually all essential basic care would be covered, including maternity and infertility problems. Cosmetic surgery and elective surgery would not considered essential care and would not be covered. These could be paid out-of-pocket or through private insurers. Health coverage would not affected by loss or change of jobs, as long as premiums are up to date, and there would be no lifetime limits or exclusions for pre-existing conditions.

Medications would covered by public funds for the elderly or indigent, or through employment-based private insurance. Drug prices would be negotiated with suppliers by the federal government to control costs. Family physicians would be chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral could be made by a general practitioner.

[Deleted]

in a modern, democratic and advanced country, healtcare (even basic healtcare) should be free, or otherwise with a japan-system like, with a little percentage of the healtcare payed by the patient. I think it will be right if this percentage rise in proportion of the patient's economical situation.

[Electrum]

I think that the Affordable Care Act, although good, won't really solve America's problems in fixing the huge amount of spending they do every year. Health care should be unconditionally available for those who need it, as it is in the best interest of nations to do so (i.e. a citizen becomes non productive to productive again). If you really wanted to save as much money as possible, you would need to institute some kind of levy, i.e. from Australia - a flat 1.5% tax on income. That way the government can bargain for the nation, making the system more efficient and preventing wastage of money whilst simultaneously having universal coverage. The thing is however, is that private insurance does not have to go. Instead they can act as an alternative to the public sector, you pay extra money for other treatments (eg. alternative healthcare) or to cut the line for elective surgery. This kind of thing shouldn't be politicized at all, the ACA is merely a half-solution aimed at appeasing as many people as possible (although it's not) - you should really go the full way.

In terms of implementation, it was also done poorly. From what I've read, healthcare.gov has been crashing and there have been technical difficulties getting a system up.

TL;DR: Universal health care is cheaper in the long term. That is all.

[Greek People Nation (GPN)]

Get the idea for it. Trusting the government to run healthcare when they can't even balance a budget, I do not. All the ACA is doing is taking money from some people to pay for the others. I went on the website to get a quote, they wanted to charge me almost three times as much as I am getting through my employer. It is a flawed system. They pushed it out to fast with out testing it or nothing. The reason why America HAD one of the best healthcare systems is that the government wasn't trying to run. UK, Canada... How is it working for you guys.

[Cerb]

Forgot I even posted this. I've heard from a few friends that opted in that they weren't able to keep up their premium payments. I'm wondering if that is a big problem that will come on top of the heels of the reassessment of premiums and costs later this year.

I never did find out just how many people actually signed up. And by signed up I mean bought insurance.

[The Candy Lane]

Jun 29, 2014 11:49:14 GMT -5 Greek People Nation (GPN) said:

Get the idea for it. Trusting the government to run healthcare when they can't even balance a budget, I do not. All the ACA is doing is taking money from some people to pay for the others. I went on the website to get a quote, they wanted to charge me almost three times as much as I am getting through my employer. It is a flawed system. They pushed it out to fast with out testing it or nothing. The reason why America HAD one of the best healthcare systems is that the government wasn't trying to run. UK, Canada... How is it working for you guys.

Honestly, the US system scares me. And it scares me that -some- Americans think that they had/have one of the best healthcare systems (or insert other system here) in the world. The American health care system was extremely flawed, and unjust in principle. Health care should not be a business. The implementation of the new system has been a mess, and the politicians responsible should be booted out of office. That doesn't mean America should go back to their old system. There are better systems out there. A Harvard study in 2009 found that US citizens were dying at a rate of 45,000 each year(1/12 minutes) because they did not have insurance. ie. these were preventable deaths.
news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/

When people say that the old system was better, we should ask, "Better for whom?" Surely it wasn't better for the 50 Million Americans (under age 65) ineligible for decent coverage, due to pre-existing and "pre-existing" conditions.

If you want to understand the canadian health care system and how it is different than the US system, I encourage you to read this >http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States and watch these >https://www.youtube.com/watch?v=iYOf6hXGx6M >https://www.youtube.com/watch?v=9WdqtPLRc1A

To summarize the links, the US spends about twice as much on healthcare (per capita) as Canada, despite insuring a lower percentage of the population and paying for a lower quality healthcare system overall. I should say, I used to think a two tier system was the way to go with elective surgeries being available through private practice, Australia tried this and apparently their wait times have grown longer than under the one tier system. Canada has private clinics where you can get MRI's and some minor surgeries, I think this is a good, though not perfect system.

[Cerb]

I'm sure part of that comes back to big pharma who use the US sales to offset their R&D costs.

[tiranistan]

As someone who's living in a country that has always provided a state-funded healthcare for its citizens, it's really hard for me to understand or even imagine life without universal access to basic medical services free of charge (or at a very low cost). Therefore, while I certainly do not know the fine details of ACA, I can't quite grasp why there would be such a broad opposition to a system which aims to make healthcare more affordable and puts at least some pressure on the medical-industrial complex? Does it have anything to do with that irrational American fear of "socialism"?

[Greek People Nation (GPN)]

You want a prime example of government healthcare... Look at the VA in the US now.

[Cerb]

Speaking of affordable care. I think they are about to rename it Less Affordable Care.
finance.yahoo.com/news/york-healthcare-premiums-explode-132658547.html

[Ardreas]

This video is about 9 months old, but many of the figures are still accurate. You may find it interesting for the debate:

[Cerb]

Yeah, a pretty fair assessment. Though it did fail to address the really excremental care that happens in the Uk (experienced that personally so I can speak to that).

It is interesting though, what they principally suggesting is that the largest costs come from a failure to negotiate. Thus what we need is a corporate hospital chain like Wal*mart. A corporation that can demand optimal purchasing rights and thus create competition.

I say corporation because they seem to have a tendancy to operate more efficiently than the government.

I'm also not so sure that the hip replacements being sold in the UK as described are super high quality. I suspect they are just barely good enough to pass inspection. That is of course just my unsubstantiated opinion.

I'm walking around with $75K of hardware in my chest and I'm willing to bet it would be cheaper elsewhere in the world. My only question is would it be as good, or would it be merely "okay".

[Witchcraft and Sorcery]

Hate on the healthcare bill all you want, at least it's doing something. The alternative to this is having your pockets emptied by companies who look for every way to deny you coverage before grudgingly giving you as little as humanly possible. Healthcare in this country is broken and even though the ACA isn't going to fix it, it's a step in the right direction. People die because of private insurance companies. With a government they at least need to be a accountable. If a company doesn't want to be accountable or to help people all they have to do is either deny coverage or in some cases *ahem* make up some bogus reason to take the issue to court...

[The Candy Lane]

I think having a privatized healthcare system has driven up the price of care in the States, they pay substantially more than in Canada for comparative procedures. On another note, which is more likely to try trim corners in terms of regulations/quality of care: Corporations, or Government. Both do it, but I think the US has shown that Corporations will swap morality for the Almighty Dollar.

[Cerb]

While broad generalizations are not ideal, I wouldn't exactly describe the US Government as either moral or fiscally efficient.

As for the
ACA moving in the right directions, health costs have risen since its implementation, which anyone could forsee. Mandating participation without regulating ppricing at the hospital side of things was always going to be a train wreck.

I think, and again this is a highly personal opinion, that the ACA has done exactly what it was intended to do. Make a bad system worse. It will make the pill of complete government takeover much easier to swallow.

Whichever way it ends up going, the people who will probably suffer the most are the lower end of middle class and those who just scrape through above the poverty line.

[Ardreas]

Right, which is a lot of what John was talking about in the video. We're already at a disadvantage in negotiating for our health care because you can't put a price on your own life. And now the government has mandated that everyone has to play on this already uneven playing field, thereby taking away our last ability to find better care elsewhere, and giving hospitals and insurance companies extra leverage to use against us. Now they can jack the prices up even more and we just have to suck it up and pay more because what else can we do? We need health care, and now they can beat us over the heads with that need and the government will help them by forcing us to pay.

If anything, the health care reform ought to force hospitals to charge less in the first place. Rather than forcing the overburdened tax payers to pay even more money for ever more expensive insurance, the government should have simply placed a cap on how much hospitals can charge for things, based on how much they cost in other developed nations (+10% leeway for our awesome wealthiness). That would evaporate our health care problems overnight.

[Deleted]

To me it made no sense to alter the health care arrangements of 100% of the American people in order to address the needs of the 15%. I had great health insurance, as well as a flexible spending account; my flex account was *halved* as a direct result of the ACA....so overall, the ACA has hurt me.

The simplest solution - which the politicians refuse to do because it would upset the big insurance companies - is to repeal IRS Regulation 501(m), which *prohibits* non-profit health insurance organizations; set one up in each state; and then let those who choose to enroll, enroll.

There is nothing adequate, American, or efficient about being forced to purchase private insurance under the dictate and punishment of government.

[Free State of New Market]

It's impossible for me to justify anything in ACA. THe fact regulations and rules keep getting added, after it has passed and has been signed into law. The fact 36 provisions of ACA are not being enforced by the branch of government mandated to enforce laws that are passed is grounds for impeachment.

I've been out of work for a year. I'm still paying COBRA (which you can do for 18 months) because ACA costs me twice as much, with 3 times larger deductables.

Yeah, this doesn't work. This was a mistake from the get go, only implemented due to a political agenda instead of actually developing something that was sane that would help those 15% who needed something.