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GOP gets its way on ACA, will help the Dems in the end

Maybe, yet care demand will go up as care provider supply remains the same or goes down. This is what causes the often cited care delay in nations (some with popualtions below that of some US states) with "free" medical care. We were told that ER (the costliest care environment possible) use would go down after PPACA was enacted on the theory that folks would receive more 'preventive' care - that did not happen.

It should be obvious to all that the often touted 'cost savings' are simply going to be achieved by paying the same care providers less for performing the same type of care. Why do you suppose that no US state offers UHC for its resisdents?

a state couldn't handle the costs, as it would have little ability to negotiate them down.

as for healthcare in general, it is an essential service with inelastic demand in which geographical immediacy is a critical factor. i'd like to see a larger public sector role.
 
a state couldn't handle the costs, as it would have little ability to negotiate them down.

as for healthcare in general, it is an essential service with inelastic demand in which geographical immediacy is a critical factor. i'd like to see a larger public sector role.

Nonsense - states have no problem negotiating any other government contract prices down - they can simply say take it or leave it by establishing a maximum bid price. The problem is primarily that freeloaders would flock in as "the rich" would move out (vote with their feet) when 'asked' to foot the bill. We have yet to see how these UHC systems would be paid for - that 'detail' is important in evaluating any such proposal.
 
It's typical skullduggery from the would-be moralists on the right. Lose in the legislature, lose in SCOTUS (twice), so they sneak in a change then base a third bite at the judicial appeal on that change.
 
Maybe, yet care demand will go up as care provider supply remains the same or goes down. This is what causes the often cited care delay in nations (some with popualtions below that of some US states) with "free" medical care. We were told that ER (the costliest care environment possible) use would go down after PPACA was enacted on the theory that folks would receive more 'preventive' care - that did not happen.

It should be obvious to all that the often touted 'cost savings' are simply going to be achieved by paying the same care providers less for performing the same type of care. Why do you suppose that no US state offers UHC for its resisdents?

Yes, the lines at the doctor's office are shorter when a portion of your population just can't afford to go to the doctor. The solution to healthcare wait times is more doctors, not fewer patients.
 
Yes, the lines at the doctor's office are shorter when a portion of your population just can't afford to go to the doctor. The solution to healthcare wait times is more doctors, not fewer patients.

The way to get more doctors is not to pay each of them less.
 
a state couldn't handle the costs, as it would have little ability to negotiate them down.

as for healthcare in general, it is an essential service with inelastic demand in which geographical immediacy is a critical factor. i'd like to see a larger public sector role.

I find the entire issue of healthcare economics contradictory, inexplicable, shallow, short-sighted, and strongly prone to making individual institutions and persons either heroes or villains, usually the latter. Honestly, I don't have an answer, at least not one that will satisfy the voter AND the consumer, the same people who hold contradictory positions.

However, a few observations:

The ACA-Obamacare was supposed to solve this, and in its supporters theory should have. Medicare (100 percent government paid medical care) was nearly doubled in the overwhelming majority of the population. Subsidies far above the poverty line were given up to 400 percent of the poverty level - essentially to median income. Family costs were supposed to drop 2500.00 per year. Exchanges were supposed to provide affordable as well as well as comprehensive plans for all - partially paid by increased taxes and charges to employers who did not provide a plan.

So let's be honest, WHO could be left out if this worked as intended (other than the minority that live in states that didn't cover the free increase in Medicaid)?

Yet there is an outbreak of a raging fever for Medicare, likely stemming from a collective feeling that things in at least some respects are lot worse, not better. In 2012 (or so) 85% of people were happy with their insurance. Since then UNSUBSIDIZED premiums and deductibles have become absurdly expensive, provider access pools have shrunk and has been sharply limited, out-of-state coverage ended, many companies no longer offering plans, etc.

In other words, it would seem that the cost of providing more insurance opportunity for the lowest quartile has been at a cost (financial or in consumer choice) to a large portion of the unsubsidized consumer - and they are not happy.

So now that we are experiencing major unintended consequences from the most latest idealistic government bromide we should do it again cause we are guessing that it will work this time?

Hey, what could go wrong?
 
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I find the entire issue of healthcare economics contradictory, inexplicable, shallow, short-sighted, and strongly prone to making individual institutions and persons either heroes or villains, usually the latter. Honestly, I don't have an answer, at least not one that will satisfy the voter AND the consumer, the same people who hold contradictory positions.

However, a few observations:

First, ACA-Obamacare was supposed to solve this, and in its supporters theory should have. Medicare (100 percent government paid medical care) was nearly doubled in the overwhelming majority of the population. Subsidies far above the poverty line were given up to 400 percent of the poverty level - essentially to median income. Family costs were supposed to drop 2500.00 per year. Exchanges were supposed to provide affordable as well as well as comprehensive plans for all - partially paid by increased taxes and charges to employers who did not provide a plan.

So let's be honest. WHO could be left out (other than the minority that live in states that didn't cover the free increase in Medicaid)?

Second, the outbreak of a raging fever for Medicare for all is likely a from a pervasive feeling that things in at least some respects are lot worse, not better. In 2012 (or so) 85% of people were happy with their insurance. Since then UNSUBSIDIZED premiums and deductibles have become absurdly expensive, provider access has been sharply limited, out-of-state coverage ended, many companies no longer offering plans, etc.

In other words, it would seem that the cost of providing more insurance opportunity for the lowest quartile has been at a cost (financial or in consumer choice) to a large portion of the unsubsidized consumer.

Last, so now that we are experiencing major unintended consequences from the most recent idealistic government program we should do it again we are guessing this will work, this time?

Hey, what could go wrong?

This idea that everything was fine in 2008 is... comical. 85% were happy with their plan? How many of those people were just... healthy? Your insurance company seems great if you just send them a check every month and never hear from them. But the problems start when someone gets sick.

Your amnesia here is similar to gas prices. People used to love posting "GAS WAS LIKE 2 BUCKS WHEN OBAMA TOOK OVER NOW LOOK ITS FOUR DOLLARS!" Just up and forgetting the 2007 gas price peak. You're now somehow forgetting that health care was the topic in the 2008 election. Why? Because the industry was falling apart. Premiums were going up double digits every year. My employer at the time dropped their plan entirely because they couldn't afford it anymore, tossing me into the horrifying individual market at its worst time in American history.

You know what could go wrong if we did nothing? Everything that was already going wrong, and more. It staggers me that even in 2018 people think "just let the free market handle it" is a solution to healthcare problems. Healthcare isn't a free market.
 
The government is not the reason medical school is the way it is.

Of course, government is rarely said to be related to the problem but is frequently said to be (or have) the solution.
 
This idea that everything was fine in 2008 is... comical. 85% were happy with their plan? How many of those people were just... healthy? Your insurance company seems great if you just send them a check every month and never hear from them. But the problems start when someone gets sick.

... You're now somehow forgetting that health care was the topic in the 2008 election. Why? Because the industry was falling apart. Premiums were going up double digits every year. My employer at the time dropped their plan entirely because they couldn't afford it anymore, tossing me into the horrifying individual market at its worst time in American history.

You know what could go wrong if we did nothing? Everything that was already going wrong, and more. It staggers me that even in 2018 people think "just let the free market handle it" is a solution to healthcare problems. Healthcare isn't a free market.

First, no one said everything was fine, in 2008 or any other year. However, I was saying that health insurance had a surprising large degree of consumer satisfaction when people were polled on their own plan, regardless of what those consumer-voters perceptions were of health-care social problems. If 85 percent are happy but think the most other guys/gals are suffering, his/her misperception is rooted in political memes, not their consumer experience.

Second, the health care issue of 2008 (and of every other election year) is not forgotten, its ignored. The point was that regardless of pre-existing problems in health care costs and services, the reforms intended to fix them have had unintended consequences that have fueled greater unhappiness - the subsidized or 100 percent free consumer are likely more happy, the people that missed out are likely less happy and it reflects the fever for UHI.

Last, other than providing medical insurance to 7% of the US population everything that was going wrong did so. And arguably, it is worse than it would have been for the many of the other 93 percent who did not get Obamacare subsidy benefits.

PS - I don't know if the free market would solve the problem - it hasn't been tried since 1940...which is also the last time than the rate of inflation for medical care was no higher than the CPI.
 
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It will be struck down on appeal and the SCOTUS will likely refuse to take the case, since they've already ruled on an identical one already.

Even if it did go to the SCOTUS, Roberts will probably side with the law as before.

This is just an activist judge making a show.

The Roberts factor is highly interesting. The fact that it's the "Roberts" court makes it even more so.

Personally, I hope like hell it gets slapped down upstream and the SCOTUS turns the case down.
 
First, no one said everything was fine, in 2008 or any other year. However, I was saying that health insurance had a surprising large degree of consumer satisfaction when people were polled on their own plan, regardless of what those consumer-voters perceptions were of health-care social problems. If 85 percent are happy but think the most other guys/gals are suffering, his/her misperception is rooted in political memes, not their consumer experience.

Second, the health care issue of 2008 (and of every other election year) is not forgotten, its ignored. The point was that regardless of pre-existing problems in health care costs and services, the reforms intended to fix them have had unintended consequences that have fueled greater unhappiness - the subsidized or 100 percent free consumer are likely more happy, the people that missed out are likely less happy and it reflects the fever for UHI.

Last, other than providing medical insurance to 7% of the US population everything that was going wrong did so. And arguably, it is worse than it would have been for the many of the other 93 percent who did not get Obamacare subsidy benefits.

PS - I don't know if the free market would solve the problem - it hasn't been tried since 1940...which is also the last time than the rate of inflation for medical care was no higher than the CPI.

There was a series of actions by the government after 1940 that pretty much made this mess inevitable. At this point, way too many Americans make their living being part of this government policy rooted problem.

I think the ACA should stay until those problems are fixed.
 
There was a series of actions by the government after 1940 that pretty much made this mess inevitable. At this point, way too many Americans make their living being part of this government policy rooted problem.

I think the ACA should stay until those problems are fixed.

ACA will be staying. Apparently the mandate, once thought to be indispensable, wasn't necessary. However ACA is getting funded, it seems to be enough to keep it going (enrollment being much less than expected most likely means there is more "per enrollee" tax money to spread around).

From purely a self-interest perspective, I wish it had never passed.
 
ACA will be staying. Apparently the mandate, once thought to be indispensable, wasn't necessary. However ACA is getting funded, it seems to be enough to keep it going (enrollment being much less than expected most likely means there is more "per enrollee" tax money to spread around).

From purely a self-interest perspective, I wish it had never passed.

I could have made that statement when it passed. Now I have an injury (injuries, actually) that put me in the "uninsurable" and "barely employable" buckets, so I have a different perspective.

Our problem is that medical costs in this country are simply too high. The reason, I think, is most people don't pay attention to the amount of money their insurance pays for medical care, and those costs are only 25-30% of "list price" that you would see w/o insurance.
 
Of course, government is rarely said to be related to the problem but is frequently said to be (or have) the solution.

I mean, you could show me which government regulation makes med school cost what it does.
 
Nonsense - states have no problem negotiating any other government contract prices down - they can simply say take it or leave it by establishing a maximum bid price. The problem is primarily that freeloaders would flock in as "the rich" would move out (vote with their feet) when 'asked' to foot the bill. We have yet to see how these UHC systems would be paid for - that 'detail' is important in evaluating any such proposal.

a single state would have little weight as a payer in a national system. the solution has to be federal.
 
I find the entire issue of healthcare economics contradictory, inexplicable, shallow, short-sighted, and strongly prone to making individual institutions and persons either heroes or villains, usually the latter. Honestly, I don't have an answer, at least not one that will satisfy the voter AND the consumer, the same people who hold contradictory positions.

However, a few observations:

The ACA-Obamacare was supposed to solve this, and in its supporters theory should have. Medicare (100 percent government paid medical care) was nearly doubled in the overwhelming majority of the population. Subsidies far above the poverty line were given up to 400 percent of the poverty level - essentially to median income. Family costs were supposed to drop 2500.00 per year. Exchanges were supposed to provide affordable as well as well as comprehensive plans for all - partially paid by increased taxes and charges to employers who did not provide a plan.

So let's be honest, WHO could be left out if this worked as intended (other than the minority that live in states that didn't cover the free increase in Medicaid)?

Yet there is an outbreak of a raging fever for Medicare, likely stemming from a collective feeling that things in at least some respects are lot worse, not better. In 2012 (or so) 85% of people were happy with their insurance. Since then UNSUBSIDIZED premiums and deductibles have become absurdly expensive, provider access pools have shrunk and has been sharply limited, out-of-state coverage ended, many companies no longer offering plans, etc.

In other words, it would seem that the cost of providing more insurance opportunity for the lowest quartile has been at a cost (financial or in consumer choice) to a large portion of the unsubsidized consumer - and they are not happy.

So now that we are experiencing major unintended consequences from the most latest idealistic government bromide we should do it again cause we are guessing that it will work this time?

Hey, what could go wrong?

the ACA was a half measure at best. they didn't set the goalposts well because they assumed that the opposition had any interest in compromising.
 
I could have made that statement when it passed. Now I have an injury (injuries, actually) that put me in the "uninsurable" and "barely employable" buckets, so I have a different perspective.

Our problem is that medical costs in this country are simply too high. The reason, I think, is most people don't pay attention to the amount of money their insurance pays for medical care, and those costs are only 25-30% of "list price" that you would see w/o insurance.

I feel that way because I never went without insurance, and had insurance before those pre-existing conditions might have affected me. Since ACA, my clinic is now an assembly line and doctors are telling me that the new mantra is cost containment - meaning, those lab tests that doctors routinely gave me at my request are not longer an option. To say nothing of the long lines and waits for prescription (nothing less than 1 hr).

Some it helped, others it did not, yet others it hurt.
 
I feel that way because I never went without insurance, and had insurance before those pre-existing conditions might have affected me. Since ACA, my clinic is now an assembly line and doctors are telling me that the new mantra is cost containment - meaning, those lab tests that doctors routinely gave me at my request are not longer an option. To say nothing of the long lines and waits for prescription (nothing less than 1 hr).

Some it helped, others it did not, yet others it hurt.

That sounds strange. Do you live in a rural area? I use the same doctors I've always used, and the system hasn't really changed except regarding opiates. I have a GP and one specialist that I see. No "clinics" and no waits. I use a pharmacy at the grocery store which is quite convenient and way cheaper than CVS or other "drugstores".

Walmarts have pharmacies...
 
Since ACA, my clinic is now an assembly line and doctors are telling me that the new mantra is cost containment - meaning, those lab tests that doctors routinely gave me at my request are not longer an option.

Just think, there used to be people who said the ACA didn't do anything about cost containment.
 
That sounds strange. Do you live in a rural area? I use the same doctors I've always used, and the system hasn't really changed except regarding opiates. I have a GP and one specialist that I see. No "clinics" and no waits. I use a pharmacy at the grocery store which is quite convenient and way cheaper than CVS or other "drugstores".

Walmarts have pharmacies...

I use the same medical care provider I always used - an HMO in a very urbanized area (east bay of SF area) with in-house doctors, labs, pharmacies, and hospitals. I still think they are the best deal out-there (for those of us who hate keeping track of invoices, deductibles, etc.) but for many years I used their clinic in a residential neighborhood near me. I thought I was in heaven, the doctor, the labs, the pharmacy in one tidy building, quiet, compliant doctors, and instant service. After ACA the lines became much longer, the service slower, and the doctors less willing to provide lab work unless guidelines required it.

When you look at the patients - its obvious why. Lots more immigrants, poor, and minority (although blacks have largely been pushed out of the area). This is not being judgmental, its just a fact that for me I liked the service, the quiet, the more customized pre ACA.
 
I use the same medical care provider I always used - an HMO in a very urbanized area (east bay of SF area) with in-house doctors, labs, pharmacies, and hospitals. I still think they are the best deal out-there (for those of us who hate keeping track of invoices, deductibles, etc.) but for many years I used their clinic in a residential neighborhood near me. I thought I was in heaven, the doctor, the labs, the pharmacy in one tidy building, quiet, compliant doctors, and instant service. After ACA the lines became much longer, the service slower, and the doctors less willing to provide lab work unless guidelines required it.

When you look at the patients - its obvious why. Lots more immigrants, poor, and minority (although blacks have largely been pushed out of the area). This is not being judgmental, its just a fact that for me I liked the service, the quiet, the more customized pre ACA.

Ah, HMO - there's your problem. PPO or EPO = convenience, but it costs more.

HMO's are ok if you never use them. I got into one briefly when they came out during Reagan. I went. I waited. In a sea of old people, all talking about their minor ailments. As soon as I could I got back into a real plan. I need that now that I need a good neurologist.

I got stuck on the ACA when my company folded over earlier this year (can't really work anymore, but I'm retirement age anyways). I really haven't noticed much of a problem beyond there being only 2 of the 4 hospital systems here covered. Before on my PPO I got 3 of them.
 
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a single state would have little weight as a payer in a national system. the solution has to be federal.

In other words, RomneyCare required an infusion of federal cash to 'work'. There is not much difference between ths state of CA and the countries of UK or France in population or GDP and CA is larger (in both respects) than Canada. As I said before, it is really more of an issue of border control (citizenship vs. state residency).
 
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