I've gone through experience of shopping for a dentist for basic case. I don't bother with dental insurance because I found it didn't cover that much.
So I go through the ratings and friend recommendations and "best dentist" lists to find someone who is (1) reasonably priced, (2) competent, and (3) honest (won't try to sell me services I don't need). It's been hard to identify dentists who are all three. And if you do go to a dentist and he tells you that you need a lot of services, how do you know? Do you trust him or seek a second opinion? It's like shopping for an auto mechanic. Once you've found someone who is reasonable, competent, and trustworthy, you stick with him, but you are likely to have had some bad experiences before you find the right one. It's bad enough paying for mistakes with a car. It's worse when it is your own body and the bills are likely to be higher.
Only the uninsured get hit by these outrages prices. The insured, not so much.
That's a big problem. Even if you want to price shop, you can't because it's hard to find out the actual price. You get a bill from your insurance company and it quotes a price that that isn't the price the insurance company actually pays. And a lot of medical places can't give you a price if you pay cash at that moment because they don't have it.
For medical services that insurance companies don't cover (e.g., cosmetic surgery) there is competitive pricing, but quality can vary greatly among providers. And among those there are providers who don't use anything close to safe procedures and people have died in backroom offices as a result. Unsanitary conditions, contaminated drugs, lack of emergency equipment.
The reason we have as many regulations as we have is that in the past we had a lot of unregulated health care that killed people. Unsafe, unmonitored medicine. Untrained practitioners. Quacks. I'm not defending over-regulation, but generally there is a reason we've ended up with each regulation.
Obama essentially adopted a Republican proposal to save health care.
Individual health care insurance mandate has roots two decades long | Fox News: "The mandate, requiring every American to purchase health insurance, appeared in a 1989 published proposal by Stuart M. Butler of the conservative Heritage Foundation called 'Assuring Affordable Health Care for All Americans,' which included a provision to 'mandate all households to obtain adequate insurance.'"
I would have tackled health care cost first, and then worried about extending coverage to everyone. So rather than the insurance mandate, I would have looked for some smaller scale experiments within states or organizations that have been successful at lowering costs and then would have pushed to expand those.
And those to the left of Obama fault Obamacare for not being a single-payer/universal healthcare system. That would have been my preference. As I said, that's what I grew up with and I like it.
I think it is a given that health care costs are too high and unaffordable for many. I think the government is going to have to use its clout to get lower prices and when that doesn't happen, I think restrictions on what services are covered will likely have to happen (that doesn't mean people with money can't buy more coverage, but the basic coverage will likely be more bare bones). Doctors, hospitals, and drug companies may have to accept that they will be getting less money. And I certainly hope insurance companies get less.
As I said in a previous comment, the healthcare situation is complex and requires changes up and down the system, including how people take care of themselves. As a country I hope we start living healthier lives and need less care.
Re: Re: Re: Re: Re: Re: So many discussions we're not having
What will you do in a post-apocalyptic world?
People would be looking at an entirely different set of priorities. And if we want to talk about that now, there is a whole lot of other stuff to put into the discussion in addition to health care as we know it today. Much of modern life is pretty expendable when we are talking about basic survival. Get rid of the multiple cars, the McMansions, the stock portfolios, the energy intensive tech devices, shipping food across the world, and so on.
If you want to ponder doomsday scenarios, we can always start with climate change.
Let's say someone gets hit by a truck. And has no health insurance.
Should the hospital take him in and treat him? Should the government have a pool of funds to cover that?
If there are no government or charitable funds, should the hospital charge higher rates for everyone else to generate a pool of money to pay the uninsured? Or if it doesn't do that, should the hospital workers work for free to treat everyone who needs emergency health care but can't pay for it?
People aren't talking about stuff like this. Do we let die people who can't pay for health care? And if not, who pays for it? Even if we drive down health care costs, how do we pay for those who can't pay?
This is a societal question. How do we deal with those who have needs but no money and no ability to earn enough to repay the debt? Those questions must factor into health care discussions. We can refuse to treat people without funds, but that will be a reflection upon our collective values. If this is what we choose to do, then we might as well be upfront about it.
Re: Re: Re: Re: So many discussions we're not having
And yet the human race has managed to survive, reproduce, and thrive.
And we can certainly go back to the days of no health insurance and more limited medical care if that is what you are suggesting.
We're all going to die, too, and no one has yet figured out how to stop that. But most people opt for techniques that prolong their lives and give them improved quality of life. But for the survival of the human race, I suppose that isn't necessary. Have your kids, live long enough to raise them, and then you can die having accomplished one of your main purposes in life.
Re: Re: Re: It's what you get when capitalists control a market...
I'm from England, but lived in the US for 5+ years. I have experienced of healthcare on both sides of the Atlantic, and found the quality of hospital care to be similar in both countries. The major difference was the cost.
Canadians have also said that given a choice between their system and the US, they will stick with theirs.
And I have an American friend who lived in New Zealand for seven years and even though she is now back in the US, she still flies to New Zealand for medical checkups/treatment because it's covered there for her, and not here. (And her ex-husband was a US doctor.)
I grew up in a US military family and our health care was covered. It was great. That was one less worry. And I liked the fact that you didn't get unnecessary treatment. I avoided treatments that were in vogue when I was a kid that now have been proven to have been harmful. I got what I needed, but nothing more, which is how I prefer my health care.
Hospitals cost shift because of non payers, which drives costs higher for payers.
Yes, that is a big issue that needs to be discussed. Rates were going up for those with money in order to subsidize those without. But then, as insurance rates go up, more people and employers drop out, which reduces the pool even more, thus driving the rates up even more.
The way health care has been working pre-Obamacare was going to go under anyway.
Re: Re: So WHO do you finger as the criminal, Mike?
I do my own treatments from putting in the needles, to monitoring the equipment, to washing everything down after I'm done. I am charged $580 per treatment for this privilege.
I'm curious. Do you pay for this out of your own pocket or is someone else (e.g., government, insurance) covering it?
Address this: Heaviest users usually least able to pay
How would all of you structure a system to accommodate the small group of heavy health care users who often have no money to pay for that health care?
Driving down the price for them helps, but they still don't have any money and probably aren't earning any if they are very ill, disabled, very young, very old, etc.
How should society address the healthcare needs of those who have the highest needs and the fewest resources? It's not a group a for-profit company is likely to serve unless someone is picking up the tab. There's no money to be made to provide services for free.
In many places a local hospital has a genuine monopoly on providing many forms of health care, as there are no other facilities capable of doing the same for hundreds of miles around.
Actually, in many areas there are more hospitals than are needed. Same goes with equipment like scanners. Lots of hospitals get them and then prescribe unnecessary tests in order to pay for the equipment. One problem is that consumers aren't able to tell when they need tests or have been sold on the idea that they need them.
Now I suppose if hospitals will only treat people who can pay, that would discourage unnecessary treatment of the poor, and that is one way for the market to work. But then we have to face up to the idea that health care varies according to income and savings.
Study: Too many Michigan hospital beds driving up consumer costs | Michigan Radio: "I found that the availability of beds themselves actually caused utilization to rise," Delamater says. "If a new hospital is built, there's pressure to get people into those beds regardless of the medical-based need for putting them in that hospital bed."
Re: Re: It's what you get when capitalists control a market...
In a free capitalistic market many of these issues would not exist. Obviously there would be draw backs to a system based purely on the capitalistic system, but considering where the system is at today I would think a shift to less regulation is what is needed.
Can you cite a medical system anywhere in the world that operates on a purely capitalistic system where everyone in that society gets affordable health care?
I'm open to anything that brings down the cost of medical care, but I don't think the system you describe exists. There are societies where there is no government health care and no regulation, but treatment is not available to everyone, either.
I'm not sure you can have a truly unregulated health care system where there is no drug testing and no training requirements for health care professionals and expect people to be cared for safely.
Here's one example. What about blood testing for HIV and hepatitis C? Let's say you've had an accident and need a transfusion. How do you know that the blood you have been given is safe? Sure, you can sue if you have been given unsafe blood, but by then you have the disease.
There was a time before insurance and all this "healthcare" stuff. Gee, how did mankind ever survive?
Actually a lot of them didn't. Women died in childbirth. People died from infectious diseases. Families had lots of kids because a good percentage of those kids didn't survive into adulthood.
The diseases that kill people in the US now (e.g., cancer, heart disease) are diseases that people get if they live long enough. We've eliminated lots of stuff, but now we are dealing with diseases/illnesses that kill people when they are older.
Ponder this situation. A mother has trouble getting pregnant. Then takes fertility drugs and gives birth to quadruplets. Some of them have are born with health issues. There are significant expenses when they are born and continuing expenses over a lifetime.
Now, insurance companies and the government could refuse to pay for the fertility treatments, so that only wealthy parents can afford those. (Or, even more dicey, these entities might refuse to pay the costs if the parents and doctor decide to let all four babies go to term rather than only allowing one or two babies to go to term.)
But who pays for the childbirth and lifetime health care issues for the children? Can society refuse to pay? Is that fair to the kids?
We've got people not wanting to deny care, but not wanting to pick up the bill either. Some people think charities and non-profits will step in, but will they? And if they won't, are we okay not paying for people who can't afford it? Or will we just pretend that we don't see health care issues for those who can't get it?
Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are.
According to this, only 44.5% of adults 18+ get employer based insurance. 25.6% are on a government-based plan. 16.9% are uninsured. And 11.1% use something else (e.g., buy their own).
Here's just one reference to death spirals. I can find many more, but this should be sufficient. It's how for-profit health insurance works when it can.
1. Under ObamaCare pre-existing conditions are gone. So you can throw that one out the window.
That's been one of the big selling points for it. But I am talking about how for-profit health insurance has been done up until this point.
2. Low rates jacked up after a year are a myth. Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are. Now this method of insuring through work is a nasty mess in and of itself. Everyone should self insure just like car insurance. The current group system allows big companies like Walmart to get a great deal while Joe the CPA and his 2 man office get the shaft. But the problem you are implying just doesn't exist.
Actually it did exist. I saw it in action and then researched it and that's where I read about "death spirals." I have been buying my own health insurance for 20 years. I was using a plan that did exactly what I described. It was low and then increased 25% after one year. I could absorb that once, but got worried about that being the annual norm. I switched insurance companies and then was quoted an even lower price from the first one that jacked up the rates.
I decided I had better find a company I was happy with in case I got sick and was stuck with it, so I switched to Blue Cross. It too has gone up every year over the past 20 years, so I know health insurance was increasing considerably pre-Obama care.
Part of the problem with our health care system is tying it to employers. That ties people into jobs for health insurance reasons. Plus as more people freelance, it doesn't work anyway.
3. What you kind of slide around but don't really touch is that 80% of health care dollars are spent on end of life care. (I'm using that term loosely here.) It's been shown that there are better outcomes with hospice care at end of life at much less cost when compared with hospital care. But discussing this always brings on the screams of "death panels". Given that in my 20s I don't really need insurance why should I pay for it? In my 80s however I'm going to cost far more than my premiums will cover. This is the one thing ObamaCare will help with.
That is part of the issue and end of life care should be discussed. However, you're right, the Republicans started screaming "death panels" and killed the discussion.
4. One thing I always note is that my dog doesn't have health care insurance and he gets better care than I do at a price that doesn't bankrupt me. That includes one very sick dog with cancer that was stabilized for almost a year and that I had to put down a little over a year ago. If the vet can manage it why can't the doctor? The only two reasons I can think of are greed. Greed on the part of the medical community and greed on the part of the malpractice system.
The dog owners I know have been paying outrageous prices for vet care. $200 for a visit. Thousands for bone repairs or cancer treatments. It's not cheap at all around here.
I'll add that for-profit insurance companies don't want to cover people who are sick or will be sick. The free market system encourages insurance companies to avoid covering people it thinks it will lose money on.
What we've had in the past is what is called a death spiral. You provide everyone with low rates to get them to sign up for your health insurance rates. Then after a year you significantly jack up the rates and everyone bitches. The healthy people leave and the same company approaches them again with low rates. The sick people are stuck with the expensive insurance or no insurance because now that they have pre-existing conditions, no one else wants to cover them.
That's the problem with our system: no profitable way to provide care for sick people, especially those without money. It is a societal question that hasn't been fully addressed in the US. When publicly funded health systems try to develop priorities which don't pay for expensive treatments which will not prolong life, people scream death panels. But private insurance companies do it all the time. They deny services, they don't sign up sick people, and so on.
Another problem is that as private health insurance gets more expensive (and it was doing this long before Obamacare), fewer people can afford it. So fewer people pay into insurance pools and it gets that much more expensive. Our country was heading for an unsustainable health care system without Obamacare anyway.
Now, we could go back to a system where everything is paid on a cash basis or credit, which is what we did before health insurance. But most people would not be able to afford most of the modern medical procedures, like cancer treatment, organ transplants, dialysis, etc. While costs would come down if there was no health insurance or government systems, they probably would not come down sufficiently to become affordable for people living paycheck to paycheck. And people probably wouldn't be putting money aside for the day when they needed to cover unexpected health expenses.
Health insurance, by its nature, isn't going to work. Insurance works when lots of people pay into it and very few actually use it. For example, many people pay homeowners insurance, but very have disasters where they need to collect.
But most people want to use health services at some point. They think they should be able to pay into the system low rates, but then have access to health care as they need it. If it works the way insurance should work, lots of people will pay in order to fund the health needs for a very few. One way to do that is to have high deductibles so that for routine treatment everyone pays out of pocket and then insurance only covers the big expenses. But you still need lots of people paying into the system to generate the money to pay out for the few. That has been the principle of requiring people to have insurance. To create that pool of money to draw upon.
That still doesn't get around the idea that the poor don't have enough money to pay those basic out-of-pocket fees. So you either don't treat them or you find ways to cover them using government funds, charity, or some other system based on a sliding scale.
What health care needs to address are several issues:
1. Bringing down the overall cost of services.
2. Getting people to skip health care services they don't really need (unless they want to pay for it themselves).
3. Getting people to pool funds (e.g., insurance, co-ops, government-supported services) so that there is money in the system to cover the expenses that are beyond most people's ability to cover themselves (e.g., cancer, organ transplants, accidents).
4. Improved lifestyles to make us healthier (e.g., should the system have to pay for the poor health of smokers?, of those who refuse to wear motorcycle helmets?).
5. Better environmental protections (so we aren't exposed to chemical/physical hazards which make us sicker).
6. Safer food systems (e.g., removing antibiotics from agriculture so that we aren't creating superbugs).
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: why are the prices absolutely insane.
Could you be more specific? Most people will not see $18,000 increases in their tax bills.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re:
So I go through the ratings and friend recommendations and "best dentist" lists to find someone who is (1) reasonably priced, (2) competent, and (3) honest (won't try to sell me services I don't need). It's been hard to identify dentists who are all three. And if you do go to a dentist and he tells you that you need a lot of services, how do you know? Do you trust him or seek a second opinion? It's like shopping for an auto mechanic. Once you've found someone who is reasonable, competent, and trustworthy, you stick with him, but you are likely to have had some bad experiences before you find the right one. It's bad enough paying for mistakes with a car. It's worse when it is your own body and the bills are likely to be higher.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re:
That's a big problem. Even if you want to price shop, you can't because it's hard to find out the actual price. You get a bill from your insurance company and it quotes a price that that isn't the price the insurance company actually pays. And a lot of medical places can't give you a price if you pay cash at that moment because they don't have it.
For medical services that insurance companies don't cover (e.g., cosmetic surgery) there is competitive pricing, but quality can vary greatly among providers. And among those there are providers who don't use anything close to safe procedures and people have died in backroom offices as a result. Unsanitary conditions, contaminated drugs, lack of emergency equipment.
The reason we have as many regulations as we have is that in the past we had a lot of unregulated health care that killed people. Unsafe, unmonitored medicine. Untrained practitioners. Quacks. I'm not defending over-regulation, but generally there is a reason we've ended up with each regulation.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: Re: Re: ObamaCare
Individual health care insurance mandate has roots two decades long | Fox News: "The mandate, requiring every American to purchase health insurance, appeared in a 1989 published proposal by Stuart M. Butler of the conservative Heritage Foundation called 'Assuring Affordable Health Care for All Americans,' which included a provision to 'mandate all households to obtain adequate insurance.'"
I would have tackled health care cost first, and then worried about extending coverage to everyone. So rather than the insurance mandate, I would have looked for some smaller scale experiments within states or organizations that have been successful at lowering costs and then would have pushed to expand those.
And those to the left of Obama fault Obamacare for not being a single-payer/universal healthcare system. That would have been my preference. As I said, that's what I grew up with and I like it.
I think it is a given that health care costs are too high and unaffordable for many. I think the government is going to have to use its clout to get lower prices and when that doesn't happen, I think restrictions on what services are covered will likely have to happen (that doesn't mean people with money can't buy more coverage, but the basic coverage will likely be more bare bones). Doctors, hospitals, and drug companies may have to accept that they will be getting less money. And I certainly hope insurance companies get less.
As I said in a previous comment, the healthcare situation is complex and requires changes up and down the system, including how people take care of themselves. As a country I hope we start living healthier lives and need less care.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: Re: Re: Re: So many discussions we're not having
People would be looking at an entirely different set of priorities. And if we want to talk about that now, there is a whole lot of other stuff to put into the discussion in addition to health care as we know it today. Much of modern life is pretty expendable when we are talking about basic survival. Get rid of the multiple cars, the McMansions, the stock portfolios, the energy intensive tech devices, shipping food across the world, and so on.
If you want to ponder doomsday scenarios, we can always start with climate change.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Another scenario
Should the hospital take him in and treat him? Should the government have a pool of funds to cover that?
If there are no government or charitable funds, should the hospital charge higher rates for everyone else to generate a pool of money to pay the uninsured? Or if it doesn't do that, should the hospital workers work for free to treat everyone who needs emergency health care but can't pay for it?
People aren't talking about stuff like this. Do we let die people who can't pay for health care? And if not, who pays for it? Even if we drive down health care costs, how do we pay for those who can't pay?
This is a societal question. How do we deal with those who have needs but no money and no ability to earn enough to repay the debt? Those questions must factor into health care discussions. We can refuse to treat people without funds, but that will be a reflection upon our collective values. If this is what we choose to do, then we might as well be upfront about it.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: Re: So many discussions we're not having
And we can certainly go back to the days of no health insurance and more limited medical care if that is what you are suggesting.
We're all going to die, too, and no one has yet figured out how to stop that. But most people opt for techniques that prolong their lives and give them improved quality of life. But for the survival of the human race, I suppose that isn't necessary. Have your kids, live long enough to raise them, and then you can die having accomplished one of your main purposes in life.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: It's what you get when capitalists control a market...
Canadians have also said that given a choice between their system and the US, they will stick with theirs.
And I have an American friend who lived in New Zealand for seven years and even though she is now back in the US, she still flies to New Zealand for medical checkups/treatment because it's covered there for her, and not here. (And her ex-husband was a US doctor.)
I grew up in a US military family and our health care was covered. It was great. That was one less worry. And I liked the fact that you didn't get unnecessary treatment. I avoided treatments that were in vogue when I was a kid that now have been proven to have been harmful. I got what I needed, but nothing more, which is how I prefer my health care.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: ObamaCare
Yes, that is a big issue that needs to be discussed. Rates were going up for those with money in order to subsidize those without. But then, as insurance rates go up, more people and employers drop out, which reduces the pool even more, thus driving the rates up even more.
The way health care has been working pre-Obamacare was going to go under anyway.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: So WHO do you finger as the criminal, Mike?
I'm curious. Do you pay for this out of your own pocket or is someone else (e.g., government, insurance) covering it?
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Address this: Heaviest users usually least able to pay
Driving down the price for them helps, but they still don't have any money and probably aren't earning any if they are very ill, disabled, very young, very old, etc.
How should society address the healthcare needs of those who have the highest needs and the fewest resources? It's not a group a for-profit company is likely to serve unless someone is picking up the tab. There's no money to be made to provide services for free.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Not a free market? No, Duh!
Actually, in many areas there are more hospitals than are needed. Same goes with equipment like scanners. Lots of hospitals get them and then prescribe unnecessary tests in order to pay for the equipment. One problem is that consumers aren't able to tell when they need tests or have been sold on the idea that they need them.
Now I suppose if hospitals will only treat people who can pay, that would discourage unnecessary treatment of the poor, and that is one way for the market to work. But then we have to face up to the idea that health care varies according to income and savings.
Study: Too many Michigan hospital beds driving up consumer costs | Michigan Radio: "I found that the availability of beds themselves actually caused utilization to rise," Delamater says. "If a new hospital is built, there's pressure to get people into those beds regardless of the medical-based need for putting them in that hospital bed."
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: It's what you get when capitalists control a market...
Can you cite a medical system anywhere in the world that operates on a purely capitalistic system where everyone in that society gets affordable health care?
I'm open to anything that brings down the cost of medical care, but I don't think the system you describe exists. There are societies where there is no government health care and no regulation, but treatment is not available to everyone, either.
I'm not sure you can have a truly unregulated health care system where there is no drug testing and no training requirements for health care professionals and expect people to be cared for safely.
Here's one example. What about blood testing for HIV and hepatitis C? Let's say you've had an accident and need a transfusion. How do you know that the blood you have been given is safe? Sure, you can sue if you have been given unsafe blood, but by then you have the disease.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: So many discussions we're not having
Actually a lot of them didn't. Women died in childbirth. People died from infectious diseases. Families had lots of kids because a good percentage of those kids didn't survive into adulthood.
The diseases that kill people in the US now (e.g., cancer, heart disease) are diseases that people get if they live long enough. We've eliminated lots of stuff, but now we are dealing with diseases/illnesses that kill people when they are older.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
So many discussions we're not having
Now, insurance companies and the government could refuse to pay for the fertility treatments, so that only wealthy parents can afford those. (Or, even more dicey, these entities might refuse to pay the costs if the parents and doctor decide to let all four babies go to term rather than only allowing one or two babies to go to term.)
But who pays for the childbirth and lifetime health care issues for the children? Can society refuse to pay? Is that fair to the kids?
We've got people not wanting to deny care, but not wanting to pick up the bill either. Some people think charities and non-profits will step in, but will they? And if they won't, are we okay not paying for people who can't afford it? Or will we just pretend that we don't see health care issues for those who can't get it?
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: It's a complex problem
This came out today.
Fewer Americans Getting Health Insurance From Employer
According to this, only 44.5% of adults 18+ get employer based insurance. 25.6% are on a government-based plan. 16.9% are uninsured. And 11.1% use something else (e.g., buy their own).
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: Re: It's a complex problem
Death spiral (insurance) - Wikipedia, the free encyclopedia
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: Re: Re: It's a complex problem
That's been one of the big selling points for it. But I am talking about how for-profit health insurance has been done up until this point.
2. Low rates jacked up after a year are a myth. Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are. Now this method of insuring through work is a nasty mess in and of itself. Everyone should self insure just like car insurance. The current group system allows big companies like Walmart to get a great deal while Joe the CPA and his 2 man office get the shaft. But the problem you are implying just doesn't exist.
Actually it did exist. I saw it in action and then researched it and that's where I read about "death spirals." I have been buying my own health insurance for 20 years. I was using a plan that did exactly what I described. It was low and then increased 25% after one year. I could absorb that once, but got worried about that being the annual norm. I switched insurance companies and then was quoted an even lower price from the first one that jacked up the rates.
I decided I had better find a company I was happy with in case I got sick and was stuck with it, so I switched to Blue Cross. It too has gone up every year over the past 20 years, so I know health insurance was increasing considerably pre-Obama care.
Part of the problem with our health care system is tying it to employers. That ties people into jobs for health insurance reasons. Plus as more people freelance, it doesn't work anyway.
3. What you kind of slide around but don't really touch is that 80% of health care dollars are spent on end of life care. (I'm using that term loosely here.) It's been shown that there are better outcomes with hospice care at end of life at much less cost when compared with hospital care. But discussing this always brings on the screams of "death panels". Given that in my 20s I don't really need insurance why should I pay for it? In my 80s however I'm going to cost far more than my premiums will cover. This is the one thing ObamaCare will help with.
That is part of the issue and end of life care should be discussed. However, you're right, the Republicans started screaming "death panels" and killed the discussion.
4. One thing I always note is that my dog doesn't have health care insurance and he gets better care than I do at a price that doesn't bankrupt me. That includes one very sick dog with cancer that was stabilized for almost a year and that I had to put down a little over a year ago. If the vet can manage it why can't the doctor? The only two reasons I can think of are greed. Greed on the part of the medical community and greed on the part of the malpractice system.
The dog owners I know have been paying outrageous prices for vet care. $200 for a visit. Thousands for bone repairs or cancer treatments. It's not cheap at all around here.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
Re: It's a complex problem
What we've had in the past is what is called a death spiral. You provide everyone with low rates to get them to sign up for your health insurance rates. Then after a year you significantly jack up the rates and everyone bitches. The healthy people leave and the same company approaches them again with low rates. The sick people are stuck with the expensive insurance or no insurance because now that they have pre-existing conditions, no one else wants to cover them.
That's the problem with our system: no profitable way to provide care for sick people, especially those without money. It is a societal question that hasn't been fully addressed in the US. When publicly funded health systems try to develop priorities which don't pay for expensive treatments which will not prolong life, people scream death panels. But private insurance companies do it all the time. They deny services, they don't sign up sick people, and so on.
Another problem is that as private health insurance gets more expensive (and it was doing this long before Obamacare), fewer people can afford it. So fewer people pay into insurance pools and it gets that much more expensive. Our country was heading for an unsustainable health care system without Obamacare anyway.
Now, we could go back to a system where everything is paid on a cash basis or credit, which is what we did before health insurance. But most people would not be able to afford most of the modern medical procedures, like cancer treatment, organ transplants, dialysis, etc. While costs would come down if there was no health insurance or government systems, they probably would not come down sufficiently to become affordable for people living paycheck to paycheck. And people probably wouldn't be putting money aside for the day when they needed to cover unexpected health expenses.
On the post: Healthcare Isn't A Free Market, It's A Giant Economic Scam
It's a complex problem
But most people want to use health services at some point. They think they should be able to pay into the system low rates, but then have access to health care as they need it. If it works the way insurance should work, lots of people will pay in order to fund the health needs for a very few. One way to do that is to have high deductibles so that for routine treatment everyone pays out of pocket and then insurance only covers the big expenses. But you still need lots of people paying into the system to generate the money to pay out for the few. That has been the principle of requiring people to have insurance. To create that pool of money to draw upon.
That still doesn't get around the idea that the poor don't have enough money to pay those basic out-of-pocket fees. So you either don't treat them or you find ways to cover them using government funds, charity, or some other system based on a sliding scale.
What health care needs to address are several issues:
1. Bringing down the overall cost of services.
2. Getting people to skip health care services they don't really need (unless they want to pay for it themselves).
3. Getting people to pool funds (e.g., insurance, co-ops, government-supported services) so that there is money in the system to cover the expenses that are beyond most people's ability to cover themselves (e.g., cancer, organ transplants, accidents).
4. Improved lifestyles to make us healthier (e.g., should the system have to pay for the poor health of smokers?, of those who refuse to wear motorcycle helmets?).
5. Better environmental protections (so we aren't exposed to chemical/physical hazards which make us sicker).
6. Safer food systems (e.g., removing antibiotics from agriculture so that we aren't creating superbugs).
Next >>