Fair enough – you have a point there. The individual marketplace ended up being a race to the bottom where insurers were competing on price (as the subsidies are set based on the second lowest-cost Silver plan) without sufficient quality controls, which lead them to design plans that would be as undesirable as possible to sicker enrollees.
Those mandates do not make sense from a traditional insurance perspective, but the traditional insurance model isn’t appropriate to apply to healthcare (I think this has already been discussed here, by me and others). The alternative is what we had before – medical underwriting for individual plans where sick patients that didn’t qualify for a government plan were left to either hope they can find group coverage at an employer or die.
In any case, the ACA didn’t adjust reimbursements even indirectly outside of the individual marketplace.
It is worth noting anyway that I don’t know if it’s reasonable to go as far as calling providers in the marketplace plan networks bad. Of course this will vary significantly by area, but the major marketplace insurer in my area has most of the local hospital systems in network, which includes their associated PCPs and specialists. Certainly though, I imagine top-tier facilities like Mayo are not going to be well-represented in those plans.
You have a highly atypical arrangement. I’m guessing you are self-employed and can work with an insurance broker to access the small group market, or use a PEO that gives you this menu of options? That does not apply in the least to the ordinary American.
US healthcare is the last industry you should make this point about.
I wish that the people who think single payer is better than what we currently have would have to experience it firsthand. While I don’t wish anyone ill, the only way to get a true picture is to be seriously ill in a system that’s been around a while. I’m sure that the English and Canadian systems were outstanding for at least a decade before budgetary concerns started affecting availability and access.
Have you experienced them first hand? (sorry I can’t remember if you’d commented so before)
We’ve all experienced the US system first hand and most of us find it seriously lacking.
I don’t know that single payer is the fix, but what we got is broke.
I have heard this often from the Left and it puzzles how we are supposed to exercise our “right.” The Declaration of Independence lists human rights as including life and liberty. I take that to mean that if someone tries to deprive me of those rights, I can resist by force if necessary. The Declaration further states that we set up governments to protect these rights presumably through police.
Now suppose you want to assert your “right” to medical care. That is a service that has to be provided by other people. Should you, or the government you set up, be allowed to force them to provide the service to you?
You may say that the government simply pays for this right. But it has to pay from taxes that are extracted from people ultimately at the point of a gun. If you doubt that, try not paying your taxes and resisting the IRS agents who show up at your door to confiscate your property for back taxes.
So how do you propose that You or “society”, as you would say, enforce your exercising your “right” to medical care without enslaving people either to provide the service or to work to pay for it?
Yes. It’s the same as all the other basic infrastructure we rely on. Taxes are the price you pay for living in a civilized society.
The same argument you made also applies to police officers, i.e. police officers are paid by the government through taxes “that are extracted from people ultimately at the point of a gun.” Is your position the same with regard to police officers?
And people have always been treated regardless of their ability to pay.
Today’s controversy doesnt really have anything to do with receiving health care, it’s about whether it’s a “human right” to not have to pay for the care you receive. People who are supposedly being deprived of care are depriving themselves, because they dont want to be stuck with the bill - be it the actual cost, or the fallout from having unpaid debts and/or bankruptcy. I dont consider facing financial consequences to be a violation of “human rights”. And I think this is the basic premise behind everyone who thinks this whole boondoggle is a farce - not that people shouldnt be able to get treatment, but that you are responsible to pay (or face the consequences of not paying) for the treatment you receive.
Nonsense. EMTALA (which dates back to 1986, not “always”) requires hospitals (technically only hospitals that accept Medicare, but that’s, like, all of them?) to provide emergency treatment regardless of ability to pay. For example, for a cancer patient, the hospital is only required to stabilize the patient from a life-threatening state; they can then discharge the patient without providing follow-up cancer treatments (e.g. chemotherapy), at least until the patient’s condition becomes life-threatening again. Or, for a diabetic, hospitals are required to treat the patient if they are in a life-threatening blood sugar situation (which may be a very expensive ICU visit), but nobody is required to provide the insulin that would prevent them from getting into the life-threatening situation to begin with.
Even if your premise of medical care always being available regardless of ability to pay is taken as completely true (which it is not, as I addressed above), this is where we differ. There is no practical difference between completely denying care and placing an unattainable price tag on it; the result – no care – is the same.
Let’s not forget that this is also the most expensive healthcare system in the world. The average deductible of individual employer-sponsored insurance is now $1,655, according to KFF. 39% of Americans say they couldn’t cover an unexpected $400 expense without borrowing money from somewhere, not paying other bills, or other drastic measures, and that’s less than the average deductible. This is not an uncommon situation by any means, and that’s only addressing people with insurance.
And let’s not even get into the “in-network hospital, out-of-network emergency doctors that you didn’t choose” balance billing scam that can leave even a well-insured person in financial ruin.
Yes, with two significant health issues. I had to return to the U.S. for one. If that didn’t tell me a lot about socialized medecine, the second one most certainly did - from shortages of eqpt, to shortages of personnel, to shortages of funds to remedy the previous two shortages. Additionally, I hear more horror stories from friends and relatives in countries with socialized medecine than I do here. Admittedly, that may be because I have more friends outside the U.S. than in.
I agree 100%, and don’t think anyone here has an argument with that. In fact, it is already true.
Anyone / everyone can go to the library and learn everything they want about health. They have the right to treat, or mistreat, themselves as they see fit.
Yep, I can go to any ER in the country and exercise that right. It’s already there and we’re already paying for it whether we use it or not, so we’re well past the ‘health care is a right’ discussion.
Paying for it is another discussion entirely, and the costs associated are the crux of the problem.
Some alternatives discussed here. Price transparency and patient incentives would certainly help with cost control, unlike a M4A approach that rations on access /wait time.
Those behavioral changes resulted in 35% lower health-care spending than when the same employees were enrolled in traditional health insurance. Even better, the study found that employees enrolled in the deductible security plan were going in for mammograms, annual check ups, and other forms or preventive medicine at the same rate as when they were enrolled in traditional insurance. Thus, these cost savings are real and not due to people delaying necessary care in order to hoard their HSA balances.
By contrast, the single-payer “Medicare for All” proposal that is being pushed by Bernie Sanders and Kamala Harris would create a health-care system in which consumers never have skin in the game and in which prices are hidden for every procedure.
That lack of skin in the game will generate an expenditure explosion. We know this because when Oregon randomized 10,000 previously uninsured people into single-payer health insurance starting in 2008, the recipients’ annual health-care spending jumped 36% without any statistically significant improvements in health outcomes.
LOL, go to any decent size ER in the country and you’ll see tons of folks with the flu etc. getting care because they can’t afford the traditional route. I’ve been there, I’ve seen it.
Get past the ‘health care is a right’ deal, that ship has sailed. All we’re bickering about now is how much it’s going to cost and how that’s divvied up.
There’s still a big difference between the current “you can have Medicaid or the ER if you can’t afford anything else” and “everyone gets the equivalent of a good group plan”. The former is reasonably affordable, the latter even the state of CA said they couldn’t afford without taxes even they couldn’t stomach and you know they looked hard. The math will be no different at a national level.
Doesn’t change the fact that health care has long been a right courtesy of those safety nets. I’m amazed that folks even consider that there’s an argument to be had about that, especially given that the ACA has enhanced that for the lower end. The fundamental arguments aren’t about whether folks are entitled to health care.
For the % who are still uninsured I don’t consider the ER to really qualify as actual “health care” or a real safety net.
Yes you can go to the ER for medical aid and some people without insurance do so as a substitue for a doctor visit. But its not a true substitute for full health care. And many people will not use (abuse) the ER in that manner as its not the real intention. If you visit the ER you’re either paying the bill, expecting charity or an intentional deadbeat. Lots of people without insurance are unwilling to do any of those 3. Hence theres really no general expectation that everyone gets a “right” to “healthcare” just by abusing the ER.
But that’s their choice. As I said earlier, their “lack of access to healthcare” is rooted entirely in their unwillingness to pay for it, not that it isnt available. The whole nexus of controversy is actually about how to get someone else to foot the bills for people who dont want to themselves.
Yeah. I agree it does boil down to who pays for it and how much should be free and free for whom.
But to my point I don’t think that telling people to abuse/misuse the ER, be deadbeats, hope for charity or just go bankrupt is a good system. Its not just “unwillingness” to pay but also inability to pay and unwillingness to freeload.
Personally I’m happy with a social safety net system. But the current safety net has some troublesome gaps. But IMO not bad enough to throw out the entire system and go for 100% socialized medicine.
We all agree (I’d assume) the system we have certainly needs some fixing. But then if it was easy to fix it we wouldn’t have been having a decade long debate on how to fix it.
