Hmm… there’s water leaking from the dam the community depends on for it’s water, in maybe a couple of hundred places. The idea that any single leak isn’t worth plugging since it won’t, by it’s self, solve the problem, seems a shallow one.
If there is a fix to the problem, it will certainly be one that proves someone wrong. Wrong as to what they believe to be fact.
Look, I am not even an amateur when it comes to health care economics, but I do understand basic freshman economics 
Employers do not offer insurance to everybody. They offer insurance to their employees. People who can hold down a full time job that offers health insurance (or even a 30 hour a week job) and who get a regular paycheck are going to be healthier than the average 18-65 year old American. Very sick people often can’t hold down a good job. The one stat I found on google is that one big insurer’s costs in the individual market were 22% higher than in the employer market last year, and the differential is likely higher this year.
I think you know this since you wrote this -
In fact, they’re much sicker.
We can argue the morality of who should pick up the extra tab for the extra proportion of sick people in the individual healthcare market. I think it should be spread among all the taxpayers. Obama agrees with me. You disagree. OK.
The reason you should listen to me and Obama isn’t because our morals are better than yours. It’s because the exchanges have possibly already entered a death spiral and may blow up in the next few years except for people who are nearly full subsidized unless this is done (this has nothing to do with the election). We’re just being pragmatic. All this moral preening about the virtues of offering healthcare to sick people in the individual exchanges won’t amount to a hill of beans if the exchanges blow up. Then nobody is getting nothing.
Like I said, I know nothing about health care. I get confused just trying to figure out which one of the 10 varieties of Robitussen at Duane Reade I should buy. I’m sure lots of what I’m saying has got flaws in it, and I don’t have one year of my life to spend learning the basics. Actually, I don’t even care about this topic that much, so I’m going to sign off.
I know that this is the conservative holy grail for reducing health care costs. However:
[New study shows that the savings from ‘tort reform’ are mythical](New study shows that the savings from 'tort reform' are mythical)
Other studies put the savings at closer to 1%.
http://www.nber.org/bah/2009no3/w15371.html
So, sure, knock yourself out and do tort reform. And then give us an idea which would actually reduce health care costs.
I’m sorry, @al2simon, I can’t figure out what your proposal here is, and I also can’t figure out why you think Obama agrees with you. Obama signed the ACA into law, so I’m assuming that he would want it to continue. ACA supporters, including myself in this very thread, have said that the current subsidies are inadequate, and subsidies should be given to people at higher income levels.
My beef is with people who voted to repeal the ACA because their insurance premiums went up when sick people could buy insurance. When you talk about your friends who used to have reasonably priced health insurance, but now are faced with $25K/year insurance for their family, I agree that they are in a bad situation and deserve help, at taxpayer expense. But that’s not what they voted for.
Rather, they, like some in this thread, hearken back to the time when they could afford insurance because sick people couldn’t. That’s what they want to go back to. That’s what they voted for. I say, if you vote for a world where healthy people can get insurance and sick people can’t, and you get that world, and then you get sick but you can’t buy insurance, you got what you asked for and I have no pity.
If I have to choose between them getting insurance and sick people not getting it, or sick people getting insurance and them not, I choose the latter. My preference would be neither of those alternatives. I’d go for a more muscular individual mandate and more subsidies.
Imo, this isn’t as simple as some dichotomy between the extremes of “healthy,” (which seems to imply no or little medical need, ever,) and “sick,” (which some assume means hundreds of thousands of dollars spent on each individual.)
It’s equally incomplete to assume the care now-insured people get via ACA is all at a drastic level, bums coming in off the street for quad bypass or free cancer treatment.
Don’t ignore that many fall into the vast middle. And due to the nature of the ACA plans, you can still have a large deductible, skin in the game.
The problem is that if you drive out all of the healthy people from the marketplace, you no longer have money to pay for health insurance for anyone. You get the whole running out of other peoples money problem. Attitudes like this one, and the inability to consider proven cost reduction methods like tort reform are why ACA failed and is in a death spiral.
The people who supported ACA designed an insurance system that does not work. Now that the health care system is in a ditch and others are trying to get it out, they want the keys back. They don’t know how to design a working health care system, but they want they keys to the car and their hands on the wheel so they can sip on a Slurpee and crash it again.
And your solution is…?
Anytime people talk of death spirals, my eyes roll. Lol.
Are some really saying insurance should only be for people who didn’t need more than a ckeck up in the last x years? Or didn’t think they did?
“The people who supported ACA designed an insurance system that does not work. Now that the health care system is in a ditch and others are trying to get it out, they want the keys back. They don’t know how to design a working health care system, but they want they keys to the car and their hands on the wheel so they can sip on a Slurpee and crash it again.”
No. Everyone knows how to design a health care system that works. We have done it before.
But no one wants to (a) pay for it, or (b) step on all of the toes of the various special interest groups that need to be satisfied or pushed aside.
Note that (b) also applies to reducing costs, since there is no one place that makes up most of the added costs of US health care versus that in other rich countries. There are many smaller added costs that add up to a large total added cost, each of which has its own special interest group defending it.
I can think of a bunch of countries that designed a better healthcare system that works.
^ The statement was that, “no one knows how to design a system that works.” That is false. We know how and have done it and millions of Americans have health insurance because of that very system. We, on this forum, will all someday have that same heath insurance, too, unless TPTB screw it up.
There are two parts to this.
It is absolutely true that many countries have created a nationalized health system that has lower cost than the US and that yields better health outcomes. This is to be commended.
However, it is a separate issue whether or not they can afford them. Most are straining their budgets even though they get a huge effective subsidy because they free-ride on the US for defense.
Thank you for explaining adverse selection to me, zinhead, but I already understood it, which you can tell if you look at the next sentence after the one you quoted. Here’s what I actually said:
Most of the rich country governments spend comparable shares of GDP on health care as the US government does. But they get more for their money, so private spending on health care is much lower. US health care is just more expensive, even though it gives no better results.
But as you have said several times, @ucbalumnus, getting costs down in the US is extremely difficult. One person’s cost is another person’s income, and the person getting the income doesn’t want to stop getting the income.
Doctors in the US are paid more per procedure than doctors in other countries. But doctors here like their high incomes, and they hire lobbyists.
Drugs here cost more than drugs in other countries. But big pharma likes its money, and hires lobbyists.
Hospitals in the US are lavish and well-equipped-- in fact, many of them are ridiculously lavish and pointlessly over-equipped. It would be cheaper to have stripped-down hospitals that didn’t have this month’s model of every high-tech machine. Then they could charge less. But hospital administrators like their lavish fiefdoms, not to mention their lavish hospitals, and the doctors in the hospitals like brand new expensive equipment. And they hire lobbyists.
The single biggest contributor to our higher health care spending versus other countries is outpatient care. But that money is going to actual medical care. We need to get a handle on it, but getting a handle on it means doing less actual medical care. Part of this is doctors owning diagnostic and surgical centers (most is not, but some is), which we should make illegal, but again, the doctors who own diagnostic or surgical centers and refer their patients to them like the money they get from their businesses. And they hire lobbyists. Medical equipment companies selling expensive technology to outpatient centers like their profits. And they hire lobbyists.
A teeny weeny contributor to costs is malpractice claims that could be reduced by tort reform. Yeah, whatever, do tort reform in the states that don’t have it. But the two biggest states already have tort reform and it has done basically nothing to reduce costs.
Hebegebe, no one on this thread or in politics has proposed a “nationalized health system.” You do know what that is, right? And you do know what “univeral coverage” is, right? And you do know that they are not the same thing, right?
Hey, CF, refresh my memory… did the ACA do anything to address medical school costs? I thought I remember something about loan forgiveness if you worked in rural places but that might be a different program.
This is a weird statement to me. We spend about as much of our GDP on just government paid healthcare (Medicare, Medicaid, subsidies for private insurance, but not employer-paid health care or unsubsidized private insurance) as the highest of the other countries spend for theirs-- and they’re covering everyone and we’re only covering old people. We’re straining our budget as much as they’re straining theirs, but we get less care for our money.
Other countries can afford their government-paid health care because they have higher taxes, not because they have lower defense expenditures.
@“Cardinal Fang” ,
The ability to afford one government funded program depends upon what you spend on all the rest. It is simple arithmetic that if you spent less money on defense, you have more money remaining that you can spend on social programs like health care. But even after under-funding their self-defense, Europe still struggles with funding their social programs. But this is a side point.
My main point is that I agree with you that countries in Europe (and Canada) do a much better job of health coverage for everyone than the US, and they do it for a lower cost. I commend them for doing so. The US has a much higher per-capita GDP, and we should be able to provide health care for a lower % of GDP than Europe.
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That’s arguable. We should be able to provide the same level of health care as lower GDP countries do, for a lower percentage of GDP, and we’re not.
But one of the things countries do with a higher GDP is spend it to get better health care. And they should. After all, better health care is of value to people, and we want to spend some of our more money on better health care. Better health care is something that richer countries can afford.
IF we spent the same percentage of GDP as other countries do, and we got better health care for it, that would be a reasonable choice. Unfortunately, as you and I agree, we’re spending much more money and getting worse results.
For example, ugh, maternal mortality in the US went UP this year. Maternal mortality should not be going up in any first world country. This is one example of the US’s failure to provide a first-world level of health care.