@fractalmstr, are you opposed to Medicare? That is government run universal health insurance for those over 65. AFAIK, most people are absolutely thrilled when they are finally eligible for it.
@emilybee - yes the deadline for continuous coverage seems to allow 63 days of no coverage before the penalty kicks in.
Medicare is also tailored to a smaller, more specific demographic, and not broad enough to satisfy the entire population’s needs. One government trying to provide an insurance system that satisfies all of our needs would be a near impossible feat, not only to architect, but to maintain. Even longstanding public single-payer healthcare systems like Sweden’s are seeing a growing number of people opting out of the public insurance plan for private insurance plans. Mismanagement and growing wait times are often to blame with government-run single-payer systems.
Switzerland’s healthcare system sounds pretty good to me…
Didn’t Colorado recently reject a single-payer system and Vermont determined it would be way too expensive and dropped it. Now some California legislators are thinking of trying it here.
If you already have a good insurance plan that you can keep at reasonable premiums after you retire, Medicare is one more layer of protection. For those who are able, I know quite a few have both Medicare AND private insurance, just to have extra coverage since sometimes one covers things that the other does and then the individual has dual coverage so that there is normally no copay.
It is a fairly substantial demographic. Note also that Medicare now has the option to take the benefit as a voucher to buy a private plan if you do not like the way traditional Medicare works (this is called Medicare Advantage).
Based on that Forbes article, many features resemble the ACA, but with everyone buying as individuals, instead of only a small part of the population buying as individuals in a market that is heavily distorted by the fact that most people in the US get medical insurance through employer or government programs.
@ucbalumnus Yep, and I think ACA was a step in the right direction (honestly), although I don’t think they have complicated exchange markets in Switzerland like we do here (someone correct me if I am wrong). My guess is the Swiss system works like a hybrid of pre-ACA and ACA, whereby there are no exchange markets to speak of, but there is a mandate.
The efficient, clear-cut nature of the Swiss system really appeals to me. You have healthy competition among insurers, a robust regulatory framework to keep prices/services in check, everyone picks their own insurance plan, and the government helps offset the cost of your plan if you need the help.
It is probably less like pre-ACA, where the individual market was even more dysfunctional.
Basically, to go to the Swiss system, the link between employment and medical insurance, and the resulting opaqueness (to the user) of cost in medicine that results, needs to be broken. Such opaqueness of cost means that most people on third party (employer or government) medical insurance have little idea of the cost, and do not really care about cost when choosing providers*, since they are not directly seeing or paying the bill for either medical care or medical insurance.
*Except for purely optional care like cosmetic procedures, LASIK, etc. where insurance is typically not used and a more normal market exists.
In our state, pharmacies CANNOT print the price of the medications when we buy them but are covered by an insurance plan. They can only print out the co-payment portion. This does NOT allow us to know the cost or even the contract cost of any of our medications. This is part of the opacity. It is impossible to price-compare when we don’t have the prices to work with. When we get coupons that MAY apply to SOME patients and not others, it is even tougher to obtain the true cost of anything. Most of my medications are “free” of copays as long as I get a 90 day supply, but have a nominal cost ($7-15) if I get a 30 days supply. To me, this is wasteful, especially if I and my providers aren’t sure I should stay on the medication but they are incentivized to order the 90-day supply so it won’t cost me out-of-pocket.
The American Hospital Association has already come out against the new proposal (and they want their money back):
http://www.vox.com/2017/3/7/14847110/hospitals-ahca-trumpcare
The new proposal gets rid of preventative care coverage
Finally, the bill would repeal the “essential benefits” required by the ACA. That means insurers would not have to provide any certain type of coverage. This would end no-cost preventative care, including for cancer screenings, vaccines and contraception.
http://www.pbs.org/newshour/rundown/everything-need-know-new-gop-health-care-bill/
“The new proposal gets rid of preventative care coverage
Finally, the bill would repeal the “essential benefits” required by the ACA. That means insurers would not have to provide any certain type of coverage. This would end no-cost preventative care, including for cancer screenings, vaccines and contraception.”
Cool! So now people with individual plans will get to pay more for less coverage and I won’t have to hear those complaints about the horror of being covered for things they’d rather pay out of pocket for. That’s a win/win in my book.
A couple of thoughts:
It was extremely difficult to actually understand how much an insurance company was actually billed by a hospital prior to the ACA because of the individual contracts negotiated between the hospital system and the insurer and the amounts shown on the bill the patient received were not was what actually being billed. I learned this the hard way while dealing with a number of hospitalizations for my mother years ago and trying to understand how much $ she had spent before her long term health care policy would kick in. Since I couldn’t get accurate information I didn’t realize that the likelihood of her reaching the deductible prior to reimbursement would never happen.
My younger d has used ACA in NY for several years. She hasn’t actually needed to visit a doctor but she did take advantage of the dental coverage to get a check-up and a cleaning in an office that was absolutely spotless in the primarily low-income but rapidly gentrifying neighborhood of Bushwick. She now has health coverage provided by her employer and she basically had a choice of that coverage or declining and continuing with ACA. Her costs would be about the same. Given the political climate I recommended she take the company plan.
I don’t participate in my company insurance plan other than dental as my husband is a retired federal employee but the company plan only offers one provider but people can select different plans from that provider. They also have AFLAC options and of course FSA. Since the introduction of ACA, every year everyone in the company that participates in the health care plan has received a rebate (thanks to ACA).
Younger d also has used Planned Parenthood for gynecological visits and birth control.
Articles about the tax cuts of the proposed plan.
You don’t have to choose the plan that does not pay for preventative care. AAll that does is add lesser options for people who want that. And yes, there are people who only want insurance for “big” issues, and expect to pay less for it.
^Who says any preventative care will be offered at all? The insurance companies will likely just not offer them in any plans - especially since most people will still want coverage.
The plans that are currently available in this area are useless. The doctors will not accept them. It’s really sad. Something needs to change.
I just looked at the bill to try to find out some answers for myself. It is very cumbersome to follow, with references to previous legislation and legalistic detail. A significant portion of the bill details how states can assure that Medicaid recipients who win significant lotteries can be taken off the rolls.
“A significant portion of the bill details how states can assure that Medicaid recipients who win significant lotteries can be taken off the rolls.”
Phew! I’m glad they solved that crucial fiscal detail… those Medicaid recipients who win significant lotteries are such a burden on this society…