The Problem With Obamacare Is Obamacare

...we are seeing large rate increases getting approved on the government exchanges due to UNBALANCED Risk Pools. It's as simple as that... Originally Posted by adav8s28

Sure, Socialism is simple enough. Make people buy something they do not need or want. You know. The thing. More of Other People's Money. Come on man!

Stud, you are describing ACA marketplace insurance, which is what Farm Bureau sells.

There’s no bigger group than that. Originally Posted by Yssup Rider

nope

Sure, Socialism is simple enough. Make people buy something they do not need or want. You know. The thing. More of Other People's Money. Come on man! Originally Posted by Why_Yes_I_Do

Who’s the simpleton here? The truth is that eventually everyone will both need and want healthcare. And the older you become the need will become more acute.

That’s what makes this discussion different than a traditional capitalist response. If everyone is going to both need and want healthcare then the way to make it economically viable is to make everyone participate. For everyone to have a stake in the system.

^^^^^^^^^^^^^^^^

Perfectly said.

Who’s the simpleton here? The truth is that eventually everyone will both need and want healthcare. And the older you become the need will become more acute.

That’s what makes this discussion different than a traditional capitalist response. If everyone is going to both need and want healthcare then the way to make it economically viable is to make everyone participate. For everyone to have a stake in the system. Originally Posted by txdot-guy

+1

Outstanding reply!!!

Make people buy something they do not need or want. You know. The thing. More of Other People's Money. Come on man! Originally Posted by Why_Yes_I_Do

Republican congresswoman MTG has relatives on Obamacare. During the government shutdown she was calling for the GOP to extend those extra Obamacare tax credits that Biden put in during CoVid. Do you think Republican MTG is a socialist?

Question for you. For the person who is 30 years old, healthy and doesn't want health insurance. This person comes down with a serious illness and needs to be admitted to the hospital. This person ends up with a bill of $20,000. The person can't afford to pay. Who is suppose to pay the hospital and doctors that treated him/her?

Question for you. For the person who is 30 years old, healthy and doesn't want health insurance. This person comes down with a serious illness and needs to be admitted to the hospital. This person ends up with a bill of $20,000. The person can't afford to pay. Who is suppose to pay the hospital and doctors that treated him/her? Originally Posted by adav8s28

Most hospitals are nonprofits that don't pursue collection of unpaid bills from indigents.

That's not to say that the USA shouldn't have universal health care. Most here probably believe it should. The question is how are you going to get there. And lower costs and improve outcomes. I believe free market solutions with some help from government, or even a single payer system favored by TxDot, would work better than doubling down on what we've got now, which is what Obamacare did.

The thread title is certainly apropos, since the fiasco that answers to the name of "Obamacare" doesn't even make any attempt to address the most fundamental issues.

The actual name of the legislation, of course, is the Patient Protection and Affordable Care Act. (A misnomer if there ever was one, as was the infamous "Inflation Reduction Act" of three years ago.)

My take on a few key points:

The total all-in cost of health care for Americans has increased at a far faster pace over the last 15 years than all the other major necessities of life. Why is that? Well, because the health care industry (including insurance companies, hospital chains, pharmacies, and physicians' practices), is a giant MINO (market in name only). There's virtually nothing in the way of pricing transparency or available information to individuals regarding what they're really getting when they shop for insurance, or even whether they're at risk of being bankrupted in the event of serious illness that exceeds coverage caps or is subject to numerous exclusions.

Then there are the "pharmacy benefit managers" (PBMs). Originally, 50+ years ago, they were intended to manage costs by negotiating prescription prices with the larger insurers and and other entities. Now, in the aftermath of vertical integration resulting in the largest PBMs being formed or acquired by large insurance companies and pharmacy chains like CVS, the pricing incentives are perverse; driving up costs for patients. The result is an edifice built on a foundation of rent-seeking and crony capitalism that's virtually without peers in the American economy.

By contrast, compare all this with the marketplace for two other necessities of American life: Paying for a home (or apartment) and buying a car. Prospective tenants shopping for an apartment can pretty easily determine, within just a percentage point or two, what they should be paying for the unit and the amenities they're getting. The same goes for buyers of new or used vehicles. These are transparent and easy-to-navigate markets where no one has to buy a "pig in a poke."

Is the answer really to stuff more subsidy cash down the gullet of this obese turkey?

(I think not! There are better answers!)

For instance, Germany and Switzerland achieve universal or near-universal healthcare coverage at a cost of five or six less percentage points of GDP than in the US. There's no reason that we couldn't do that with properly design reform, regulation, and efficiency. Instead, we allow the bank accounts of politicians (of both parties) to be lubricated with a flood of lobbyists' and PACs' cash, meaning that many of them continually make every effort to avoid solving the very problems that some of them publicly fulminate over.

Perhaps worst of all, this acts as a heavy tax burdening working-class and middle-class America. If we could reduce all-in health care costs by six percentage points of GDP, as we obviously could if we simply followed the examples set by the Germans or the Swiss, costs per household could be reduced by about $11K to $13K annually.

Some might say, "Well, that's not a problem for me. I have a good job and my employer pays for my health coverage," my answer is this: No, they do not! That's part of your compensation, and every employer that pays for coverage "figures it in" when deciding on your total compensation package.

As many have noted, coupling of HSAs or similar structures with well-designed catastrophic coverage would allow much greater price transparency and place decision-making power in the hands of better-informed patients, and if properly engineered could save massive amounts of money.

Sadly, though, no one in a position of power is likely to do a damn thing in the way of properly addressing the most pertinent issues.

The thread title is certainly apropos, since the fiasco that answers to the name of "Obamacare" doesn't even make any attempt to address the most fundamental issues.

The actual name of the legislation, of course, is the Patient Protection and Affordable Care Act. (A misnomer if there ever was one, as was the infamous "Inflation Reduction Act" of three years ago.)

My take on a few key points:

The total all-in cost of health care for Americans has increased at a far faster pace over the last 15 years than all the other major necessities of life. Why is that? Well, because the health care industry (including insurance companies, hospital chains, pharmacies, and physicians' practices), is a giant MINO (market in name only). There's virtually nothing in the way of pricing transparency or available information to individuals regarding what they're really getting when they shop for insurance, or even whether they're at risk of being bankrupted in the event of serious illness that exceeds coverage caps or is subject to numerous exclusions.

As many have noted, coupling of HSAs or similar structures with well-designed catastrophic coverage would allow much greater price transparency and place decision-making power in the hands of better-informed patients, and if properly engineered could save massive amounts of money.
Originally Posted by Texas Contrarian

My back of the envelope idea, is to guarantee catastrophic care for all US citizens (think Medicare part A), coupled with Trump's idea of direct payments (think Medicare B and D), of, say, $1,500 to $2,500 annually, depending on income, to replace Obamacare. I suspect Republicans won't go for it, since it closely mirrors Medicare for all

The thread title is certainly apropos... Originally Posted by Texas Contrarian

Excellent post! It reflects my beliefs, I'm just not nearly as good at expressing them.

My back of the envelope idea, is to guarantee catastrophic care for all US citizens (think Medicare part A), coupled with Trump's idea of direct payments (think Medicare B and D), of, say, $1,500 to $2,500 annually, depending on income, to replace Obamacare. I suspect Republicans won't go for it, since it closely mirrors Medicare for all Originally Posted by Capital

Interesting post Capital, thanks. I suspect this is something like what TxDot's proposing, perhaps without the direct payments.

How would Medicare for all work? Not very well without radial changes. See this paper,

https://jamanetwork.com/journals/jam...rticle/2769102

Please note that people over 65 in the USA are in the Medicare program. Here are per capita expenditures for people over 65, in 2015 adjusted for purchasing power.

United States $24,655
Australia $13,316
Canada $11,773
Germany $12,442
Netherlands $12,285
Japan $9972
Switzerland $16,788
United Kingdom $9584

If you adjust to 2025 dollars using the CPI, that's $33,500 per person per year (for over 65's) spent on healthcare in the USA!

Healthcare spending for over 65's in the USA is double the eight country average.

Furthermore, please note from the table in the JAMA paper that the "expenditure relative to the mean" for over 65's in the USA is 2X the 8 country average, compared to 1.9X for all ages. On the surface this would indicate Medicare is slightly more expensive than health care for under 65's, compared to other countries. Admittedly that may be a LITTLE deceiving since you have close-to-universal health care for over 65's in the USA, and you don't for younger people.

Still $33,500 a person is insane! And the USA's population is aging. And there's no way the politicians and retirees are going to allow changes to Medicare. In other words, we're fucked.

From the JAMA article,

Our findings suggest that despite appearing similar in structure to the health care systems of other high-income countries, the US health care system for individuals aged 65 years and older is comparably more costly. These findings suggest that moving to a Medicare-for-all model may not substantially reduce US health care spending relative to that of other high-income countries. Different approaches are likely needed if the US is to adopt a system that achieves this aim.

Who’s the simpleton here?... Originally Posted by txdot-guy

A floor length floor mirror might help.

...The truth is that eventually everyone will both need and want healthcare. And the older you become the need will become more acute... Originally Posted by txdot-guy

Potentially true-ish enough. But that is not actually the issue. Is it Comrade?

...If everyone is going to both need and want healthcare then the way to make it economically viable is to make everyone participate. For everyone to have a stake in the system. Originally Posted by txdot-guy

Why should the wealthy, i.e. well off, aka well funded, participate at all in a rigged and one-size-fits-all commie system then?

Thimk hard on that one Comrade.

A floor length floor mirror might help.Potentially true-ish enough. But that is not actually the issue. Is it Comrade?Why should the wealthy, i.e. well off, aka well funded, participate at all in a rigged and one-size-fits-all commie system then?

Thimk hard on that one Comrade. Originally Posted by Why_Yes_I_Do

Because the corporations and companies that make their money need a robust and thriving nation to keep their companies running.

Society works best when healthy happy educated people inhabit it. You may not like it but it’s the responsibility of everyone, including the well funded, to participate in the society in which they live in.

We both think that the system is rigged and we’re both probably right. We just disagree on who is benefiting from the current system more.

Because the corporations and companies that make their money need a robust and thriving nation to keep their companies running... Originally Posted by txdot-guy

Seems odd-ish that the employees of said corporations and companies are not shunning the corporation's and company's group health care coverage in favor of HillaryCare in droves. Eh Comrade?

...Society works best when healthy happy educated people inhabit it... Originally Posted by txdot-guy

Well... at least you make a good and strong case on why the Federal government should no longer be involved in indoctrination centers, aka public education, but it fails to address making people pay for something they do not want or need...

...You may not like it but it’s the responsibility of everyone, including the well funded, to participate in the society in which they live in... Originally Posted by txdot-guy

I think all can successfully participate in Society with their own ability to make their own choices, while also deciding what and where to spend their own money on. Don't you Comrade?

Seems odd-ish that the employees of said corporations and companies are not shunning the corporation's and company's group health care coverage in favor of HillaryCare in droves. Eh Comrade?Well... Originally Posted by Why_Yes_I_Do

If the company you are employed by offers you a group health insurance plan, you are not eligible to apply for an "Obamacare" health insurance policy on the government exchanges HEALTHCARE.GOV.

The ACA is not a Universal Health Care Plan. It's only for the individual market. That would be self-employed people or people who work for a small company that does not offer group health insurance coverage.

So, if you work for a GM, ATT or IBM you can't apply for an "Obamacare" policy.