[Cog]

“We have to pass the bill so that you can find out what is in it,” --Pelosi

So from this august beginning we now have a disaster on our hands. Who could have possibly foreseen such a thing? Perhaps not a single Republican vote for the ACA should have been a clue. The insurance companies embraced this thing because they helped write it and there was no downside for them. I don't blame them for taking advantage of Congressional incompetence. That is what corporations do.

Here is the real problem which Chris does not address. There is no price discovery in the medical field. Even before the ACA this was a problem with rates rising each and every year. I can not find out what a medical procedure will cost me. In every service or product I buy in America I get at least an estimate of what its going to cost me and go to a competitor if I don't like the price point.

Its even worse than that. Depending on which insurance I have, the costs that are charged to the insurance company by the provider are different for every single person. A cash price, a Medicaid price, a Medicare price, and a main stream insurance company price. This is the most bizarre convoluted system the world has ever known.

My actual preference would be a law requiring doctors and hospitals to list their prices for their services. Then I could price shop if I needed a medical procedure done and just pay cash. Since I am fairly healthy and take no prescription meds, I would then just buy an inexpensive catastrophic policy to cover the unexpected. But since none of that is law, I am stuck paying for coverage I do not use and probably won't use.

[Cog]

@baha

My doctor and I had this exact conversation. People who are fat typically develop Type 2 diabetes, hypertension, joint problems, and have coronary heart disease. She always advises them to lose weight through diet and exercise. But most of them won't diet or exercise because that is hard. She then moves on to prescribing the whole litany of pills to treat all of the above symptoms. She doesn't like it but she is trying to save the patient because the patient won't do the work to save themselves.

And you are quite correct that the average American diet now is basically poison with its emphasis on processed foods and carbs.

[ROCKMAN]

"Why has the cost and size of the industry skyrocketed over the last few decades?" Similar to the increases in college education: you can't have $1+ TRILLION injected into a system and not induce inflation. In this case by govt loans. Same way inflation works in the private sector: hundreds of $BILLIONS injected by oil companies into the shale plays caused all segments of the process to boom: $150/acres leases jumping to $5,000/acre; $9,000/day drill rigs jumping to $23,000/day; a $45,000/yr worker jumping to $85,000/yr; etc.

[Newfie]

You CAN find out what a procedure costs and shop around, just not in the USA. There is a whole growing industry of medical travel developing around folks who do just this.

Here is one site advertising. I'm posting this only because it is at my fingertips. Not advocating or recommending.

http://www.guatemalamedicaltravel.com

SNIP

PRICE – Residents of the United States generally pay two to ten times more than people in other countries do for routine medical procedures. You may be shocked to find out that you can save $45,000 on a knee replacement in Guatemala, or $130,000 on a new heart valve. The entire dental implant package is $1550, not $4500. In Guatemala, your cancerous tumor could be surgically removed and successfully eradicated for less than what you paid for your son’s wedding or your kitchen renovation. Your Guatemalan hospital suite looks more like an elegant 5-star hotel. Together with the latest medical instrumentation and 24-hour nursing, this hospital room costs only $130 per night.

[Paulo1]

@VT and Baha

You guys need to show a little compassion and a wee bit more imagination. First of all, catastrophic illness can happen to anyone and at anytime. For example, my extremely fit and intelligent wife had the misfortune to contract type 1 diabetes at age 13. Luckily, she is a Canadaian and has prospered, living a full and productive (contributing) life. If she had been in the US she would have been denied coverage as she turned to adult age due to a pre-existing condition, and would be dead now.

Do you people even know the difference between type 1 and type 2 diabetes? It is most likely that as she caught a cold at age 13 her immune system kicked in to fight it off. It then did not shut off and accelerated going on to destroy her pancreatic islet cells which produce insulin for us. It is also thought that the same process is at the root of Lupus, various arthritis conditions, and other auto-immune disorders.

My sister's best friend was out for a walk and was run down and killed in a crosswalk last week. The funeral is today. When this woman's daughter was 17 she developed a headache. A ct scan revealed a brain tumour. She died by age 20. What? You think she was cornchip fat? She was a gymnist. The point of this is that bad things can happen to good people. (Even you two idiots)

There is a solution. It is called single-payer. There are drawbacks, but basically the Canadian healthcare system provides better outcomes at about 60% of the cost of the US system.

When I was 30, and fit as hell (I might add), I developed a stomach ache. I blew it off because I did not have time to be sick. I was too busy working. Well, it turned out into a ruptured appendix and I developed peritonitis. Two operations later, and after a short stay in hospital I returned to work. If I had been a US citizen we would have lost our house. As a Canadian living with single-payer I did not receive a bill.

I have always been fit, and I have always been debt free. I am still fit and debt free retirng at age 57. This has nothing to do with the vagaries of contracting disease, or having an accident. Bad things can happen to good people. Maybe even you.

You folks would not state such idiotic things if you had had a child develop luekemia, or something else. What, would you say, "They asked for it"? Show some compassion and use your imagination before you post. Your smugness is showing.

[vtsnowedin]

$this->bbcode_second_pass_quote('Paulo1', '@')VT and Baha

You guys need to show a little compassion and a wee bit more imagination. First of all, catastrophic illness can happen to anyone and at anytime. For example, my extremely fit and intelligent wife had the misfortune to contract type 1 diabetes at age 13. Luckily, she is a Canadaian and has prospered, living a full and productive (contributing) life. If she had been in the US she would have been denied coverage as she turned to adult age due to a pre-existing condition, and would be dead now.

Do you people even know the difference between type 1 and type 2 diabetes? It is most likely that as she caught a cold at age 13 her immune system kicked in to fight it off. It then did not shut off and accelerated going on to destroy her pancreatic islet cells which produce insulin for us. It is also thought that the same process is at the root of Lupus, various arthritis conditions, and other auto-immune disorders.

My sister's best friend was out for a walk and was run down and killed in a crosswalk last week. The funeral is today. When this woman's daughter was 17 she developed a headache. A ct scan revealed a brain tumour. She died by age 20. What? You think she was cornchip fat? She was a gymnist. The point of this is that bad things can happen to good people. (Even you two idiots)

There is a solution. It is called single-payer. There are drawbacks, but basically the Canadian healthcare system provides better outcomes at about 60% of the cost of the US system.

When I was 30, and fit as hell (I might add), I developed a stomach ache. I blew it off because I did not have time to be sick. I was too busy working. Well, it turned out into a ruptured appendix and I developed peritonitis. Two operations later, and after a short stay in hospital I returned to work. If I had been a US citizen we would have lost our house. As a Canadian living with single-payer I did not receive a bill.

I have always been fit, and I have always been debt free. I am still fit and debt free retirng at age 57. This has nothing to do with the vagaries of contracting disease, or having an accident. Bad things can happen to good people. Maybe even you.

You folks would not state such idiotic things if you had had a child develop luekemia, or something else. What, would you say, "They asked for it"? Show some compassion and use your imagination before you post. Your smugness is showing.

[evilgenius]

I don't think the problem is so much cost control by providers either. Just think about the history of it for a second. As a country we decided against the kind of national health care coverage that was instituted in England, per se, in favor of an employer based approach. I suppose that was a conservative, little c, decision, something that gave a nod to our role in the fight against communism. In the process of doing this an insidious situation developed, nobody had the incentive to control the price. The employees were not in charge. They didn't have the money coming out of their checks in a way that they could intervene and pay less. In fact, most of the time the contributions were pre-tax. Employees were incentivized to pay less attention. Employers loved that too. They also loved how they could use the rising costs to tell employees that they were getting paid more, when it didn't cost them as much to pay for higher insurance costs as it would have cost them to pay their employees more in wages. It created a kind of false economy. We should never have allowed pre-tax contributions.

Incidentally, I think this also played a direct role in the 2007-08 crash. That was largely brought about by people defaulting on debt. That debt was the instrument they used in lieu of higher wages. Those missing wages eventually had an effect upon the greater economy as well.

I guess you can blame the Apostle Paul. He's the one that said that people who don't work shouldn't expect to eat. His statements underlie the core of the Protestant work ethic. Never mind that the early church, when it was called the Way and not Christianity, threw their lot all in together. They could hold back as much as they wanted. The only requirement was to be honest about how much they were holding back, unlike this insidious situation where paystubs appear as if they reflect the truth, of getting a raise, when they don't.

I don't know if a national single payer system is the answer. That doesn't necessarily produce price discovery. Cog is right that the system doesn't have any price discovery. It's easy to see why when nobody cares about costs. It's less easy to see why when everything is covered. You still have people working in the system who want more wages. There are still cost burdens that can be astronomical for people who have something rare. You still have to pay for research, basic and targeted. It's just as hard to peer into those things and decide based upon price or other market features under a single payer system as the one we have now. One thing's for sure, single payer is more humane. It might eliminate the doctor's panel decisions, thin air, regarding what things should cost that are the current standard. If it did that it would be a better way to get people preventative care at a cheaper cost. Most of the stuff we like to complain about with fat and otherwise self-abusive people falls under the category of being capable of getting addressed by preventative care.

[Zarquon]

Here's my two Eurocents on health and insurance:

1) I read an interview (can't find the link) with a Swiss(?) economist who argued that the constantly rising costs of healthcare are due to several factors, some of which are obvious. Medical procedures keep improving, but better tech comes at a cost. Like fracking, if you like. Secondly, an aging population costs more. But what was new to me was that a huge factor is that labor productivity in all areas of the economy keeps improving and thus wages increase - but the healthcare sector can't keep up with industry or other services. You can't heal a broken leg 2% faster every year. You can't treat diabetes 2% more efficiently every year. But if productivity gains in health care constantly lag behind other sectors, prices must rise or doctors and nurses must starve. In a way, computers and robots cause your health insurance cost to rise.

2) The German health insurance system dates back to the late 19th century and was set up as a system of insurance collectives, or non-profits. And their administrative overhead is something like four or five percent of premiums; they pay out an average of 95 cents on the euro. That's difficult to compete with if you need to keep the shareholders happy. So, in the mid-nineties, the conservative German government decided to liberalize the market and allow private health insurance. That would flush billions every year into insurance companies and thus capital markets, which is good for the economy. And as a little welcome present they bought mandatory private insurance for all civil servants.

At first, the market boomed. Private insurers found millions of customers, drawn by low premiums and the promise of being "first-class" patients, because private insurance offered extra services and procedures (which were then routinely performed by doctors and hospitals, often regardless of medical necessity, but that's a different topic). And the customers the insurers were going after were young, healthy wage-earners, for obvious reasons. Anyone over fifty or sixty or with existing health conditions didn't get these sweet deals. They were stuck with the non-profits, raising costs for everyone else.

Fast forward thirty years. Since average health costs of thirty-somethings are almost negligible but begin to rise sharply at over fifty and explode for septuagenarians, you don't really have to be a financial wizard to anticipate rising industry costs in the 2000s and costs exploding after 2010. Which they did. Every intern could have told the companies back then that they would need to build reserves for the days when their early customers turned sixty. Which they didn't, and why would they? Who cares about what happens thirty years later? The only other way to cover these huge costs would have been a constantly growing customer base, but like every other Ponzi scheme, this one had run its course already.

The situation now is that private insurers, bleeding money, reduce services where they can and getting them to pay for an ingrown toe-nail is an uphill fight. Customers try to get out of their contracts and get back into the old non-profit system. Funny thing is, though, that except for one catch-all insurer, the one with the worst health plan, the non-profits are not required to sign up anyone who previously opted out of the system.

It's all a bad hangover.

[Newfie]

If you think about it for a second you will realize we DO have a single payer system in the USA. It's the taxpayer. If you have a good job part of your compensation is health care. But you also get to pay taxes which underwrite all those poor folks who don't have employee health care. It's why we have an incredibly INNEFFICIENT and STUPID method of redistributing the money.

Trump has a golden opportunity. The Ds put up ACA. It tried to improve and did some good but has a lot of problems. Trump needs to provide a new or modify the existing system to provide better care. He just needs to fix bad parts without wrecking good parts. ACA leaves a lot of opportunity to do that.

I'm hoping Trump can get congress to support him in this. We shall see.

[salinsky]

For a better understanding of the health care problem, take the time to read this.

http://market-ticker.org/

SAL

[GoghGoner]

Like Chris, maybe the Republicans will start calling it ACA instead of Obamacare. That way they can say they fixed it, Obamacare is now gone. Haha. All of these comments in this thread have been made before and will be made again. We ain't going Canadian and we ain't fixin' nothing.

[ROCKMAN]

Not unsympathetic to the 3 circumstances Paulo described. But he's not correct: in all those cases (and any other cases one wants to toss in) would have been covered by insurance...had they been insured. Which goes to the problem I have with covering preexisting conditions: if a person had insurance prior to developing the condition they it would have been covered. Granted an extreme example but none the less very possible: a person is born and is never convered by insurance for a single day. IOW never contributed a single penny to the insurance pool. And then when 60 years old develops a serious medical condition. Then pays a monthly premium of, let's $1,500, and then runs up a $200,000 medical bill.

Why would anyone pay for insurance coverage if they can wait till they have a problem to sign up? What if car insurance was handled that way? Of course there's a problem with the poor who just don't have the funds to pay for insurance. Later on that issue.

But what about folks that have the money but chose not? Same problem with folks that don't carry mandatory auto ins. in Texas. Which is why I pay a bit more for my auto ins. for a uninsured motorist rider. The state tries to minimize that situation by not issuing either yearly inspection and registration certificates without proof of ins. But you can still get hit by a drunk with no license, ins or registration so if you're smart you still pay for an uninsured driver rider.

I'll assume everyone understands the basic concept of insurance: you put in more then you get out...on average.

[Outcast_Searcher]

$this->bbcode_second_pass_quote('Paulo1', '
')Two operations later, and after a short stay in hospital I returned to work. If I had been a US citizen we would have lost our house. As a Canadian living with single-payer I did not receive a bill.

[ROCKMAN]

And to emphasize Outcast's point prior to the ACA coming into effect 84% of Americans were covered by some form of health insurance. And since ACA went into effect the insured have increased from 84% to 86.6%. From:

https://en.m.wikipedia.org/wiki/Health_ ... ted_States

"These changes took effect March 23, 2012. The Commonwealth Fund reported in July 2014 that an additional 9.5 million people aged 19–64 had obtained health insurance, roughly 5% of the working-aged population."

[MD]

I stopped buying health insurance in 2013.

I'm just playing the system as it stands now.

Why would I pay ridiculous premiums for something I don't use? My medical costs last year were under $700 CASH, and I don't pay any penalty.

So if I get in an accident or suddenly come down with something deadly? I will sign up on the spot, or die. No big deal.

In the mean time all you ignorants can have your doctor's offices full of snot-nosed kids with colds there to have useless antibiotics pumped into their systems, or as mentioned above, unhealthy Americans with terrible lifestyle choices that are addicted to pharmaceutical industry cures.

Good grief what a mess.

And yes, to answer those with misdirected heartfelt empathies: I will cry and be hurt and sad if anything bad happens to me or mine. But I won't wail and rail against the healthcare system.