That the ACA largely works. The law absolutely has problems. It hasn’t created the chaotic insurance hellscape you seem have heard it has. It seems from the way you talk about the ACA that you’ve internalised a good deal of the way the law is characterised on the political right (not that the media helps dispel their, so I’m not sure there’s anything that can persuade you otherwise. I figured reading about the law and how it interacts with the markets from someone that actually works on making it work might’ve been helpful.
I mean, 20-odd million more people with access to healthcare over the status quo ante would be considered an improvement by most people seems to me nothing to sneeze at. And it would’ve been even more if Justice Roberts hadn’t re-written it from the bench.
So, chaos…
Some insurance companies, despite being profitable, tried to use Exchange participation as a cudgel to get unrelated concessions from the feds (Aetna/Humana merger). They didn’t get their way, they pulled out. Not the law’s fault.
Some new players in the markets - and even a few that should have known better - had absolutely no clue what they were doing and it’s absolutely unsurprising they’re having problems. (United - I think? - might fall into this category, and Oscar pretty definitely does.) Not really the law’s fault.
A single patient that generates over a million dollars in claims a year when the population of the entire state is a mere 3 millions makes it hard to get companies into the market and design plans that work (hi, Iowa!). Not written into the law, and good luck getting any coverage for this poor young man in the status quo ante. Not the law’s fault.
That huge spike in rates in current filings this year? Is pretty much entirely due to the uncertainty created by the president* and Congress’ actions regarding the future of the ACA. Not the law’s fault.
Etc.
That’s actually quite a problem under the ACA. All of the preventative care type stuff that mandates be no-cost-sharing generally pay off down the line (years down the line) in reduced claims costs. But in the current private market, its virtually guaranteed that the patient will be some other insurance company’s customer (whether through Exchanges or change of employer or what have you) by the time those savings are realized.
California is going to require a shitton of waivers in order to pull off single payer. It may not be possible.
California has a massive problem in the privileges and immunities clause of the Constitution. US citizens can travel between any state without discrimination. So what happens if you live in the other 49 states, have cancer, and (thanks to the GOP) no longer have health insurance? There’s absolutely nothing that stops you from moving to California and becoming a resident. I imagine for most of us, jobless and being alive is better than having a job and a death sentence. Or, you don’t have insurance, you live in Alabama, you to got visit LA and Disneyland, and you have a heart attack. Who pays that bill?
The problem with single-payer is the country pretty much has to go all-in, or really sick folks will flock to the state/s that have single-payer.
I suspect they would do the same thing they do with the free tuition to state schools. You need to live there for a period of time to establish residency before you can use such things.
But you at least have to be accepted to a state school. Again, there’s nothing stopping someone from moving to California, living there a month or two, and filling out the “I live here, give me healthcare” form.
Cancer and no healthcare, so move to california, Cancer, maybe some healthcare if you live long enough, no house, no job, no support network of any sort…
Sure, it sounds okay until you think about it.
Hardly lots of states have residency requirement before you are eligible for any state assistance. It is no different than having to qualify for Medicaid in most place.
Right now if Alabamian goes to Disneyland and get sick he gets sent to a hospital where they treat him and they try and figure out who pays for it. No different than Californian without insurance who goes to Alabama and goes to the hospital.
People without insurance get treated every day for cancer in probably all 50 states.
Hawaii has the nation;s worse homeless problem per capita. Not surprisingly people figure, if I’m going to sleep outside lets do it an warm climate. Depending on their individual situation we either put them in a homeless shelter, or buy them a ticket back home if they have family, but in some case, we provide them with apartments.
This is an issue all state face in one degree or another, CA, TX, and MI face it is with higher education.
I know the problem is complicated, but honestly, the real problem is providers of all sorts just gouging the shit out of the payment system wherever feasible. It’s like making medical devices and drugs is a license to print money, they’ve gotten used to that, and they’re going to wail and gnash their teeth at anything that tells them, sorry, you’re just gonna make less money. They just have to or the country will be broken by the costs.
The feds are the only ones with the fiscal flexibility to pay the costs in the near term (because the federal “debt” is just other people’s super-safe savings, that have never been reneged on), but the the costs have to come down, both what’s being charged for drugs, devices and services, and the need for them in the first place. That also means that governments at all levels have to get serious about incentivizing people to eat better and be more physically active. If everyone got the recommended 150 minutes a week of moderate exercise (5 thirty minute walks ffs, it’s not rocket science), and people (particularly kids) ate proper food in reasonable quantities and weren’t drinking fizzy sugar water all day, our obesity and diabetes problems would be hugely reduced.
You talk about providers but then you move on to explain your statement by using suppliers and pharmaceutical companies which are not… the providers. Many providers simply do a moderate mark-up on the drugs and equipment they purchase to give to patient. Last I check, most of the procedures with high costs in equipment or drugs are either money losers that are done for the good of the community or have minor profit margins at best. Hell some of the equipment everything think is “normal” actually falls under clinical trials under the government payors… also not money makers.
Companies who make medical equipment, software, drugs… aren’t usually described as providers by the way, which is why I am making the distinction.
I know in Ontario that you need to be a resident for 3 months before healthcare kicks in. Unless I had a very early stage cancer (and even then) I don’t think I would be waiting 3 months to get treatment. I suppose the alternative isn’t any better though.
He should meet with someone about that chin. I think his face is slowly melting down his neck. I’m not sure if he just has that much loose skin or it’s a bad picture but that just looks strange.
