Obamacare is worthless

I completely agree. In order to get the system turned around, there needs to be patience… but no one has more than what 4 years of that? There’s all this bitching about the short-sightedness and short-term nature of so many CEO’s as they run companies into the ground to squeeze out a few more dollars for wall street and themselves rather than long-term health… except that’s exactly how the voting populace, well votes too.

Political bragging points and self importance.

Obamacare covers 11.3 million people this year and roughly equal number due to the expansion of Medicaid.
The vast majority of Americans (!~300 million) get their insurance from employer or medicare and the impact on ACA on those forms of insurance was non-existent until last year and pretty minimal even then. Due to things like with waivers and many employers offering healthcare plans that were better than ACA plans. So it is foolish to credit (or blame) the <10% of the population affected ACA for any impact on the rise in healthcare costs. The impacts of the great recession and employers rebelling against the rising healthcare costs are almost certainly a bigger factor in the decrease in healthcare inflation (which started back in 2009) than ACA. As we all know correlation is not causation.

I have zero problems with your girlfriend paying twice as much as the average person. Nor as me as pre-diabetic paying more now and twice as much if I get diabetes. It sucks for your girlfriend who’s likely had little or control over her type 1, but 90% of diabetes is type 2 and this primarily a lifestyle choice. There has to be some incentive for people to take care of themselves and money works. Even at twice the price, healthy people will still subsidize sick people, which is fine that’s the nature of insurance spread the cost of bad result over a lot of people so it isn’t catastrophic for them. Life’s unfair maybe she got more than her fair share of brains or beauty.

But the fundamental problem with healthcare in America isn’t insurance. If we eliminated every single insurance company and all the people in government involved in medical insurance it would drop our cost by 7%. The problem is that your girlfriend had $20,000 deductible and still spent more. It is crazy that giving somebody insulin should cost anywhere near $20K/year. Yet somehow we seem to spend that much. The individual healthcare market was the proverbial canary in the coal mine. Individual policies were unaffordable because health care is unaffordable and without an employer or government agency picking up the tab it became obvious.

I started to respond to Juan about prescription drugs and medicare. Yes, it is problem that Medicare can’t negotiate bulk prices with big Pharma. But the fundamental problem is that US spends $1,150 per person on prescription drugs vs $350 UK (they are the low side in Europe). Is that because drug prices are too high, or US physician over prescribe or both? I don’t know. X-ray, drugs, hospital stays everything in the US is crazy expensive compared to the rest of the world. Let’s not kid ourselves, if only the government provided it would be better isn’t true. Neither the VA nor Medicare provides affordable healthcare.

We also have to stop pretending that not getting access to the best medical care is a death sentence. Tens of millions
of people worldwide have survived untreated diabetes for years, decades and many have lived a normal lifespan. Hell looking at the data it appears that roughly half the folks in West Africa survived Ebola without professional medical assistance. I bet at least 9 out 10 visits to a doctor, provide minimal benefit to the patient. Our bodies have evolved over millions of years to fight disease, heal broken bones etc.

I’m not suggesting we don’t provide treatment for people with diabetes or spend what takes to prevent pandemics. We have to be willing to say we are going to provide you with this level of care, but not the platinum care. Which means reducing end of life care, but also setting limits on other treatment. If no cancer treatment gives a 30% chance of surviving, while the $100K give us a 70% and the $500K gives you a 74% Clearly we spend the $100K for everybody, but maybe the 70-year-old doesn’t get the $500K unless he pays for it. The premmie baby that’s going to require 200K/year in medical costs also requires some tough choices, so lifetime medical caps make sense.

Whatever it’s intention ACA as it exists today does nothing to address the bigger problem of healthcare in the US.

Something something Death Panels.

Driving a car can be a death sentence, so can walking your dog and posting on social media. Should we provide everybody with Teslas, dog walkers with bulletproof vest, and untraceable VPN networks?

I can’t see how this isn’t suggesting that some people’s kids are going to have to die. You can rationalize it away all you want, Machiavelli, but you’re the one who’s saying it.

Plus those who got coverage through the Medicaid expansion, plus kids staying on their parents coverage, and the total goes up to over 20 million people who otherwise would not have had coverage prior to the ACA.

Twice as much for the premiums. For a plan which only covered 30% of her costs, and had a $20k annual deductible.

So what you are saying is that you believe that she should be economically destroyed, due to her genes. Because unlike you, her diabetes is due to an inability for her pancreas to produce insulin, rather than an insulin resistance due to lifestyle choices.

And indeed, that’s what happened. It fairly quickly eroded her savings, which she had acquired over years through living a responsible life. It resulted in complications which are permanent, and will cause her to suffer for the rest of her life.

Oh, and this is a woman who had dedicated her life to helping the underprivileged. She had worked to help homeless families get shelter, putting herself at great risk just to help others she didn’t know. She helped troubled youths who had various behavioral problems, and helped literally hundreds of them over the years, turning kids who would almost certainly have become criminals, or in many cases already had, go into productive lives, actually gong to college and turning things around.

How much value do you think that brought to society? The total amount of money gained from those people she saved being productive, and the reductions in criminal justice costs that would have had to be spent?

The incentive is that diabetes is a terrible disease which will destroy your body, and ruin your life.

Someone who does not grasp that, isn’t going to suddenly grasp it by virtue of a threat that they won’t be able to pay for instance in the future. And as a punishment after the fact, it serves no purpose, because it can’t be undone. A pre existing condition is permanent.

In the past, it was common for diabetes to lead to amputations, blindness, chronic pain, and almost inevitably death.

And no offense, but no, you do not survive type 1 diabetes for years without treatment. Your body cannot produce insulin. That means that you die without regular insulin injections. Prior to the invention of insulin, the mortality rate from diabetes was 100%, with the only treatment being restricted caloric intake diets, which essentially kept a patient alive for a few years at the absolute most, by literally starving then, with daily caloric counts of around 500.

Now, you can say that you do not care about such people, or cancer patients, or any of the other millions of people who suffer from pre existing conditions in the US. But then I ask you, why should anyone care about you? Why should I care about whether you live or die? Or whether someone murders you, and steals your property, or strips you of your liberty?

Yup, I am. In world, where 3 billion people try to survive (and many fail) on less the $2.50/day ($1,000/year), I’d much rather take the resource we spend on keeping that one baby alive to give 200 family $5 day which would save scores of children from starvation and water born illness. Closer to home 200K would provide the funds to give about two dozen opiate addicts a treatment program. It seems clear to me that society benefits from those things or score of other alternative uses of the resource than keeping one baby alive.

Saying that some people are a poor investment of limited resources is a reasonable position, and necessary, though it may be distasteful to think about it in such a way.

If the US wants to save scores of West African children from starvation, it can.

If the US wants to save all the preemie children it can in the US, it can.

If the US wants to fund opiate clinics for every addicted American, it can.

If the US wants to increase the amount of money Americans have in their pocket to spend on things like Playstations and McDonalds, it can.

In fact, it can do the first three things all at the same time. But not all four.

You choose. But spare me the sob story.

I don’t even know how you can say that with a straight face.

Timex

My post was already long enough. I’m not saying that individual healthcare market wasn’t broken pre ACA, it was… I was stuck with Kaiser because of my conditions.

I’m saying that I don’t think it bad that your girlfriends and I have to pay more than a completely healthy person. There should be a cap maybe twice certainly no more than 3x. So assuming she is 30 something she’ll pay $500-600/month not $250-300/month. What’s crazy is that the additional $3,000-4,000 that she pays a year shouldn’t be able to more than pay for insulin and additional doctors appointment or two and various test. I’m pretty sure that rest of the world doesn’t more than $20,000 to treat somebody with Type 1 diabetes. We have to fix that problem.

I think it’s terrible. As Timex already pointed out, she has no say in the matter. It’s not like she could have done anything to avoid Type 1 diabetes.

You say there has to be some financial incentive for people to take care of themselves. Are you aware that those incentives already exist and are encouraged by the ACA? Employers are allowed to offer substantial premium reductions to employees who participate in “wellness programs”. Rather than discriminate based on medical history, they discriminate based on what you are currently doing to maintain your health.

But I suspect if you got what you wished for, you would regret it. My workplace does this, and the incessant monitoring is annoyingly intrusive. My colleagues hate it too. Maybe that’s why in general these programs don’t seem to work. Well, at least they are fair.

Not really, raising healthcare costs are squeezing out discretionary spending for both the working class and government. There is a mountain of data to show that a very small percentage of the population is responsible for a huge amount of the cost in the system.

We celebrate Dr. Carson for separating conjoined twins without a lot of thought if this is the right thing to do. But we absolutely provide an financial incentive to do expensive things like this.

So why is ok for insurance companies to raise rates on virtually any other type of insurance, car, homeowner, workman’s comp, life insurance, based on past history/behavior but not health?

Because one is literally life and death?

It’s why using insurance companies as the front line for health care is a terrible idea and no one does it. Except us because we’re fucking stupid.

We can spend a trillion dollars on a plane that doesn’t really work, but when it comes time to keeping our citizens alive, well then we gotta tighten our belts and let people die because we can’t afford it.

Hell Trump’s plans are going to basically increase the debt by over $7 TRILLION according to some figures, but God-forbid we spend any of that on health care, that would be crazy talk. Our hands are totally tied, nothing we can do guys. It’s so sad. Oh well.

But we’ll have a big beautiful wall!

Does the GOP agree with the fact that he just offered universal healthcare?