The underlying cost of healthcare continues to be ACA's Achilles heel
Jackson_Fusion said:
ridski said:
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
The only question is whose labor will pay for it, yours or someone else's.
Totally wrong answer.
UNIVERSAL HEALTH CARE IS THE SOLUTION.
mikescott said:
Jackson_Fusion said:
ridski said:
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
The only question is whose labor will pay for it, yours or someone else's.
Totally wrong answer.
UNIVERSAL HEALTH CARE IS THE SOLUTION.
Its a help but not the solution. Cost control is.
As I've commented previously linked in this thread, with links to comparative studies, U.S. healthcare costs exceed EU and other first world countries costs from three to twenty times.
And don't tell me that if more are insured costs will be contained. We heard that with Obamacare.
Jackson_Fusion said:
The only question is whose labor will pay for it, yours or someone else's.
I don't accept this as the choice we are facing. We need the will to demand that insurance companies work for us, not vice versa. We need laws and enforcement. And government does have a monopoly on writing laws and enforcing them, and no one has come up with an alternative, and that's fine with me. Government doesn't necessarily need to be in the health insurance business. But whoever our insurers are, they need to respond to our needs, and one of our needs is a freedom from price gouging. Some medications and procedures are not luxuries and are necessary for life. They should not be priced out of reach.
Tom_Reingold said:
Jackson_Fusion said:
The only question is whose labor will pay for it, yours or someone else's.
I don't accept this as the choice we are facing. We need the will to demand that insurance companies work for us, not vice versa. We need laws and enforcement. And government does have a monopoly on writing laws and enforcing them, and no one has come up with an alternative, and that's fine with me. Government doesn't necessarily need to be in the health insurance business. But whoever our insurers are, they need to respond to our needs, and one of our needs is a freedom from price gouging. Some medications and procedures are not luxuries and are necessary for life. They should not be priced out of reach.
As far as I know, pricing of meds is based on expenses incurred by the particular BigPharma producing the meds. Such as materials, overhead, R&D, costs of litigation, etc. Your proposed standard of "[drugs] should not be priced out of reach" is quite utopian* (but as far as I can tell unworkable).
*- I understand that some of BigPharma have patient assistance programs which offer limited assistance to a small number of needy people. It appears these BigPharma programs are merely "window dressing."
Tom_Reingold said:
Jackson_Fusion said:
The only question is whose labor will pay for it, yours or someone else's.
I don't accept this as the choice we are facing. We need the will to demand that insurance companies work for us, not vice versa. We need laws and enforcement. And government does have a monopoly on writing laws and enforcing them, and no one has come up with an alternative, and that's fine with me. Government doesn't necessarily need to be in the health insurance business. But whoever our insurers are, they need to respond to our needs, and one of our needs is a freedom from price gouging. Some medications and procedures are not luxuries and are necessary for life. They should not be priced out of reach.
Tom, too hard to define what is out of reach and even harder to decide which procedures should be done. Most health insurance carriers operate on thin margins and one of the reasons so many pulled out (and the trend started long before Obamacare). Health insurance needs regulations and it needs cost controls but both are hard to implement and there will be people who will be disappointed. However, Everyone should have health insurance.
Tom_Reingold said:
Jackson_Fusion said:
The only question is whose labor will pay for it, yours or someone else's.
I don't accept this as the choice we are facing. We need the will to demand that insurance companies work for us, not vice versa. We need laws and enforcement. And government does have a monopoly on writing laws and enforcing them, and no one has come up with an alternative, and that's fine with me. Government doesn't necessarily need to be in the health insurance business. But whoever our insurers are, they need to respond to our needs, and one of our needs is a freedom from price gouging. Some medications and procedures are not luxuries and are necessary for life. They should not be priced out of reach.
2 years ago a "necessity of life" didn't exist. Then a company came up with a cure for Hep C. One pill! Nearly 100% effective. Millions of lives will be saved. What did they charge for this miracle? $84k. They were crucified.
Gilead just announced a 3rd competitor in the space. Prices are down to $74k.
If there is a violation of the Sherman Act among insurance companies, file suit or start a competitor.
Jackson_Fusion said:
ridski said:It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
The only question is whose labor will pay for it, yours or someone else's.
You may have better alternatives if you quit your job, as well as the freedom to pursue them without family or other obligations. The question is whether everybody does.
Either you work for some boss or you work for some other boss in your scenario. The problem is that health insurance is tied to working for others. It discourages entrepreneurship and self-employment. In and of itself the US employment based insurance system is a job killer and the first wall built to contain the American Dream, but it's all okay, as long as we can exchange one cubicle for another and say we're doing better, right?
Jackson_Fusion said:
ridski said:
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
The only question is whose labor will pay for it, yours or someone else's.
In my best Mr. Blonde voice- I don't have a boss. I do have someone who pays well for my services- and if someone offers a better package, adios.
Entrepreneurs work for people, too. If they think they don't, they're not entrepreneurs, they're either trustafarians or on the dole.
What a fractured view of success- where one sits!
In any case- I get people want something at a price they're willing to pay. I also get that some people, if they can't bring the price down, they'll look for someone else to pay it, and they'll support anyone who says they'll help make that happen. It's great for getting votes. It's terrible for business, and in this case the consequence is fewer miracles.
The history of how employer sponsored health plans came to be "a thing" is interesting. Government causes a problem and is right there with another solution. And it's always the same solution.
Something to consider- maybe. Of all areas of the economy, advances in healthcare has the biggest impact for the most people- and it's forever. As you move forward and slay demons, they stay, for the most part, slain. You want the best... THE BEST... Working there.
But the best don't come cheap. About a decade ago there was much handwringing that a huge portion of kids coming out of Ivies were going into finance and "social" tech- structured finance & hedge funds in general, and quants in specific on one side, and tons off to the Valley to make apps that will be forgotten in 2 years. Smart kids. They looked at their opportunity set and saw that the most money could be made outside medicine. So they're bad guys, whatever! They're smart "bad guys", and if they want filthy lucre to go slay demons, pay them. Don't tell them "if you create a hugely successful drug, at equally huge risk, and it works too well, someone will decide its critical to humanity and take it from you, and call you horrible things to boot." Why bother? Go into PE. Go make Facebook. People will deify you.
ridski said:
Either you work for some boss or you work for some other boss in your scenario. The problem is that health insurance is tied to working for others. It discourages entrepreneurship and self-employment. In and of itself the US employment based insurance system is a job killer and the first wall built to contain the American Dream, but it's all okay, as long as we can exchange one cubicle for another and say we're doing better, right?
Jackson_Fusion said:
ridski said:
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
The only question is whose labor will pay for it, yours or someone else's.
BG9 said:
mikescott said:
Jackson_Fusion said:
ridski said:
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
The only question is whose labor will pay for it, yours or someone else's.
Totally wrong answer.
UNIVERSAL HEALTH CARE IS THE SOLUTION.
Its a help but not the solution. Cost control is.
As I've commented previously linked in this thread, with links to comparative studies, U.S. healthcare costs exceed EU and other first world countries costs from three to twenty times.
And don't tell me that if more are insured costs will be contained. We heard that with Obamacare.
I believe that the rate of increase in total healthcare costs HAS been significantly slowed with Obamacare. But the cost shifting that has occurred makes that not apparent to most of us because we are getting hit with higher premiums or dedutibles or both. I don't know if this is just the insurance companies taking advantage of the situation (certainly some of that at least) or other factors, but more needs to happen.
The biggest problem with the ACA is that it should have been considered as a start and then work done to tweak and improve it. Instead, there has just been obstruction and attempts to cripple or repeal it. No major legislation of this sort was ever gotten right the first time. In fact they are all (Social Security, Medicare ... ) still evolving but I think that most people would tell you that they like their Social Security and Medicare, warts and all.
I think that the "public option" should have been included. And, it still could and I believe that this (in some form) is in some of the candidate platforms. If this provided competition to result in better cost control, that would be great. If it drove other insurance carriers to pull out (as some are doing now anyway) then perhaps we would be left with "Medicare for all" which I think would likely be a good thing.
We also need for the government to have the power to negotiate drug prices for Medicare and other government healthcare programs that exist now or may exist in the future. The fact that big Pharma was able to block this is telling and a big part of the current cost problem.
terp said:
They were hemmoraging $$ too with these activities. I think Aetna's lost over $400 Billion.
Relying on the young and healthy to sign up to fund the old and sick isn't going to work unless you really punish the young and healthy for not signing up. It's that simple.
The ACA was an attempt to get an entitlement without a new perceived tax. It is failing miserably. But of course, the geniuses that decry anyone who was against it think we just need more government.
Just to be factual, Aetna lost about $340 million, not billion.
dianaid said:
terp said:
They were hemmoraging $$ too with these activities. I think Aetna's lost over $400 Billion.
Relying on the young and healthy to sign up to fund the old and sick isn't going to work unless you really punish the young and healthy for not signing up. It's that simple.
The ACA was an attempt to get an entitlement without a new perceived tax. It is failing miserably. But of course, the geniuses that decry anyone who was against it think we just need more government.
Just to be factual, Aetna lost about $340 million, not billion.
As if that's important.
sac said:
BG9 said:
mikescott said:
The only question is whose labor will pay for it, yours or someone else's.
Totally wrong answer.
UNIVERSAL HEALTH CARE IS THE SOLUTION.
Its a help but not the solution. Cost control is.
As I've commented previously linked in this thread, with links to comparative studies, U.S. healthcare costs exceed EU and other first world countries costs from three to twenty times.
And don't tell me that if more are insured costs will be contained. We heard that with Obamacare.
I believe that the rate of increase in total healthcare costs HAS been significantly slowed with Obamacare. But the cost shifting that has occurred makes that not apparent to most of us because we are getting hit with higher premiums or dedutibles or both. I don't know if this is just the insurance companies taking advantage of the situation (certainly some of that at least) or other factors, but more needs to happen.
It may have slowed but last year healthcare costs increased 5.3%. A much higher rate than the rate of inflation. That rate causes a cost doubling in 13 to 14 years.
http://www.thefiscaltimes.com/2015/12/03/Federal-Health-Care-Costs-Surge-17-Percent-GDP
Acording to Kaiser's chart, lot of the cost is being shifted to the insured. Yet, the chart show that even with that shift insurers are showing a consistent increase in their cost( paid by insurance).
http://www.healthsystemtracker.org/insight/payments-for-cost-sharing-increasing-rapidly-over-time/
What we need is not just a slowing in the rate of increase. We need significant cost cutting for the same services. Can anyone really excuse why comparable healthcare costs here are three to twenty times higher?
Would be helpful if the chart broke down where the increases have been coming from. I am guessing the largest increase has been for prescription drugs.
There is no simple answer to the problem but I think everyone recognizes we have a huge problem. A public option (Medicare) should be added to Obamacare.
Since part of the premise of Obamacare was to require everyone be insured or pay a penalty. I would suggest the penalties for younger people was way too low. We require everyone owns a car to have auto insurance, so not sure why it is so difficult for people to understand it needs to be the same for health insurance if we want private insurers to be the primary source of health insurance. The penalty for not signing up should be at least 50% of what the premiums would be. And of course for those who can't afford the cost has to be subsidized by those who can pay (just like we do with the uninsured autos).
Jackson_Fusion said:
ridski said:
Jackson_Fusion said:
Insurance carriers can be fired. Government cannot. If my health care sucks that bad I go to an employer with better benefits.
Only in America is quitting your job the answer to cheaper insurance.
It's also the answer to better work environment, better pay, more vacation, better benefits, better educational opportunities, better lifestyles...
The only question is whose labor will pay for it, yours or someone else's.
Yeah, because finding a new job is sooooo easy.
Yikes! 
Price and profit regulation are not new ideas at all. They have been done in many places at many various times, and they work. Why are people saying they are too hard?
There is enough money in our economy to bring everyone to good health. Yet we haven’t resolved to bring it to everyone. All we need is the will to do it. It’s clear enough to me, and I hope to everyone else, that it would be an investment in society that would bring increased prosperity to everyone. A healthy person brings more value to society than an unhealthy one. If a person can’t afford adequate healthcare, it is not a moral failure to be poor. We just have to figure out a decent distribution system, and that can be government funded or through private enterprise. For either way to work, it has to be done well, and there is potential for it to be done badly by either mechanism, too.
As I’ve observed, the nation is not ready for the idea of government funding and distributing most of our healthcare. Let’s go with this as a premise. If we are to have a healthcare system, it should be decent and available to everyone. There are enough doctors in most places. There are enough drugs and companies making them. Until recently, there were enough hospitals, and we could get there again. It seems like a very few hospitals and very few pharmaceuticals are getting legislation and enforcement done on their behalfs. The new drug price trend could be said to be gouging patients or the insurance companies. Either way, I don’t see why we should tolerate that.
I’ve heard the term “wealth transfer” used to refer to taxes paying for services that people can’t afford to buy for themselves. But this takeover of the medical industry is an enormous wealth transfer, from the many to the few. Is this what we want? Some people are prosperous beyond most people’s dreams, and the way we have made this happen is by denying an increasing number of people adequate healthcare. If you don’t think there is a cause and effect, tell me where I’m wrong.
I am perfectly fine with coming up with amounts of money that are obscene and unconscionable. When people who become that wealthy have the power to make people’s lives decent on a grand scale and they choose not to, they don’t deserve anything from us, and currently, we are giving them quite a lot so they can have their yachts and helicopters. We are living shorter and less healthily than an increasingly shrinking fraction of the population. The infant mortality rate is rising in a great fraction of the population, and that fraction is growing. We have the resources to turn these trends around. Will we? We need advocacy and activism to change it. We need to talk about how we want society to look.
The moral failure is to say it's good enough for me, so I'm cool with how it is for everyone else. The moral failure is the failure not to say, "This is messed up. Let's fix it." The moral failure is to say price or profit regulation is off the table. If we want to run the industry by the profit motive, fine, but regulations will be needed to make it work.
Seriously guys. The only solution here is full government control. Remember when the greedy capitalists decided that they were going to jack up the prices of chairs? For a long time people could not afford to sit. Then they decided, upon their own accord mind you, to jack up the price of shoes. For a long time people were forced to walk barefoot! Only the rich could afford footwear.
While that seems unbelievable, people were only able to sit with shoes on once the saintly government bureaucrats who's only goal in life is to stop the capitalists stepped in and added thousands and thousands of regulations. Price ceilings and price floors are the only answer.
Just ask Venezuela. Price Controls. Only government can decide the right price for goods.
terp said:
Seriously guys. The only solution here is full government control. Remember when the greedy capitalists decided that they were going to jack up the prices of chairs? For a long time people could not afford to sit. Then they decided, upon their own accord mind you, to jack up the price of shoes. For a long time people were forced to walk barefoot! Only the rich could afford footwear.
While that seems unbelievable, people were only able to sit with shoes on once the saintly government bureaucrats who's only goal in life is to stop the capitalists stepped in and added thousands and thousands of regulations. Price ceilings and price floors are the only answer.
Just ask Venezuela. Price Controls. Only government can decide the right price for goods.
We have de facto price controls.
The controls are there when government prevents consumers from getting the lowest prices such as drugs from Canada. You can illegally buy the drugs yourself, but try getting insurance to pay for those "illegal" drugs.
You have price controls when only one manufacturer is "licensed" to sell Epi Pens. Ironically, the $600 monopoly price for that pen becomes $100 for the same pen from the same manufacturer in countries that do no have licensed Epi Pen monopolies.
You have price controls when Medicare by law is not allowed to bid for lower priced drugs or allow less costly alternatives from other countries to be imported. Because we have to protect our consumers from drugs Canadian French, Swiss and Germ drugs. It seems only we know how to manufacture safe and effective drugs.
So, if you ask about government price controls - they exist, de facto, as a benefit to the pharmaceutical industry.
Mylan boosted EpiPen’s price amid bonus target for execs
As Mylan (MYL) was jacking up the price of EpiPens over the past two years, the drugmaker was also planning to boost something else: its top executives’ pay.
In 2014, Mylan adopted a one-time incentive plan for about 100 top executives that promised to reward them if the company could reach adjusted per-share earnings of $6 by 2018. At the time, the bonuses were worth $82 million to its five top executives alone, according to The Wall Street Journal.
Since the plan was adopted, Mylan has doubled the list price of the EpiPen, a life-saving allergy treatment whose rapid price increases and current $608 price tag has stirred outrage among parents, lawmakers and health-care advocates.
As the saying goes, "It's not personal, it's business."
I think there's really just two criteria when discussing health care -- quality and accessibility. Cost is important insofar as it's a component of accessibility; if health care costs too much, fewer people can afford it and/or it crowds out other spending.
Improving according to these criteria is always a process, always relative. Employer-sponsored health care was a huge step forward compared to the previous era, making health care accessible to millions more than previously had it. While the U.S. went with that model, we've seen other countries (especially in Europe) try various models that don't tie health care to employment, and compared to ours, they do an even better job of getting quality health care to more people (yes, even the much-maligned UK system beats us -- something to consider).
The ACA has clearly been a huge success making health care available to millions more people. Compared to its more ambitious hopes, though, it has been disappointing. As a model that tried to keep our private-sector health insurance industry viable while expanding access, it was an experiment worth trying. The difficulties private insurers are having suggests that either this model needs more tweaks, or perhaps simply is not possible. Maybe keeping health care accessible and affordable for a country's entire population is simply incompatible with a for-profit model.
I think a lot of conservative critics of the ACA are being pretty intellectually hypocritical. It's one thing to point to where the ACA falls short, if you follow it up with proposals on how to address those weaknesses. Instead, the either propose things that will make things worse, or propose nothing at all, implicitly arguing for a return to the pre-ACA era, which was a worse situation than our current one.
Just because I, or other folks on the left, can't think of a way to deliver universal health care without more government intervention doesn't necessarily mean it's not possible. There's an opening here for conservatives to propose a better way. So long as all their proposals rely on restricting, rather than expanding, health care coverage, though, it really suggests that if you care about universal health care, conservatives have nothing to offer.
PVW said:
The ACA has clearly been a huge success making health care available to millions more people. Compared to its more ambitious hopes, though, it has been disappointing.
PVW said:
The ACA has clearly been a huge success making health care available to millions more people.
Actually, it has not been a great success. Available healthcare that is not usable is not a success.
ACA will pay for something very basic like a preventative visit but for anything else, unless they are really very sick, forget about it. Its the deductibles and sometimes the very limited networks that do them in. Employees that have good well paying jobs have employee healthcare. The ones who need ACA are the ones who don't have much money. The ones working in stores that limit them to 29 hours a week.
They get sick, they get treated and then they find that the first 6,000 or often more of medical expense comes out of their pockets which they usually cannot afford. And this is after paying about $900 a month in premiums for their Bronze plan. I realize our government pays part so they may only pay $100 up to $900 depending on income level. Still, they see $900 has been paid in and when its time to collect 90% will get zip.
About 90% of ACA subscribers will not benefit from their their ACA healthcare insurance, even when needed. 13 million have ACA and are paying in but only about 1.5 million will benefit. A failure.
I find the biggest supporters of ACA are well-to-do smug liberals who don't have it and the really very sick who are in dire need.
ps - the general uselessness of ACA is one reason why the medical bankruptcy rate has not gone down.
I think you are ignoring the many who now qualify for medicaid who did not before. And I think you are greatly underestimating the benefit of having even basic health insurance if previously you had none.
As a liberal, I share many of the disappointments you've outlined here. I think many (not all!) of those in the individual market still pay too much for too little. Compared to what they had before, it's an advance, but compared to what is within our ability as a nation to provide, it's in many ways a disappointment.
But again, this is a liberal critique. Conservatives who criticize the ACA for not doing enough, while offering or implying that it should do less (eg Republican governors refusing medicaid expansion) don't really have a leg to stand on.
ETA - basically I agree with Sarah Kliff:
The health care law has undoubtedly driven America’s uninsured rate to an all-time low. Twenty million more people have health insurance because of Obamacare. If you’re someone who cares about expanding coverage, this is a big win.
But it's still true that the law is a far cry from what health wonks envisioned just a few years ago when they saw the health care marketplaces reshaping the industry. And if your key priority with Obamacare was building a more consumer-centric insurance marketplace, then the law is quite clearly falling short — and possibly on the path to failure.
BG9's facts and figures above may hold true in his/her experience. However, based on personal/family experience, let me throw in:
- $350/month for Silver plan, with no subsidy ($350 is the total premium), single person.
- Even though deductible is biggish ($4,500 in network PLUS $9,000 out of network), we find we're still benefiting big time, because of the price reductions contracted with providers, so far 50% or more off the "list price." E.g., on a $10K hospital visit, the insurance paid $5K before our responsibility kicked in; $300ish dr. visits cost us less than $50.
- The network is pretty big, largest or second-largest "group" in the area, including hospitals, clinics, docs and specialists, lab, PT, OT, etc.
Note on viability of insurers: our insurer is a local start-up co-op. Under the ACA, they were to receive $xxx in federal funds over I think 3 years to help them get started. They based their business plan on that expectation, then Congress in its wisdom cut the amount by 80% or 90%, so naturally they are hanging on for dear life. btw, this was not a bunch of starry-eyed, inexperienced do-gooders. Top management and planning came from established insurance firms and providers.
happy Labor Day, all, and may we all soon see a medical system where the first thing that happens in the case of serious illness is NOT that you lose your insurance/access because you can't work.
BG9 said:
ps - the general uselessness of ACA is one reason why the medical bankruptcy rate has not gone down.
I skipped over this point since I hadn't read any reporting on this, but are you sure that's true? I got curious after I saw you post this, and found reports that seem to contradict this. Eg, in the NYT, Obamacare Seems to Be Reducing People’s Medical Debt
Nut graf:
A new study is showing that, by giving health insurance to low-income people, Obamacare seems to have cut down on their debt substantially. It estimates that medical debt held by people newly covered by Medicaid since 2014 has been reduced by about $600 to ,000 each year.
Though I guess it's possible both that the medical bankruptcy rate has held steady even as the total debt owed has gone down? I know you through that in as a "ps," but I'd be curious as to further context and sources.
PVW said:
BG9 said:
ps - the general uselessness of ACA is one reason why the medical bankruptcy rate has not gone down.
I skipped over this point since I hadn't read any reporting on this, but are you sure that's true? I got curious after I saw you post this, and found reports that seem to contradict this. Eg, in the NYT, Obamacare Seems to Be Reducing People’s Medical Debt
Nut graf:
A new study is showing that, by giving health insurance to low-income people, Obamacare seems to have cut down on their debt substantially. It estimates that medical debt held by people newly covered by Medicaid since 2014 has been reduced by about $600 to ,000 each year.
Though I guess it's possible both that the medical bankruptcy rate has held steady even as the total debt owed has gone down? I know you through that in as a "ps," but I'd be curious as to further context and sources.
That's Medicaid and there ACA did help because more are eligible for that program.
But I was talking about non-Medicare ACA subscribers, the ones who have to pay that deductible. I just downloaded the database, ran it and see currently its 87% of ACA subscribers who can't collect. Which is why I was talking about the high deductibles doing them in. Medicaid covers deductibles.
That doesn't mean insurers are making money. There are too many in that 13% category who have $100,000 or more in yearly medical expenses. Which is the really sick signing on and then dropping ACA if their medical issues are resolved.
Just received an interesting story about an extreme case of cost difference between here and foreign countries. Someone who had four rabies shots. Two in Thailand, $18.50 at a clinic and $125 at a hospital. The third and fourth shots were done here. They were $427 at a medical group and $5,254.85 at a hospital. Its crazy.
http://www.latimes.com/business/lazarus/la-fi-lazarus-rabies-vaccine-prices-20160906-snap-story.html
ps - Joe or Jane Blow who work at the crappy job that does not have health coverage will never be able to afford that silver or gold plan. Hopefully they are eligible for Medicaid. So they're stuck with the Bronze plan whereupon they usually discover they're still on the hock. Then some wonder why the low paid healthy are resistant to signing up for ACA. Their only real motivation is the penalty. If ACA was really so wonderful, a penalty would not be needed to "motivate" subscribers.
I wonder how many here, who are touting ACA, would switch from their employers plan to ACA given the option.
PVW said:
I think there's really just two criteria when discussing health care -- quality and accessibility. Cost is important insofar as it's a component of accessibility; if health care costs too much, fewer people can afford it and/or it crowds out other spending.
Improving according to these criteria is always a process, always relative. Employer-sponsored health care was a huge step forward compared to the previous era, making health care accessible to millions more than previously had it. While the U.S. went with that model, we've seen other countries (especially in Europe) try various models that don't tie health care to employment, and compared to ours, they do an even better job of getting quality health care to more people (yes, even the much-maligned UK system beats us -- something to consider).
Exactly how was Employee-sponsored health care a huge step forward? This was done to get around World War 2 wage controls. This had the effect of raising prices . This caused issues for people who could not get healthcare from their companies, including retirees.
To combat this situation, the Johnson Administration passed Medicare and Medicaid. This put further upward pressure on healthcare prices. This has continued today w/ bandaid approaches HMO's/Patient Bill of Right until the ACA.
This is the classic example of the great Ludwig Von Mises quote:
Every government intervention [in the marketplace] creates unintended consequences, which lead to calls for further government interventions..."
It is delusional to think linking Healthcare to Employment to get around government wage controls is a huge step forward.
PVW said:
The ACA has clearly been a huge success making health care available to millions more people. Compared to its more ambitious hopes, though, it has been disappointing. As a model that tried to keep our private-sector health insurance industry viable while expanding access, it was an experiment worth trying. The difficulties private insurers are having suggests that either this model needs more tweaks, or perhaps simply is not possible. Maybe keeping health care accessible and affordable for a country's entire population is simply incompatible with a for-profit model.
I think any rational person should be really really worried about the ACA and its effects on healthcare and the economy. Socialist schemes tend to work pretty well in the short term. Usually it takes some time until the cracks start to show in the dam.
Take Social Security for example. That was looking really promising early. The first retirees got a tremendous return on their "investment". However, as time goes on the $$ necessary to keep the program afloat increases and benefits will be cut. It is no longer a good deal for people and is getting worse.
The ACA has Insurance companies pulling out. Most of the Coops have closed. People have less choice with higher premiums and deductibles. The young and healthy are not signing up.
PVW said:
I think a lot of conservative critics of the ACA are being pretty intellectually hypocritical. It's one thing to point to where the ACA falls short, if you follow it up with proposals on how to address those weaknesses. Instead, the either propose things that will make things worse, or propose nothing at all, implicitly arguing for a return to the pre-ACA era, which was a worse situation than our current one.
Just because I, or other folks on the left, can't think of a way to deliver universal health care without more government intervention doesn't necessarily mean it's not possible. There's an opening here for conservatives to propose a better way. So long as all their proposals rely on restricting, rather than expanding, health care coverage, though, it really suggests that if you care about universal health care, conservatives have nothing to offer.
Na. The hypocrisy is on the left. They assured us they knew what was best for us. They assured us that we could keep our health plans. They lied. They called it a penalty. They called it a tax. What they called it depended on what was more convenient to call it. We are all poorer and less free for it.
Before the ACA was passed what many people said was going to happen is exactly what happened.
You try to run our lives and the result is that you make us poorer and sicker. Then you call us hypocrites for asking you to stop. That is dishonest, evil and yes hypocritical.
All of your proposals restrict individual rights, yet do not expand healthcare. Your proposals actually limit access to healthcare.
Let me ask you a simple question. If you increase the demand for a product but continue to limit the supply, what is likely to happen to the price of that product? The answer is simple. It is one you are unlikely to answer.
i know you don't like answering my questions, though you will carry on when I don't answer all of yours. Hypocritical?
Tom_Reingold said:
Yikes!
Price and profit regulation are not new ideas at all. They have been done in many places at many various times, and they work. Why are people saying they are too hard?
There is enough money in our economy to bring everyone to good health. Yet we haven’t resolved to bring it to everyone. All we need is the will to do it. It’s clear enough to me, and I hope to everyone else, that it would be an investment in society that would bring increased prosperity to everyone. A healthy person brings more value to society than an unhealthy one. If a person can’t afford adequate healthcare, it is not a moral failure to be poor. We just have to figure out a decent distribution system, and that can be government funded or through private enterprise. For either way to work, it has to be done well, and there is potential for it to be done badly by either mechanism, too.
As I’ve observed, the nation is not ready for the idea of government funding and distributing most of our healthcare. Let’s go with this as a premise. If we are to have a healthcare system, it should be decent and available to everyone. There are enough doctors in most places. There are enough drugs and companies making them. Until recently, there were enough hospitals, and we could get there again. It seems like a very few hospitals and very few pharmaceuticals are getting legislation and enforcement done on their behalfs. The new drug price trend could be said to be gouging patients or the insurance companies. Either way, I don’t see why we should tolerate that.
I’ve heard the term “wealth transfer” used to refer to taxes paying for services that people can’t afford to buy for themselves. But this takeover of the medical industry is an enormous wealth transfer, from the many to the few. Is this what we want? Some people are prosperous beyond most people’s dreams, and the way we have made this happen is by denying an increasing number of people adequate healthcare. If you don’t think there is a cause and effect, tell me where I’m wrong.
I am perfectly fine with coming up with amounts of money that are obscene and unconscionable. When people who become that wealthy have the power to make people’s lives decent on a grand scale and they choose not to, they don’t deserve anything from us, and currently, we are giving them quite a lot so they can have their yachts and helicopters. We are living shorter and less healthily than an increasingly shrinking fraction of the population. The infant mortality rate is rising in a great fraction of the population, and that fraction is growing. We have the resources to turn these trends around. Will we? We need advocacy and activism to change it. We need to talk about how we want society to look.
The moral failure is to say it's good enough for me, so I'm cool with how it is for everyone else. The moral failure is the failure not to say, "This is messed up. Let's fix it." The moral failure is to say price or profit regulation is off the table. If we want to run the industry by the profit motive, fine, but regulations will be needed to make it work.
The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design. To the naive mind that can conceive of order only as the product of deliberate arrangement, it may seem absurd that in complex conditions order, and adaptation to the unknown, can be achieved more effectively by decentralizing decisions and that a division of authority will actually extend the possibility of overall order. Yet that decentralization actually leads to more information being taken into account. - FA Hayak
Terp: First off social security would still have a great return if the government had stopped "borrowing " the money for other purposes. (and this has been a bipartisan ).
Second, the ACA is the republican version of the healthcare reform proposed by Obama. He agreed to go with the Romney plan -- and every Republican candidate except for Rand Paul during the 08' primary season said they were in favor of health care reform. you are trying to change the history of how we have gotten to where things are and blaming one party. If there is any blame to be placed it is on the Bush/Cheney administration for deciding to go to war for no reason and ignoring the health care crisis. 8 wasted years.
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My understanding is that one of the macro problems with BigPharma, and its pricing, is that BigPharma spends R&D all over the world and then, disproportionately allocates such R&D expenses to the US (thereby raises their costs for US pricing purposes and thus, BigPharma's justifiable pricing points in the US are pushed upward). Imagine 60 to 80 percent of worldwide R&D costs being allocated to the US.
Thanks for the Big Pharma R&D number of $52 billion (do you have support or source for that number)?