ACA Agonistes
Insurance Discrimination: It’s Baaack
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  • Corlyss

    i.e., the usual suspects demanding that the government give the public everything for free.

    • Andrew Allison

      I think that the real problem hear is the refusal to recognize that we simply can’t afford top quality health care for everybody. Attempting to do so will simply drive insurance premiums up to the point that insurance becomes unaffordable for those not getting subsidies.

      • rheddles

        And we can’t afford top quality cars for everybody. Or top quality computers. Or top quality anything.

        drive insurance premiums up to the point that insurance becomes unaffordable for those not getting subsidies.

        That’s a feature, not a bug.

      • f1b0nacc1

        While I agree with your assessment, let me point out that those (particularly politicians) who remind people that they we cannot provide unlimited quantities of high-quality healthcare for everyone typically experience strongly negative responses to this observation.

        • Andrew Allison

          I’m sure you’re right, although I’m not aware of any politician actually doing that! All we get from them is creation of unfulfillable expectations, hence this week’s news that 36% of Americans over the age of 18, and 14% of those over the age of 65, have no retirement savings. Now that the previously uninsured have some insurance, they want more coverage than they are paying for. Why should people who are getting an average 80% subsidy care how high the premiums really are?

          • f1b0nacc1

            Because we tell them that they deserve it!

          • Andrew Allison

            Nope, they’re told that they’re ENTITLED to it, whether they deserve it or not.

  • Suzyqpie

    I agree. ACA, aka, 0bamaCare has created a debris field. No one should be surprised. The Democrats passed a 2400+ page unread bill, then the bureaucracy blew it up to 10,535 unread pages all the while the Democrats lied about various aspect of what the bill would do. ACA, aka, 0bamaCare has, however as planned, been great for Wall Street. Since 2010, share values have doubled for Cigna, Well Pt, Humana, United Health, and Aetna. So we have that going for us. Thanks, 0bama!

  • ljgude

    The problem is to base the entire healthcare system on private for profit insurance companies. Thier first duty, indeed their fiduciary duty, is to be profitable. Unsurprisingly entirely insurance based systems are more expensive because every transaction has to have a profit component. The second most expensive system after the US is Switzerland which spends 11% of GDP on healthcare and is the only other completely insurance based system. The OECD average is a bit below 10% while the US went into the ACA spending 16%.http://pgpf.org/Chart-Archive/0006_health-care-oecd All these other countries employ a combination of government healthcare acessable to all and a private system accessible through insurance. None of these is perfect but they produce better health outcomes at at about half the price. The ACA is what is to be expected if you turn over healthcare reform to the party of big business.

    • Andrew Allison

      All the other countries provide a system government-sponsored health INSURANCE. Some of them leave the provision of healthcare services to the private sector (that’s the only model which could work in the US, but which would be fought tooth-and-nail by the, highly lucrative, private insurance industry).
      p.s. The Democratic Party, which passed ACA without a single Republican vote, is not usually considered to be the party of big business, but the doubling of insurance company market value since passage suggests that perhaps it should be renamed the party of the healthcare industry.

      • ljgude

        Correct me if i’m wrong but I think you emphasize the word INSURANCE to preclude the incorrect notion that ‘free government provided healthcare’ is actually free. And fair enough. I think the root of the problem lies in that human health does not respond to market forces the way most goods and services do. The invisible hand is absent until it smacks you up side the head – then you have no choice. Consequently, a lot of healthy people don’t buy insurance and government sponsored universal healthcare really gets around this very human market failure. A case in point happened about 50 yards from my front door. An inexperienced first year driver lost control of her car making a tricky turn in front of traffic and jumped the curb hitting two young teenage girls. One was thrown about 15 yards onto some railroad tracks and the other went under the car. A gang of us picked the car clean off the second girl in one go and then we waited for the ambulances knowing they would both get the best care Australia had to give and that it had nothing to do with where their parents worked or the level of insurance they had. That is an example of universal healthcare at its best, but on its own it develops certain well known and predictable problems. Waiting lists develop. More subtly such systems are subject to Pournelle’s law which states that the people who work for the good of the clients eventually get pushed out by the people who work for the good of the organization or worse the employees. We saw that in France when a heatwave killed 15,000 elderly people because their carers were all off on the sacred August vacation. The VA in the US shows the same kind of symptoms that any government run healthcare system tends to develop because, I believe, it has no competition. BUT, experience since WW2 has shown that the invisible hand still works at the collective or aggregate level. That is why a dual system works better: specifically a private system on top of a universal public system. It keeps the universal system honest, by providing a private alternative. At the same time the public system keeps the private system honest by not allowing it to charge anything it likes the way the current US system does. Last year WRM had an article about how a Hoboken NJ hospital was one of the most expensive of hospitals despite being in a poor area. More recently WRM published a study purporting to show that a blood test in California costs anywhere between $10 and $10,000 but I suspect the study was flawed simply because it was probably based on quotes.- not actual prices charged. But in any case it is clear that US hospitals can charge just about anything they like and that the pricing is ludicrously disconnected from market forces. The US has a terrible problem in that the entire system is addicted to making twice what systems in other countries operate on. It will be a genius indeed who can pry those very lively fingers off about 7% of the US GDP. And that’s a tidy sum. PS I meant the Democrats being the party of big business ironically. US politics is like going the ball game and discovering that its the Yankees versus the Yankees and that the Yankees always win. Just grand.

        • Andrew Allison

          I emphasized insurance because it is the one thing that all single-payer “healthcare” systems provide. Most, if not all, of them also have private insurance available for those that want it. Many countries, like Australia, also provide medical services (heath care), but some utilize the private sector, in the same way that Medicare does in the US. The only hope of comprehensive, affordable health insurance is single-payer. There’s immense resistance to this from the insurance companies and medical profession. I see absolutely no chance of government-provided medical services coming to pass.

          • ljgude

            Thanks for the reply which makes me realize that I may not understand exactly what ‘single payer’ is. It sounds like it is a complete government monopoly with unilateral control over pricing. But you have made me realize that I don’t fully understand exactly what the difference is between single payer and a fully nationalized healthcare system like the NHS in the UK where the doctors are government employees or Australian Medicare which mre like US Medicare, there is a mix of public and private hospitals with self employed doctors practicing in both. I have never heard the term single payer outside the US context and have always thought it would be a bad idea because it would mean highly rationed care with medical tourism the only way out for many people. But, please, tell me what you can about single payer.

          • Andrew Allison

            In my mind single-payer means exactly that: a single insurer (as in Medicare A & B). Unfortunately, to most in the US it means government-delivered health CARE, which is anathema. The medical profession is opposed to Medicare because it has the power to negotiate prices, the insurance industry because insurance it’s their livelihood, and conservatives on general principles. Simply put, there’s no national consensus as to whether or how health insurance should be universal, or recognition that no economy can support the sort of health care to which the insured have become used for everybody.

          • ljgude

            Thanks, I always have the feeling that it’s advocates mean the power to control prices and that most people hear single provider and therefore fear being stuck with low quality care. Medicare A&B then is single payer system without being a single provider system, no? And Medigap insurance is a way increase choices for those who so desire it and can afford it. In theory a workable system, but subject to the problems we have discussed at length in previous comments.

          • Andrew Allison

            Close. Medicare A&B are, indeed, single-payer not single provider. However, in order to be “universal” (for those over the age of 65), the coverage is limited. Medigap insurance is private insurance for Medicare participants intended to fill the gaps in Medicare coverage. It’s an illustration of the fatal flaw in ACA, namely that you can’t provide full coverage to everybody with affordable premiums.

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