ok, so first and foremost, don't go partisan in discussing it, but....
What is the essence of the affordable care act?
As best this poor soul can figure out, there are two basics:
you must have insurance. if you're poor enough, the gov't will subsidize it. if you're not poor enough, the gov't will penalize you for not having it.
the act makes it easy for your work place to not cover you when you retire. It may just be coincidence, but starting in 2015, almost everywhere, when you retire, you're on your own.
So, all you believers, convince me. What else did the affordable care act do to make the health care business more affordable.
I really hope this isn't political, but it's something I've been thinking about, and most of what I'm thinking is I must be missing something. Tell me what I'm missing.
If you agree w/ universal healthcare, then I can respect that. But the ACA is just a clusterfuck all around that accomplishes nothing for all "sides".
What car to drive, what house to buy...they can be non political. Why is health insurance any different?
Before I get jumped all over I have my own healthcare and this bill probably hurts me more than helps me.
Keep kids on till 26 I think
Helps people get insurance that couldn't afford otherwise
But makes things worse for more people
Higher rates for lower levels of coverage for many...If they threw me a bone and let me write off my health insurance on my taxes...I might feel better about it.
But it's a start -- the pre existing condition issue was a big one
No real input other than to preemptively antagonize another person.
I retired in 2001.
In 2005 my former employer took away the "for life" free drug coverage they had promised my wife and me for the 21 years I worked for them.
The next year, 2006, they took away the "for life" free medical coverage they had promised my wife and me for the 21 years I worked for them.
I've been on my own in this respect before anyone heard of Barack Hussein Obama or "the act".
my insurance went from a nice HMO to a high deductible plan (which sucks, but I don't know as it had anything to do with the ACA. it was coming. the company didn't want to pay what it would take to keep me in a good insurance plan, so they downgraded. was going to happen one way or another)
"It really does nothing to control costs ... Highter deductibles, higher co-pays ... Networks are also narrower." I assume you're referring to the Medicare Prescription Drug plan since 2005.
Less care. Well if you are paying more in premiums, copays and have a higher deductible, you will probably not go to the doctor as often. So the ACA is doing exactly the opposite of what it promised to do. What Obamacare does is give people a false sense of security that they are 'covered'. You can have insurance and not get good care.
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Unless you get a subsidy, you are likely paying more and getting less. Highter deductibles, higher co-pays and less care. Networks are also narrower.
"It really does nothing to control costs ... Highter deductibles, higher co-pays ... Networks are also narrower." I assume you're referring to the Medicare Prescription Drug plan since 2005.
You won't find me defending that. Anytime the government gets involved, stuff costs more and is less efficient.
If you're referring to the Medicare Prescription Drug plan, I fully agree.
The health care industry was on a path to canniblize the entire economy, and the law, creating new markets, allowed the cost curve to shift without rationing or putting in price controls, either of which which would been more constitutionally suspect.
And ironically, its a huge transfer of wealth from blue states who support it to red states that despise it, so the likelihood of repeal is pretty remote.
When the Medicare Prescription Drug plan was enacted it was a mess. Both side of the aisle tried to make it work. No one talked about repeal. Is that too political?
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1) no I could not keep my same plan, 2) my premiums increased 3) I have a deductible now when i didn't before and 4) my coverage got worse
If you're referring to the Medicare Prescription Drug plan, I fully agree.
My prescription plan actually remained exactly the same. I have no problems with my prescription plan on its own, but like I said, I now have higher premiums for worse coverage and a deductible.
My health insurance doubled in the decade before Obamacare.
The Hillary attempt at universal health care taught that a free society can't control health care on a level as intimate as the patient/physician relationship, so the ACA took a different tact: incentivize it. Create markets for patients no-one previously wanted to cover, reward foward thinking behavior, risk reduction, preventive care, incentivize more efficent practice models: electronic records, accountable care organizations. Its dismantling the old broken system in a death by a thousand cuts. Something new will grow out of this, and it will be better, because it has to.
Court case doesn't matter. The republicans came out and said the subsidies will be funded no matter what the outcome. Nobody loses coverage.
As far as the ACA? It is what it is. As mentioned above, I would feel better is they threw me a bone with a tax deduction for my premiums. Other than that, insurance was a shit show before and it's a shit show now.
If you have a specific question, I can answer it.
I begged for someone to educate me otherwise.
Do you wish to contribute to the conversation? Or just dismiss my question as a rant?
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I don't disagree with you as far as the direction health industry was going, but, again, I'm looking for an explanation of how the ACA is staving off the health industry abuse. I see it as feeding the industry, not controlling it.
The Hillary attempt at universal health care taught that a free society can't control health care on a level as intimate as the patient/physician relationship, so the ACA took a different tact: incentivize it. Create markets for patients no-one previously wanted to cover, reward foward thinking behavior, risk reduction, preventive care, incentivize more efficent practice models: electronic records, accountable care organizations. Its dismantling the old broken system in a death by a thousand cuts. Something new will grow out of this, and it will be better, because it has to.
Reports coming out are that ER visits are steady rising. This time of year, season in Fl., 3 weeks to get a doctors appointment. What's left?
I'm not so sure that in won't turn into a two tiered system like many other countries. It already has to an extent.
Must be profits then. Why I mentioned either or.
Thanks.
When the Medicare Prescription Drug plan was enacted it was a mess. Both side of the aisle tried to make it work. No one talked about repeal. Is that too political?
This is such a crucial point. The ACA probably has some problems. Congress could be working on improvements, revamps etc. They arent. Anything more I could say would be too political (though I dont blame one side 100%).
Plenty of examples of the government taking over private enterprise, with improvement in quality and cost. Right?
Things mandated by the government since the mid-2000's.... EMR, resulting in significant increase in cost and physician workload with no real evidence that quality improves.
Shifting of payments from physicians to hospitals and MSG.... which tend to cost more from the outset. Great move?
Significant increase in roadblocks to creating ambulatory surgery centers, even though they have ridiculously less costs than hospital based OR's. Hooray!
Meaningful use requirements that few physicians can meaningfully use. Government inaction....
Proliferation of special extortion units to railroad physicians to give hard-earned money back to the government. After all, if you call it fraud, it must be bad, right?
from the beginning, I explained I wanted a discussion. I said what my thought of the ACA was, and I begged for someone to educate me. Don't make this into something it isn't. I sincerely want to know if my view of the ACA is wrong.
HH, if you have nothing to contribute to the thread other than snarky comments, please do not post. it is not productive.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
Well pumping money that is borrowed into the market will do that. Plus interests rates are non-existant so there is no where else to put your money. But that will change and it won't be pretty.
Add in how hard it is to have price sensitivities in any regardless of who is paying. You have a doctor, has been your doc for 10 years. He sends you for an MRI, he has no idea how much it costs or it is in his practice and it would be really weird to start negotiating. Or you're having a heart attack -- stop to negotiate? Shoot, you're in the hospital and random docs send you bills, ones you dont even remember seeing.
Now look at the distorting power of market participants with too much power. In many places, eg. NYC, the insurance companies are kind of at the mercy of the hospitals, which are banding together in bigger and bigger consortiums (or corporations where allowed). How are you going to be an insurer in NY and not have Sinai/Beth Israel, or Cornell/Columbia? These hospitals can make their own rates. I understand there is essentially one entity that controls all hospitals in Pittsburgh. Then turn to drugcos (who I think are sometimes unfairly maligned). They often have patent monopolies which lead to good new drugs, but really high drug prices.
The healthcare "market" is naturally dysfunctional. This isnt Obama's fault, and it isnt the GOP's fault. It's impossible to try to replicate and Adam Smith type model of small buyers and small sellers all with perfect information setting market prices and allocating resources through the invisible hand. You cant pretend that but-for the guv'mint, this would all work out fine.
The ACA also isn't a single payer system, and wasn't designed to be one, though the health outcomes of single payer systems are superior to ours in a number of ways, and inferior in others.
The ACA is an attempt to patch over the significant number of pitfalls in our system, including quality of care, health outcomes, costs, and access to care.
However, it has created a significant number of issues.