5 ms·

> Obama was going in the right direction Can you expand on this? I've heard many critics of Obamacare (that say it doesn't actually work that well in reality)

by tomp 10y ago

> Obama was going in the right direction Can you expand on this? I've heard many critics of Obamacare (that say it doesn't actually work that well in reality), and in general, it seems that it was only tackling a part of the problem. In Europe, you usually have a single payer, single buyer and single executor (or at least each of those is very regulated, so there's less chance for exploitative monopolistic behaviour than in the US).

alkonaut 10y ago
ACA is a step in the right direction. Before US healthcare actually improves for a majority (and not just the uninsured - which isn't a small thing in itself) many more steps is needed. The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider.
- ZenoArrow 10y ago
  > "The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider." One of the main reasons ACA is more expensive than it should be is because health insurance companies are jacking up the price. The insurance companies are surplus to requirements, once the US gets rid of them (and cuts down on price gouging by the pharmaceutical industry) the overall healthcare costs should drop dramatically.
  - knz 10y ago
    To give some context to the cost - between my employer and I, a family plan (the options are single or family) was $14,400 for 2017. That's a high deductible plan that requires us to pay the first $6,000 before insurance pays anything. Back in my native New Zealand, the total income tax for an average household is about $6,000 USD. $14,000 just for insurance vs $6,000 for "free" healthcare and all of the other infrastructure a country needs. The US healthcare system is a joke. A joke that wastes money and costs lives. I took my kid to the doctor recently and a 15 minute appointment was $250. It doesn't cost $1,000/hour for a doctor to do a routine exam. Part of the problem is the US is that the actual cost of insurance is buried in your benefits so people think that the $200/month they pay is the cost of insurance.
    - snotrockets 10y ago
      The $250 bill isn't for the 15 minutes you spent with the Dr, but for the 15+ years he spent in med school and residency.
      - knz 10y ago
        $1,000/hour is over $2 million/year for a 40 hour work week. Google tells me that a GP makes about $200,000/year here in Minnesota.
ThomPete 10y ago
The primary issue with the system before Obama was two-fold. 1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations. By forcing everyone to pay the idea was that you could even out the cost. 2) Pre-existing conditions. I.e. the insurance agencies wouldn't cover you if you came into their plan with an existing condition. To give you an example of that from real life. I had a stage 1 melanoma. They tried to excise it but didn't get everything out and I had to get more complicated operation. My insurance wouldn't cover it because they claimed I had that coming into the system. I later convinced them otherwise but until that happened the only thing my doctor could offer me was to monitor my melanoma for the year I had to wait until they would cover me again. Imagine that.
- maxerickson 10y ago
  1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations. This shouldn't be a significant problem. In an actuarial sense, the burden of the cost should largely be born by the party with the risk. If you aren't doing that, it isn't insurance. If you are providing healthcare instead of insurance, you don't pay for it by taxing poor young people (those are the young people opting out of the system, not the wealthier ones). So the premiums the young people weren't paying should anyway only be high enough to cover the cost of insuring them. The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem". We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
  - ThomPete 10y ago
    I understand what you are saying. It's like asking people who don't have a car to pay for car insurance. And I agree generally. But the whole point of insurance is that you make it work because most people wont be needing their insurance so it's a question of interpretation. And yes I think you are right about your solution. I can compare same treatment in Denmark with those of here in the US and the difference is just too big to be true.
jules 10y ago
It's different in different countries. The Netherlands has a system that is similar to Obamacare in that it is a system where everyone is required to have insurance and insurance companies cannot charge more to people with pre-existing conditions, but in the Netherlands there is a lot more competition between insurers. There are 30+ insurance companies and switching is easy. A standard insurance package is €100/month with a €400 deductible.
- tomp 10y ago
  The important questions is, however, who's setting the prices for the drugs & procedures. I imagine it's the same in NL as in most Europe - the procedures covered by (obligatory) insurance is set by a centralized agency (probably government), along with the costs of said procedures and the drugs that can be prescribed as part of the insured procedures. IIRC in the US, the main problem is that those setting the prices have much more bargaining power than the insurers (especially the smaller ones), so they're pretty much free to raise prices...
cowl 10y ago
sorry but that boat has already sailed for US. the problem is not just an insurance one. The global tax-payed healthcare of EU could never pay the declared hospital costs of US. EU's public healthcare works because hospital costs (what the state pays instead of citizens) are still reasonable.
- DasIch 10y ago
  Of course it would work for the US, if the US had sufficiently powerful insurance agencies. If hospitals and doctors want a certain amount of money and insurance agencies have the power to say no, these healthcare providers just won't see any patients or only rich ones. This is how it works in Germany for example. As a hospital you have to accept the money you'll get or you won't get any at all. The healthcare market in the US is not balanced and this gives healthcare providers to increase prices to ridiculous levels, especially in rural areas.

by tomp 10y ago

alkonaut 10y ago

ACA is a step in the right direction. Before US healthcare actually improves for a majority (and not just the uninsured - which isn't a small thing in itself) many more steps is needed. The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider.

ZenoArrow 10y ago
> "The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider." One of the main reasons ACA is more expensive than it should be is because health insurance companies are jacking up the price. The insurance companies are surplus to requirements, once the US gets rid of them (and cuts down on price gouging by the pharmaceutical industry) the overall healthcare costs should drop dramatically.
- knz 10y ago
  To give some context to the cost - between my employer and I, a family plan (the options are single or family) was $14,400 for 2017. That's a high deductible plan that requires us to pay the first $6,000 before insurance pays anything. Back in my native New Zealand, the total income tax for an average household is about $6,000 USD. $14,000 just for insurance vs $6,000 for "free" healthcare and all of the other infrastructure a country needs. The US healthcare system is a joke. A joke that wastes money and costs lives. I took my kid to the doctor recently and a 15 minute appointment was $250. It doesn't cost $1,000/hour for a doctor to do a routine exam. Part of the problem is the US is that the actual cost of insurance is buried in your benefits so people think that the $200/month they pay is the cost of insurance.
  - snotrockets 10y ago
    The $250 bill isn't for the 15 minutes you spent with the Dr, but for the 15+ years he spent in med school and residency.
    - knz 10y ago
      $1,000/hour is over $2 million/year for a 40 hour work week. Google tells me that a GP makes about $200,000/year here in Minnesota.

ThomPete 10y ago

The primary issue with the system before Obama was two-fold. 1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations. By forcing everyone to pay the idea was that you could even out the cost. 2) Pre-existing conditions. I.e. the insurance agencies wouldn't cover you if you came into their plan with an existing condition. To give you an example of that from real life. I had a stage 1 melanoma. They tried to excise it but didn't get everything out and I had to get more complicated operation. My insurance wouldn't cover it because they claimed I had that coming into the system. I later convinced them otherwise but until that happened the only thing my doctor could offer me was to monitor my melanoma for the year I had to wait until they would cover me again. Imagine that.

maxerickson 10y ago
1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations. This shouldn't be a significant problem. In an actuarial sense, the burden of the cost should largely be born by the party with the risk. If you aren't doing that, it isn't insurance. If you are providing healthcare instead of insurance, you don't pay for it by taxing poor young people (those are the young people opting out of the system, not the wealthier ones). So the premiums the young people weren't paying should anyway only be high enough to cover the cost of insuring them. The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem". We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
- ThomPete 10y ago
  I understand what you are saying. It's like asking people who don't have a car to pay for car insurance. And I agree generally. But the whole point of insurance is that you make it work because most people wont be needing their insurance so it's a question of interpretation. And yes I think you are right about your solution. I can compare same treatment in Denmark with those of here in the US and the difference is just too big to be true.

jules 10y ago

It's different in different countries. The Netherlands has a system that is similar to Obamacare in that it is a system where everyone is required to have insurance and insurance companies cannot charge more to people with pre-existing conditions, but in the Netherlands there is a lot more competition between insurers. There are 30+ insurance companies and switching is easy. A standard insurance package is €100/month with a €400 deductible.

tomp 10y ago
The important questions is, however, who's setting the prices for the drugs & procedures. I imagine it's the same in NL as in most Europe - the procedures covered by (obligatory) insurance is set by a centralized agency (probably government), along with the costs of said procedures and the drugs that can be prescribed as part of the insured procedures. IIRC in the US, the main problem is that those setting the prices have much more bargaining power than the insurers (especially the smaller ones), so they're pretty much free to raise prices...

cowl 10y ago

sorry but that boat has already sailed for US. the problem is not just an insurance one. The global tax-payed healthcare of EU could never pay the declared hospital costs of US. EU's public healthcare works because hospital costs (what the state pays instead of citizens) are still reasonable.

DasIch 10y ago
Of course it would work for the US, if the US had sufficiently powerful insurance agencies. If hospitals and doctors want a certain amount of money and insurance agencies have the power to say no, these healthcare providers just won't see any patients or only rich ones. This is how it works in Germany for example. As a hospital you have to accept the money you'll get or you won't get any at all. The healthcare market in the US is not balanced and this gives healthcare providers to increase prices to ridiculous levels, especially in rural areas.