3 ms·

> Because it's the only way to get universal coverage, which if you don't have, means a portion of the population gets really sick, jams the ER, can't afford to

by mgh95 2y ago

> Because it's the only way to get universal coverage, which if you don't have, means a portion of the population gets really sick, jams the ER, can't afford to pay the resulting bill (maybe declaring bankrupcy), and someone then has to eat/cover the cost. Often by hiking prices for those that do have coverage. The alternative that is always there is to repeal EMTALA. > It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on. This misses the problem: [the ACA causes a moral hazard for lower classes likely to use it.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8567089/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8567089/) The issue is a policy designed for a highly uniform, high social class, high status state (Massachusetts) was applied to the USA as a whole.

PaulDavisThe1st 2y ago
> The alternative that is always there is to repeal EMTALA. I suspect you think it's not great having homeless people on the street. Wait till you see what it looks like when they actually start dying in the street because emergency health care is no longer available to them, nor to many of their housed neighbors, family and friends.
- mgh95 2y ago
  I don't see what EMTALA has to deal with homelessness in this context. It largely comes down to uninsured, even post-ACA. If we can't afford the current system, it's not a matter of if, but when, either hospitals or providers leave medicare. To put it in perspective, the AMA reports (https://www.ama-assn.org/practice-management/medicare-medicaid/heartbreaking-medicare-cuts-start-hit-home-congress https://www.ama-assn.org/practice-management/medicare-medica...) that physician medicare compensation has declined 29% since 2001. At a certain point, it will simply be financially unsustainable. Whataboutism to distract from the fact that medicare alone is 3.7% of gdp and is forecast to grow to 5.1% by 2033 (https://www.cato.org/blog/fast-facts-about-medicare-social-security https://www.cato.org/blog/fast-facts-about-medicare-social-s...) doesn't fix anything. And FWIW, US Medicare spending alone is shaping up to grow to almost as much as some EU nations on a % of GDP basis (https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_expenditure_statistics_-_overview#:~:text=By%20contrast%2C%20current%20healthcare%20expenditure,the%20lowest%20ratio%20(5.6%25).&text=Relative%20to%20population%20size%20and,%E2%82%AC6%20590%20per%20inhabitant https://ec.europa.eu/eurostat/statistics-explained/index.php...).). Medicare isn't the solution. It's the problem.
  - inferiorhuman 2y ago
    And FWIW, US Medicare spending alone is shaping up to grow to almost as much as some EU nations on a % of GDP basis Your source puts Austria, France, and Germany at the top, or roughly 11–13% of GDP. https://www.bea.gov/news/2023/gross-domestic-product-fourth-quarter-and-year-2022-advance-estimate https://www.bea.gov/news/2023/gross-domestic-product-fourth-... https://crsreports.congress.gov/product/pdf/IF/IF10830 https://crsreports.congress.gov/product/pdf/IF/IF10830 The U.S. Bureau of Economic Analysis puts the 2022 GDP at $25.46 trillion ($25,460 billion). Congress puts 2022 spending on private health insurance at $1,290 billion (5%) and Medicare at $944 billion (3.7% of GDP).
    - mgh95 2y ago
      Yes, we are tracking to grow to as much as some not all or most. Emphasis on tracking to grow which you should see the source for 2033 forecast. The fact that one program (Medicare) is growing to be as large as the NHE should be cause for pause.
      - inferiorhuman 2y ago
        So your argument is that Medicare spending might potentially approach the same proportion of the GDP as a European country that doesn't spend a lot on its healthcare?
        mgh95 2y ago
        Pretty much. And that's just one program that services a small portion of the population. The issue is we can't make this level of spending work, why should we believe spending more money will be successful?
  - PaulDavisThe1st 2y ago
    > If we can't afford the current system, What we can and cannot afford is a choice, not some immutable fact of nature. A cynical, if realist, version of this would be: if we choose to not spend any more ... But that's still better since it acknowledges that we, as a nation, have agency in this.

by mgh95 2y ago

PaulDavisThe1st 2y ago

> The alternative that is always there is to repeal EMTALA. I suspect you think it's not great having homeless people on the street. Wait till you see what it looks like when they actually start dying in the street because emergency health care is no longer available to them, nor to many of their housed neighbors, family and friends.

mgh95 2y ago
I don't see what EMTALA has to deal with homelessness in this context. It largely comes down to uninsured, even post-ACA. If we can't afford the current system, it's not a matter of if, but when, either hospitals or providers leave medicare. To put it in perspective, the AMA reports (https://www.ama-assn.org/practice-management/medicare-medicaid/heartbreaking-medicare-cuts-start-hit-home-congress https://www.ama-assn.org/practice-management/medicare-medica...) that physician medicare compensation has declined 29% since 2001. At a certain point, it will simply be financially unsustainable. Whataboutism to distract from the fact that medicare alone is 3.7% of gdp and is forecast to grow to 5.1% by 2033 (https://www.cato.org/blog/fast-facts-about-medicare-social-security https://www.cato.org/blog/fast-facts-about-medicare-social-s...) doesn't fix anything. And FWIW, US Medicare spending alone is shaping up to grow to almost as much as some EU nations on a % of GDP basis (https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_expenditure_statistics_-_overview#:~:text=By%20contrast%2C%20current%20healthcare%20expenditure,the%20lowest%20ratio%20(5.6%25).&text=Relative%20to%20population%20size%20and,%E2%82%AC6%20590%20per%20inhabitant https://ec.europa.eu/eurostat/statistics-explained/index.php...).). Medicare isn't the solution. It's the problem.
- inferiorhuman 2y ago
  And FWIW, US Medicare spending alone is shaping up to grow to almost as much as some EU nations on a % of GDP basis Your source puts Austria, France, and Germany at the top, or roughly 11–13% of GDP. https://www.bea.gov/news/2023/gross-domestic-product-fourth-quarter-and-year-2022-advance-estimate https://www.bea.gov/news/2023/gross-domestic-product-fourth-... https://crsreports.congress.gov/product/pdf/IF/IF10830 https://crsreports.congress.gov/product/pdf/IF/IF10830 The U.S. Bureau of Economic Analysis puts the 2022 GDP at $25.46 trillion ($25,460 billion). Congress puts 2022 spending on private health insurance at $1,290 billion (5%) and Medicare at $944 billion (3.7% of GDP).
  - mgh95 2y ago
    Yes, we are tracking to grow to as much as some not all or most. Emphasis on tracking to grow which you should see the source for 2033 forecast. The fact that one program (Medicare) is growing to be as large as the NHE should be cause for pause.
    - inferiorhuman 2y ago
      So your argument is that Medicare spending might potentially approach the same proportion of the GDP as a European country that doesn't spend a lot on its healthcare?
      - mgh95 2y ago
        Pretty much. And that's just one program that services a small portion of the population. The issue is we can't make this level of spending work, why should we believe spending more money will be successful?
- PaulDavisThe1st 2y ago
  > If we can't afford the current system, What we can and cannot afford is a choice, not some immutable fact of nature. A cynical, if realist, version of this would be: if we choose to not spend any more ... But that's still better since it acknowledges that we, as a nation, have agency in this.