7 ms·
Great story of compassion and triumph. So... How do we make it scale? Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably
by nwenzel 13y ago
Great story of compassion and triumph. So... How do we make it scale?
Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k.
Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some are net consumers of govt services. But tax payers mean us, and those with more earned income more than those with less. I think the main difference between taxes and donation is choice.
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. Not that putting profit seeking entities in charge has yielded the ideal result.
Making drug providers, healthcare providers and everyone else in that supply chain non-profit? Profit has enormous motivational powers. Not always for good. But it is pretty amazing what can be accomplished by organizations setup to create wealth.
Big Data? Sorry, I couldn't resist. Well, lets use that as a proxy for innovation. It would seem that greater opportunity for innovation would help. Lower barriers to trying new drugs, procedures, diet, treatments would allow for potentially lower cost solutions to be created.
Separating health care from your job? Of your insurer only needs you to be healthy until you find a new job, there's not much in incentive for long-term healthcare and preventative screenings to identify tumors and other problems before they become an expensive problem. Though that would seem to be an arguement in favor of a single payer system.
Sorry, I don't have an answer. Hopefully, great stories like the OP continue. But if we don't make it scale then we haven't really done all we possibly can do.
- SeanDav 13y agoI don't begin to understand the US health system (I live in the UK with its National Health), but didn't Obama try bring in compulsory health insurance to counteract just this sort of thing and it was defeated?
- Moto7451 13y agoNot defeated, it just hasn't rolled out fully yet. States are figuring out how to implement everything, and of course the partisan foes of his health plan stage votes in Congress to repeal it (which never pass) every month or so.
- btilly 13y agoIt gets worse. According to CBO estimates, the plan underestimated the costs of the original rollout severalfold. Republicans are gleefully attempting to guarantee failure by refusing to approve any additional funds for that purpose.
- specialist 13y agounderestimated the costs I could have told them that. I designed and implemented portable electronic medical records for 5 regional exchanges. Hospitals, clinics, pharmacies, ambulances, permanent stays (nursing homes), insurers, labs, etc. Coordination was tough, because everyone thinks they own the data (and loathe to share) and are often competitors. It's all about the incentives. The only fix I can think of is single payer, which will compel everyone to play nicely together. That said... Simply having the state by state insurance comparison portals seems to be very effective for price competition, better than I could have predicted. So on balance, it looks like the impact of Obamacare / ACA will be really good, if not perfect.
- parasubvert 13y agoCitation please. As of February, it was about $130 billion off over 10 years (i.e. $1.3 trillion vs. $1.17 trillion). That is not 'severalfold'. http://www.californiahealthline.org/articles/2013/2/6/cbo-updates-spending-projections-for-aca-medicare-medicaid http://www.californiahealthline.org/articles/2013/2/6/cbo-up... And insurance premiums on ACA exchanges are coming in 20% lower than expected: http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/rb_premiums.pdf http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPre... I do agree Republicans believe this thing is going to fail and are trying hard to encourage that.
- meowface 13y agoIt was not actually defeated, but if a Republican wins the next election (which is possible) and the senate and house can achieve a Republican majority, it will almost definitely be repealed.
- krapp 13y agoThe next election, or the election after that, or the election after that... As soon as they can, even if it takes then twenty years, they'll stab it in the heart with jubilant rapture. They're still attacking Roe vs. Wade, after all.
- earh 13y ago1. Roe vs Wade is a court ruling, not a law. 2. There is a theory that Roe vs Wade is such a good campaign issue that no one wants to actually "accomplish" any changes.
- parasubvert 13y agoIt's highly unlikely they would repeal it unless they had an alternative. No serious proposals have been forthcoming (party because the ACA was actually the conservative proposal in the 1990's...) It would be political poison, especially given the rollout will have had a few years to cement by March 2017 (the earliest anything could be taken to floor). Hard to tell what public opinion will be like in 3.5 years, but I'd wager it will be net-positive on ACA.
- raganwald 13y agoSingle-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make universal, socialized healthcare work. We could make it cheaper than Canada's. We could make it better than Sweden's. We just don't want to for ideological reasons." But how can it be that the attitude is, "It would never work here?" You're the greatest empire in the history of civilization. What is this word "can't" and why is it in your vocabulary?
- rjeaster 13y agoIt may be a vicious cycle at this point, Americans have no faith in their government, and their government proves itself unworthy of their faith.
- Nursie 13y agoPretty sure us Brits still get a claim on the empire thing. Pretty sure...
- wozniacki 13y agoHe meant the benevolent kind of empire. Since the US doesn't annex territories for itself and keep them as colonies as part of some Commonwealth Realm. Although the US could have if it tried, with the slightest flex of a myoblast, in the last great war. It still can. Pretty sure that's what he/she meant.
- gonzo 13y ago> Since the US doesn't annex territories for itself and keep them as colonies as part of some Commonwealth Realm. Nope. Neve happens. (Cough >Hawai'i<, cough)
- bebop 13y agoPuerto Rico, US Vigin Islands, American Samoa, CNMI, Guam, and most importantly Hawaii are all annexed territories of the United States. Not to mention California and most of the west really.
- happy_dino 13y agoI still can't decide what's more embarrassing: That the US have a third-world health care system or that people act like it is a hard, unsolved issue to implement something better.
- pyre 13y agoIt's not third-world. If you have the money, it's first-class. It's just the 'if you have the money' part that causes issues.
- twstws 13y agoI can't understand how Americans, who have the least efficient, most expensive health care system in the world, are so quick to write off public healthcare. The idea that government healthcare is more wasteful than a private system is not supported by facts, but the theory is too hard to let go of. Which is not to say there is a perfect solution. But just about any of the alternatives would be better than the US system.
- sneak 13y agoAmerica doesn't have a free market healthcare system. It is heavily regulated. The fact of the matter is that we've somehow managed to end up with a set-up that has just the bad parts from both models. All the runaway costs of regulatory capture, and all of the gross inefficiency of entrenched bureaucracy.
- jw_ 13y agoSeriously, this is not an unsolved problem. The US spends more per capita than the rest of the world but has huge swaths of people denied basic care, and poor outcomes overall for an allegedly developed nation. There are a range of options available - look at any of the varied options successfully implemented by every other developed nation on Earth. Americans may choose to reject them based on ideological grounds, but it's ridiculous to approach this like a problem that has never been tackled. Governments exist to address precisely these problems that require collective action without profit motive. One note on efficiency - something like 30% (yes yes, citation needed) of American health dollars go towards insurance administration. A family member of mine works in Canadian health care and had a recent arrival (a physician, IIRC) from the States ask where the "billing floor" was because an out-of-country patient needed some sort of paperwork done. Well, Canadian hospitals don't have floors dedicated to processing payment. There was a small office. On a second note, having your healthcare connected to your employment situation seems like insanity - I can't fathom anything that would argue in favour of that, unless you're an employer looking for additional leverage over your serfs.
- Wingman4l7 13y ago> having your healthcare connected to your employment situation seems like insanity It really is, although I don't think people realize it until you say it out loud. Precisely when you can least afford paying for a medical emergency -- when you're unemployed and thus have no income -- is precisely when it's most expensive. How broken is that? It would be insane in any other industry to charge your customer significantly more for the exact same service, simply because they're using a different payment method. Not to mention the horrible situation that arises if you acquire a medical condition so debilitating -- which usually also means it's expensive -- that it prevents you from working.