Opinion on affordable care act

[winterallsummer]

Health insurance != free medical care. Insurance is SHARED RISK. That means that healthy young people pay more money so that sick old smokers can be covered. Is that fair, moral, or ethical? To compel people who make good health choices to subsidize the poor health choices of others? Oh, to be sure, most of the risk is age-based, but let's not ignore the impact that obesity, smoking, uncontrolled HTN, and the like have on healthcare costs.

 

By all means, people should have some recourse to pay for their health care, but if all the ACA money was divvied up equally, MOST Americans would be better off taking their share and paying out of pocket, if for no other reason than the overhead is going to be enormous.

 

With all due respect... What happens when the healthy 20 y/o develops leukemia or is in a major MVA or is dx'd with bipolar and needs a $1000 script every month?

 

I could make the same argument about car insurance. There are plenty of people who have never been in a wreck that was their fault but still shell out $150/mo for car insurance. Would it be in their best interest to stop paying car insurance, since most of the coverage goes to the "bad drivers" anyways?

[Guest JMPA]

I agree. Law should never control medicine. Why should laws determine who can practice medicine, who can dispence drugs, or who can make new drugs. Regulation is always bad. We should be like artist. If I want to skip school and practice in the square that should be my right!

 

lawyers should have prescribing rights.

[burnpac]

With all due respect... What happens when the healthy 20 y/o develops leukemia or is in a major MVA or is dx'd with bipolar and needs a $1000 script every month?

 

I could make the same argument about car insurance. There are plenty of people who have never been in a wreck that was their fault but still shell out $150/mo for car insurance. Would it be in their best interest to stop paying car insurance, since most of the coverage goes to the "bad drivers" anyways?

 

Excellent point and analogy. It is in society's best interest to share the risk of motor vehicles among all drivers. It is also in society's best interest to share the cost of a healthy population. We can always make the argument that bad decisions / lifestyle choices lead to bad and costly health outcomes, but that is the exception, rather than the rule. Basic health care should be readily available and affordable to all the peoples of the world. It improves our overall well-being and strengthens our communities.

[Super Duper]

Sorry I was rash with my earlier response. I will be more lucid; govt should have a limit in our healthcare system. I don't see how it is right for them to justify they can fine citizens if they do not purchase a health insurance plan. We have every right to choose if we want to purchase healthcare or not. That is just my own opinion. What do I propose to replace the current system? Well I do believe in government assistance for lower income families and individuals. Therefore, implement a voucher system, the govt will give you X amount of dollars to purchase your own private insurance option. But hey every piece of legislation has its pros and cons, nothing can be perfect. The ACA is in the right direction, but like I said earlier some revisions need to be applied.

 

If you don't think people should be forced to buy health care, then what is your plan to deal with the asymmetry of information problem that occurs in health insurance markets?

 

 

I find it odd that the same people who so vocally protest against an insurance mandate (the free market solution to the asymmetry problem originally proposed by republicans) are often also against socialized medicine or single payer systems.

[winterallsummer]

Also, a lot of people are against Obamacare because "they don't want to pay for unhealthy people's medical bills."

 

But when someone goes to the ER and is diagnosed with stage 4 lung CA or a bacterial pneumonia that has progressed to requiring ICU care or DKA from poorly controlled DM and they are uninsured... who do you think pays for their health care? Do you think there is a magic fairy in medsurg and ER and ICU who waves a stick and those costs never make it to your pocket? I am not trying to be condescending, but be realistic people. And what is the reason these people's diseases have gotten so bad? 1) Poor understanding of the health care system, and 2) no real access to a PCP.

 

Even though I have insurance I still have the mentality (albeit has gotten better since entering HC) that if I'm not dying, I'm not going to the doctor. When you grow up with insurance, you learn to utilize health care. When you come from generations of take a tylenol and pray it gets better, then guess what, you are more likely to end up going to the PA or doc or NP when what could've been a simple fix has evolved into an expensive and agonizing mess.

 

Obamacare is definitely (IMO) a step in the right direction, but it will also be important to have community outreach programs educating people on how to utilize the health care system (and how not to) in order for this whole thing to pan out. The "medical home care" model is okay, but really what we need is more community health fares, education in schools, churches, etc.

[Hemegroup]

 

Obamacare is definitely (IMO) a step in the right direction

 

Yup, and Hillary will be the perfect one to step in and fix it. She was the one I voted against Obama for in the primaries for the very reason that I felt her ideas were much more solidly developed. Although probably anyone by 2016 will be able to see what's working and what isn't. What they'll do about it tho is up for grabs.

[UpRegulated]

With all due respect... What happens when the healthy 20 y/o develops leukemia or is in a major MVA or is dx'd with bipolar and needs a $1000 script every month?

The pre-existing illness clause will have two interrelated negative affects on insurance coverage for your healthy 20 year old. The pre-existing illness clause will drive up premiums (substantially in many cases) but also allows people to purchase insurance at any time. The result will be that your 20 year old will just pay the fine and wait until he or she is ill to buy insurance. So, we will still have millions of uninsured people showing up at ER's without insurance, and the hospitals will continue to foot the bill.

[UpRegulated]

Basic health care should be readily available and affordable to all the peoples of the world.

Insurance coverage does not equal care.

[burnpac]

Insurance coverage does not equal care.

 

Agreed. But insurance coverage makes quality care more accessible.

[UpRegulated]

Agreed. But insurance coverage makes quality care more accessible.

Not necessarily. Ask the Canadians or the British or those in Massachusetts that have to wait 45+ days to see a PCP.

[burnpac]

Not necessarily. Ask the Canadians or the British or those in Massachusetts that have to wait 45+ days to see a PCP.

 

So your point is the old system in the US, where folks had no access to a PCP, is preferable to the NHS in the UK? Again, how you pay for health care, and how you deliver it, are two different problems. Show me one Brit or Canadian with chronic health care problems who would trade their HCS for being uninsured in the US.

[physasst]

Not necessarily. Ask the Canadians or the British or those in Massachusetts that have to wait 45+ days to see a PCP.

 

That operates under the assumption that the wait is bad? Should we compare outcomes? Wait times likely don't really matter as much as we think with many things. Not when you look at the macro level at outcomes.

[UpRegulated]

So your point is the old system in the US, where folks had no access to a PCP, is preferable to the NHS in the UK?

No. That is not my point. My point is quite simple: insurance does not equal care. Those in Franklin County, MA for example, are almost universally covered. Yet it takes 205 days (7 months!) for a new patient to get in with a provider. They have insurance, but they aren't getting care.

Again, how you pay for health care, and how you deliver it, are two different problems.

Precisely. Just because care is covered doesn't mean it will be delivered.

[UpRegulated]

That operates under the assumption that the wait is bad? .

Apparently Danny Williams, the Canadian Prime Minister thought so which is why he flew to the US for his heart procedure. Apparently the Canadian Medical Association thinks so too as it just released a report this month entitled "Canadians still waiting too long for health care."

[cbrsmurf]

Yet Canada spends less per capita on healthcare, has a higher average life expectancy and infant mortality, and superior outcomes compared to the U.S.

[burnpac]

No. That is not my point. My point is quite simple: insurance does not equal care. Those in Franklin County, MA for example, are almost universally covered. Yet it takes 205 days (7 months!) for a new patient to get in with a provider. They have insurance, but they aren't getting care. Precisely. Just because care is covered doesn't mean it will be delivered.

 

So what is your point? I'm not following you. No coverage, and relying on the ED for primary care is better? Look at the health status indicators of the UK, Canada and the US, and the costs per capita, and tell me that our system is better. I never said our HCS is perfect, but I believe that we can do better than we are doing, and spend our limited HC dollars better.

[UpRegulated]

Yet Canada spends less per capita on healthcare, has a higher average life expectancy and infant mortality, and superior outcomes compared to the U.S.

Correlation does not imply causation. Canadians tend to lead much healthier lifestyles than Americans, for example, and Canada has a lower minority population. There are other factors as well.

[physasst]

Apparently Danny Williams, the Canadian Prime Minister thought so which is why he flew to the US for his heart procedure. Apparently the Canadian Medical Association thinks so too as it just released a report this month entitled "Canadians still waiting too long for health care."

 

No, Danny Williams flew to the US for a procedure that NO ONE was doing in Canada, it had nothing to do with wait times. Do you seriously believe that the PM would have to wait in Canada? As far as the CMA, of course they want to reduce wait times. No one WANTS the wait. That wasn't what I said, I said that perhaps the wait doesn't matter when you look at health outcomes. That does not mean that increased wait times are desired.

[UpRegulated]

So what is your point? I'm not following you. No coverage, and relying on the ED for primary care is better?

Why must I have a point beyond saying that insurance coverage does not necessarily translate to care? That is a point all in itself that stands independent of any other belief or opinion that I may have.

Look at the health status indicators of the UK, Canada and the US, and the costs per capita, and tell me that our system is better.

See my last post. Correlation does not imply causation and you, as a trained medical provider who should have a solid grasp on statistics and research, know that. There are many more factors that play a role beside insurance coverage including lifestyle, minority populations, how "live births" are defined and calculated, etc.

I never said our HCS is perfect, but I believe that we can do better than we are doing, and spend our limited HC dollars better.

If I were to have a point beyond what I've already mentioned, it is that we are trading a system that doesn't work well for one that will work even more poorly.

[UpRegulated]

No one WANTS the wait. That wasn't what I said, I said that perhaps the wait doesn't matter when you look at health outcomes.

You did not say that, you said, "That operates under the assumption that the wait is bad?" To which I said that the CMA itself thinks it is bad. I'm OK with you revising/clarifying your statement, but now you need to show me how longer wait times don't effect outcomes.

[burnpac]

If I were to have a point beyond what I've already mentioned, it is that we are trading a system that doesn't work well for one that will work even more poorly.

 

This is where you lose me. "doesn't work well...." is somewhat of an understatement. While you seem to believe that you can see the future, I put these kinds of doom and gloom statements right up there with warnings about "death panels". ACA is the law of the land, and we will have have first hand experience as to how well, or not, ACA and HCR will work in a few short months. My prediction is that it will be much better than the current system.

[UpRegulated]

While you seem to believe that you can see the future....My prediction is that it will be much better than the current system.

See what I did there? :)

[burnpac]

See what I did there? :)

 

Yep. I'm just in awe in your superior debating skills and power of reason.... :-)

[burnpac]

As a nation, we spend more money per capita on HC than any other nation, and rank 38th. My point is (way up this thread) that we need to seriously look at all options for delivering HC to our population, and not just the ones that are politically expedient. Every nation ahead of us on the list spends much less per capita for HC and gets a greater bang for buck. We are arrogant as Americans. Let's study the best practices of other countries and continue to positively reform our system.

[UpRegulated]

As a nation, we spend more money per capita on HC than any other nation, and rank 38th...Every nation ahead of us on the list spends much less and HC and gets a greater bang for buck.

But again, you cannot conclusively state that the reason we get less "bang for the buck" is because of our health care system. Lifestyle, genetics, ethnicity, socioeconomics, etc. all play a role. I have little faith that the ACA will fix our ranking(s). Futhermore, the ACA will theoretically increase the number of insured Americans (increasing demand) but we already have a PCP shortage (too low of a supply) which exacerbates an already large problem. Again, insurance does not ensure care.

My point is (way up this thread) that we need to seriously look at all options for delivering HC to our population, and not just the ones that are politically expedient.

I agree completely. And I am by no means defending what we have, just stating that I don't think the ACA will help - it is just rearranging the deck chairs. Instead of only the uninsured getting less care than they need, now everyone will get less care than they need (due to increased wait times), just to perhaps a lesser degree . It's just spreading the misery around. If you want a model to look at that is most similar to the ACA, then look at Massachusetts. Wait times have exploded, as have premiums, and increased wait times lead to poor outcomes. While many in MA say they are "happy" with their insurance, the intent is to improve health not provide people with warm feelings.