swansont

Affordable Care Act in US

54 posts in this topic

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Ok, so from that I infer that you would not be in favor of banning private medical arrangements, then? I think that's the most frightening aspect of all of this to me - that someone will propose that the only way for things to be "fair" is for the government to completely control all access to healthcare services. As long as you're willing to leave the freedom to make other arrangements in place, then I'm open-minded to almost any arrangement. It was swansont's comment earlier that doctors would stop turning away Medicaid patients lickety split if Medicaid was all there was that caused me to engage that worry.

 

I would assume that the only reason doctors would turn away Medicaid patients would be because they worried they wouldn't get paid (although I suppose it could also be related to difficulty of dealing with a bureaucracy). Either way, I'd say let's fix Medicaid so that they don't want to turn those patients away, rather than either impose some coercion on the doctors or attempt to make Medicaid the only game in town.


To tie this back to ACA, I think anything like ACA, if implemented in a freedom-respecting sort of way, would have no impact whatsoever on people who already had health insurance / didn't need the ACA benefits. Short term you might see an increase in demand for medical services, as the new beneficiaries flowed into the situation, but supply and demand should cause that to take care of itself in a small number of years. So by "no effect" I meant no direct effect, not second order effects arising from increased demand.


In other words, the attitude should be, "Hey, here is a new benefit for those of you who need it," not "Here is a new way and now all of you have to use it."

Edited by KipIngram
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Private supplemental insurance is pretty common in countries that have national healthcare. I think that is something that gets glossed over frequently in these discussions.

 

The desire for single-payer isn't driven by a desire to ban insurance as a practice. It is driven by the primary concern that healthcare is not an ordinary commodity. It is quite literally a "your money or your life" situation.

 

 

You can't choose to budget around future healthcare expenses the way you can around a big purchase like a car or a house because you don't know what those expenses will be. And while you can go to an open house, decide the asking price is too high and go check out another one the next town over, that option isn't really available when you show up at the hospital while having a heart attack. Sometimes it's literally unavailable even if you were so inclined to risk your life wasting time trying to find a good deal on emergency surgery because you get carted to the hospital while unconscious and then get billed for services you didn't consent under the presumption that you would have because the alternative is dying.

 

The only way to mitigate these problems is with insurance, which does provide a cost that can be planned around, but unfortunately, there are tons of people who it is simply not profitable to insure, either because they don't have the money to pay for their calculated share of the risk or because their calculated share of the risk is so high that almost no one would reasonably have that much money. Ironically, leaving these people uninsured winds up driving costs up for everyone anyway because it means they can't afford to do basic maintenance lik check-ups that catch things when they can be treated early and cheaply instead of when they are an emergency, thus landing those people in emergency rooms where they are guaranteed service but at a much higher cost to the healthcare system and placing greater strain on our emergency resources.

 

 

An optimal solution provides a base level of healthcare to everyone regardless of income or health that includes emergency room visits, hospital stays for anything that is threatening to life or long-term health and basic health maintenance that keeps people healthy and overal costs down like an annual check up, recommended exams as people get older, vaccinations, that sort of thing.

 

If you then want private insurance to cover extra things like braces, or a nutritionist, or extended private care for additional recovery time after you leave the hospital or cosmetic surgery or what have you, then yeah, have at it.

 

We're talking about making sure that the system keeps people alive without bankrupting them and driving up overall medical costs, not advocating free nose jobs for everyone or the abolition of insurance as a business sector if people feel they would like to supplement a basic level of care provided to everyone.

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Yes, re: showing up at the hospital with a heart attack I do see the difference - emergency services do seem more akin to the "house on fire" example I mentioned above. I'm beginning to think that it's important in these discussions to differentiate amongst the various sorts of medical service. You've got your emergency services, you've got your routine "health maintenance" type stuff, where feeling comfortable with your doctor really does highlight the importance of getting to exercise some choice, and you've got your discretionary services that likely shouldn't even be included in the debate about assisted funding at all. It's a spectrum for sure.

 

I am a huge, huge fan of consistency of reasoning in things like this - as soon as I had the thought last night about the similarity between emergency medical services and stuff like firefighting, police protection, and so on I felt that we should bring similar reasoning to all of those things. With police protection, for example, we expect that to be funded by our general tax payments. The same with firefighting, though I did see last night that some places have controversially started to try to charge for the service. After having those thoughts I'm quite open to the idea of emergency medical service being "free" (i.e., covered from general revenues) just as police protection and other such services are. But I do think that would mean "free for everyone."

 

I like iNow's way of describing it - your fire department protection is free, but you are also still allowed to get smoke alarms etc. to enhance your situation if you choose to. I've suggested that a privately funded system might do the job better, but I don't KNOW that - it's just an attitude that's rooted in my general political / economic philosophy. What I really want is "the best system we can put in place," with best defined by the quality and effectiveness of the services rendered. If it turns out that a single-payer style system is the best solution in those terms, then that's what I want. If a privatized system is best, then that's what I want. I want people to have access to quality healthcare services as much as anyone else in this debate.

 

I think all of the possible solutions here have their weaknesses and would need very, very careful oversight. Private businesses succumb to greed. Government organizations often succumb to bureaucratic inefficiencies. I don't think any solution is just going to "automatically work" without us being vigilant. I also understand that an effective system will have a cost, and I'm totally down for the "more fortunate" bearing most of that cost, simply because the less fortunate can't.

 

This all particularly comes home for me when we talk about children. I can't even put into words how wonderful I think children are (all children), and the idea of a child suffering or (worse) dying because his parents didn't have access to medical care that could have made a difference absolutely breaks my heart. And even though I try to be rational and fair minded, the place I am most likely not to be is when my own children are involved. I have five daughters, and one of them had a struggle with anxiety and depression that would up requiring a therapeutic boarding school stay to address. The facility we chose was out of our insurance network, so we had to cover it totally. During that selection process we heard horror stories about the state-provided alternatives. I don't know how true those stories are, but if they are true then it absolutely was a situation where our financial good fortune made it possible for us to "get something better." It more or less cleaned us out, but we were able to do it. Trust me - I have thought about that a great deal, and I do not consider it right that others wouldn't have had that opportunity just because they hadn't been as lucky. And the availability of those funds really was luck - in 2012 I was working for a small company that got bought by IBM, and I got a windfall from that, even though I'd only been with the company for five months. In no way can I say I "earned" that largesse in any tangible way. It was a case of being in the right place at the right time.

 

BTW, my daughter is in college now and is doing great - I don't know what those people did, but it worked and I cannot thank them enough. So I really do support solving these problems - no parent should have to watch their child suffer, physically or mentally, when something could be done about it, if only it could be afforded.

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Ok, so from that I infer that you would not be in favor of banning private medical arrangements, then? I think that's the most frightening aspect of all of this to me - that someone will propose that the only way for things to be "fair" is for the government to completely control all access to healthcare services. As long as you're willing to leave the freedom to make other arrangements in place, then I'm open-minded to almost any arrangement. It was swansont's comment earlier that doctors would stop turning away Medicaid patients lickety split if Medicaid was all there was that caused me to engage that worry.

 

 

 

There are going to be procedures not covered by basic care. Universal healthcare is probably not going to cover elective surgery, for example.

 

There is a monetary incentive to only accept private insurance when they pay more, so naturally some doctors will decide to limit the number of medicaid patients they accept. That's only a negative if basic healthcare has the two options, because it goes away when everyone is covered for the basics.

 

In the long-term, one might choose not to go into the kind of medicine covered by universal care if it doesn't pay well enough. I don't know if this is an issue in the developed (health-care-wise) world.

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