Why do People Hate Obamacare?

[Josh]

Nothing's going to get better until we as a people agree on how to control costs.

[temporal1]

not sure there can be any rays of sunshine until-unless what's left of the DNC leadership backs away from calling for removal of Trump as POTUS; these months in, i'm not optimistic.

but, i live in Illinois, where voters had the gall to elect a Republican governor; it was not close, and he is not a staunch conservative, not unlike Trump, also not a staunch conservative (our governor did not support Trump in 2016, he was silent) - yet, he has received complete obstructionism from the Chicago-D.C. DNC. since 2014! no let up.

the fact he is a liberal Republican reveals the partisan nature of this war.
they are dug in and do let up. it's mind boggling.

so, i have this horrible state experience impacting my view.
it's a fight to the death, and they do not care who gets hurt in the process.

one irony in Chicago you may have heard of - the city placed a large gold "sculpture" in front of Trump Towers in Chicago, it's the words, "Fake News." the irony being, Trump built that building(s) when he was a Democrat. clearly, they had no problem with him then. in fact, most current accusations+complaints were of things he did during his Democrat years. no problems then. nothing but partisan politics.

things are awfully bad in Illinois.
politicians are generously paid, no matter outcomes.

i don't believe any retired president ever spoke or behaved so badly in retirement as what we are witnessing in 2017. neither any election hopeful(s) who lost. evidently, still trying to claim the office.

W was magnanimous in retirement. hopefully, he was not the last of that kind.

i'm visiting family; here, i view a Canadian tv news station occasionally.
one interview was with Al Gore, regarding global warming. he dedicated much of his interview to shamelessly trashing this current admin. there was no discussion, just his pontifications, the interviewer smiled+nodded "knowingly?" Gore spoke as tho he were unaware that he is not respected on the topic, or, any other topic, that i'm aware.

i believe we are in a war.

an essentially paper/legal war over transfer of wealth. law school wars. the titans are clashing. billions are at stake.
the titans are looking old, puffy, not well. no matter how much they spend on facials, make up, botox, cosmetic surgery (yes, i am referring to the men, too.) Al Gore, and many of these guys are so made up they look like cadavars.

all indicators are, they plan to take their wars to their deaths. do they not realize where they are headed? (fwiw, from my perspective) their futures are not looking bright.

[mike]

Can't complain about money if we're not willing to do anything to confront the cost side of the equation.

Nothing's going to get better until we as a people agree on how to control costs.

And telling private industry what they are allowed to charge for their products or services will have what effects?

[temporal1]

It may well be that this is the only reasonable, civil, multi-perspective discussion of Obamacare on the entire internet.

yes. the first pages paint a most interesting picture of first-person accounts of life with ACA-UCA. most interesting because each account describes a separate sort of scenario, all very hard.

appleman's description of "how insurance works," matches my feeble understanding.
i.e., a whole lot of people must pay in, without ever recovering that money, and, understand, recovering that money means you have lost, in health, and/or life.

car insurance, home owners insurance, life insurance .. it's all the same.
you pay, and hope not to need it.

[Judas Maccabeus]

Be very thankful if you are one of the lucky ones that would pay more into the plan than you ever take out. Your dollars have gone to help others less fortunate.

This is an excellent perspective.

It really is the only perspective that people should have towards their insurance premiums. I do not understand the mentality that says that over the course of an insurance policy that unless I get back an amount in claims equivalent to the premiums I paid out it was a bad deal. That really is very selfish and wrong headed thinking.

Study the history of many old insurance companies and you will find that at their roots is simply a very simpe mutual aid type plan. At it's core insurance really is simply organized mutual aid.

Before the 1973 HMO act all managed healthcare had to be mutual or not for profit. The 1973 act changed all of that. It resulted in a free for all for $$$$$. For a description look here:

https://healthcare.uslegal.com/managed- ... t-of-1973/

It made it possible to create for profit entities that divert money from patient care to corporate profit. The overhead for a government single payer program is like 4% (Money that gets collected that does not go to patient care). For a for profit MCO (Managed Care Organization) it is normally more like 20-30%.

If you look at Boot's chart a few pages ago, you will not the big divergence begins in about the early 80s you will note that US begins to really diverge at that point from the rest of the developed world. Most of the healthcare insurance in Germany is managed by a group of not-for-profit organizations. Boot can likely elaborate.

Until you get the for-profit corporations out of the mix, costs in the US will continue to rise.

J.M.

[appleman2006]

Are you talking about profit at the healthcare level or at the insurance level?

I get leery of running down profit for various reasons. One being that it seems to become quite arbitrary as to who is allowed to make a profit. It seems to be perfectly alright for doctors and nurses to make a profit but somehow the people that front the money to put in a healthcare facility should not be able to get a return on their money.

And how do you measure the cost of admin. For example admin. Of our health system costs far more than 4 percent here in Canada. And the waste is atrocious. In Ontario alone we spent over a billion dollars to attempt to set up a Ehealth systmn. Some 8 years later we still have nothing at all for money spent. Only government could waste that badly.

[Judas Maccabeus]

Are you talking about profit at the healthcare level or at the insurance level?

I get leery of running down profit for various reasons. One being that it seems to become quite arbitrary as to who is allowed to make a profit. It seems to be perfectly alright for doctors and nurses to make a profit but somehow the people that front the money to put in a healthcare facility should not be able to get a return on their money.

And how do you measure the cost of admin. For example admin. Of our health system costs far more than 4 percent here in Canada. And the waste is atrocious. In Ontario alone we spent over a billion dollars to attempt to set up a Ehealth systmn. Some 8 years later we still have nothing at all for money spent. Only government could waste that badly.

I am talking about at the "Insurance" level. What get raked off before the people that actually do the care see a dime.

Most doctors and nurses in a managed care system make a salary not "profit" since they don't own the practice anymore, the HMO/MCO owns it. And most of ours have not even kept pace with the case of living.

If they had simply bought an off-the-shelf system like Epic, Medtrack, Protouch or McKesson, it would have been done. I have been involved in a "custom" system. It is a lot harder to implement than it looks.

J.M.

[Hats Off]

No for-profit company would be allowed this level of waste and extravagance. And what Appleman mentions is just the tip of the iceberg. We had an air ambulance system that was government sponsored/supported/mandated and the waste there was astronomical. But the people of Ontario continue to re-elect the government that is responsible for this waste. The same type of situations apply in other government agencies outside of healthcare. A for-profit company could make an obscene profit and yet be more economical for the people than our government run programs.

[MattY]

I thought the Cassidy-Collins bill seemed like a decent step in the right direction. The "federalist" option...let states keep Obamacare if they want, or let them opt out and experiment with their own policies, with some minimum requirements and adjustments. I liked it much better than the main Republican plan, which seemed like a worse version of Obamacare, except for maybe interesting reforms of Medicaid. When the system still doesn't work very well, there will be more incentive for people to support single payer health care.

For bigger, sweeping, long-term reforms, I think the best thing in the long run would be to end the system of employer-provided health care, which creates a bunch of perverse incentives that encourage unnecessary procedures with no incentive to control costs. But I don't want single payer - that has its own problems, and I don't like socialism; I think it will not be good in the long run either. At least not national single-payer, like the Canadian and British systems. The best single-payer systems are in Sweden and Denmark, but those systems are run mostly by the local governments. Some of the best health care systems overall are Switzerland and Singapore; they have individual markets where everyone buys their own health care. I think we really need to develop a plan modeled after their systems. Now liberals point out that those markets are heavily regulated and there is a "mandate" requiring people to have insurance. But I don't really care about the mandate - if it takes a mandate to make such a system work, fine. Liberals would get universal coverage - a goal I happen to agree with, as my goal is universal or near-universal coverage with as free a market as possible - and conservatives get a market-based system with lower government spending on health care.

That's my dream, at least. It would require people from both parties to work together on sweeping reforms (rather than being scared by the respective angry "base" in each party and dragging the existing system a bit toward their side while demonizing the other party). Pie in the sky, right?

For further reading:
https://www.theatlantic.com/magazine/ar ... er/307617/

http://www.nationalreview.com/article/4 ... alth-plans

[haithabu]

It seems to me that health insurance companies are carrying on two different businesses when they collect your premiums:

1) As insurers
2) as resellers of medical services.

How this would work is that your premium is set not only according to your anticipated health needs, but also according to the anticipated cost of meeting those needs at a certain standard cost. However once having set the premium, the insurance company is free to negotiate a bulk discount from the health care provider which then adds to its profit. It ends up buying those services cheap and "selling" them high by way of policies which are rated at higher standard price levels. This especially applies in a local market where there are only a few insurance companies operating (which seems to be most states nowadays). In an increasing number of cases you end up with something close to a monopsony (a situation where there is only one buyer).

But the deeper the discount which the insurance company negotiates as part of its second line of business, the higher the provider needs to set its standard cost for everyone else to compensate (which sets up a feedback loop which affects the policies based on those standard costs) .I suspect that this second business carried on by insurance companies is what drives most price inflation for medical services in the US.

One partial solution might be to move from 50 separate state markets to a nationwide market, which though a no brainer economically seems to be politically impossible.

Another might be for the government to enter the medical services reseller business itself to provide an element of competition where there otherwise would be none. It could do this by allowing a Medicare buy in whereby people not otherwise eligible for Medicare coverage could purchase medical services at Medicare rates through the Medicare network either by paying cash or by referring the charges to a private health insurance plan which sets its premiums according to those rates with low or no mark up. This would create a new market for health insurance which operates as a pure insurance policy - something which currently does not exist.

I know that the entry of a large number of new users which this innovation would entail would stress the existing Medicare providers network, but the withdrawal of the same number of users from the conventional health care market would make it more competitive and induce more providers to pick up Medicare business to supplement their lost market share. In the end the providers will follow the market.

An added feature might be to provide for personal health care savings plans, the contributions to which would enjoy the same tax deductions as a 401(k) and the unused portion of which would be available for retirement at age 65. Although if I'm not mistaken, a 401(k) itself could be used as a health care savings plan under current hardship provisions, though it's not set up for that.