Republicans are fond of saying that "The US has the best health care in the world," which is true. What they fail to add is, "...if you can afford it." 

Many people have poor health care or none at all. And many of those who have none at all are NOT unemployed. They simply can't afford the premiums or they have what are called pre-existing conditions. 

Ten percent of the population account for 60% of health care costs, and many of those people who go to the ER for their health care once their condition has gotten totally out of control. Not only are millions of people left with the ER as their health coverage, which is incredibly expensive, but the current system isn't designed to lower costs. Quite the opposite. In most states, one or two companies have 80% of the business and are not under much pressure to keep costs low, because most people don't really shop for their health care. And with only one or two real choices, most companies don't, either, especially now that more and more companies are asking their employees to pick up more of the tab.

Obamacare makes several important changes designed to reduce costs. First, it moves to make payouts based on outcomes rather than pay-per-procedure. Secondly, it brings many of those left-out people into Medicare, which is costly. However, it's based on the well-established idea that catching health issues early and treating them relatively cheaply saves a lot of money later on.

Here's an example: someone has type II diabetes in his mid-sixties and takes two forms of insulin (one quick-acting taken at mealtime and one slow-acting and constantly in the background). The quick-acting insulin costs $500/mo and the other one $600/mo in round terms). The patient, who is already struggling to live on Social Security by living without many things and by making a lot of compromises when it comes to healthy food has Medicare Part B and pays only about 1% of those costs.

Suppose, though, that his condition had been diagnosed early enough to prevent it, when he was in his 30's or 40's. Even if he did get diabetes but it was treatable with some daily pills costing $20-$50/mo, I think you can see the wisdom of this approach.

There's a glimpse at the upside. What's the downside?

Tags: ACA, Act, Affordable, Healthcare, Obamacare

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reminds me of Elysium

The downside is that its a non-free-market approach. It takes away a persons right to choose not to have health care if they so desire. Of course, if we think about the real world, the people who choose not to have health care eventually end up in hospital at the taxpayers expense anyway...

There is no true "free market" in health care, if one is talking about health insurance companies, because you typically get the one your employer chose. Perhaps you could choose a different one, but that's more theoretical than practical. Only someone who's very well off could really seriously decide to use an insurance company other than the one his employer endorses.

Remember, it's the insurance companies who pay or don't pay the claims, and since they are for-profit institutions, they assiduously look for reasons not to pay claims, especially for very expensive procedures.

People choose doctors for irrational reasons. My endocrinologist is smoking hot. I'd think twice before choosing another doctor. See what I mean? I'm not sure what the real value of being able to choose your doctor really is anyway. Does being free to choose your own doctor guarantee the best care? I don't think so.

The so-called free market is dysfunctional when it comes to health care. If it worked, we wouldn't have the most expensive health care in the world.

Obamacare doesn't take away anyone's right to choose not to have health care. For example, I doubt if it can force you to have an apendectomy. 

Not sure how your health insurance works in the US... In Australia, our employers have no say over what/how/if we insure ourselves. Having said that, we also have public health care, so everyone has that minimum of access.

Does being free to choose your own doctor guarantee the best care?

My point wasn't that free choice of doctor or insurance provider guarantees the best care... My point was that if you can't choose, you can't choose... something the libertarians in America are generally against, I believe.

Almost everyone in the US who has health insurance gets it through a deal their employer has with a specific insurance company. Thus, the insurance company's real customer isn't the insured person but rather the insured person's employer. The insurance company works more to please the employer than the employee.

Dysfunctional enough for ya?

There is no public health care in the US in the sense of government-funded insurance. Rather there is minimal health care for the truly indigent and people over 65 or older. 

The downside is that its a non-free-market approach.

It's free enough for me. The Health Insurance Exchanges (HIX), which open October 1st, are state- and federal-run online marketplaces for buying private health insurance from competing providers. You use calculators to determine if you qualify for subsidies (which generally means you're a retiree or a low-income child). These are factored in and used for price and comparison shopping between all the health plans you qualify for. That's about as free as I'd like the private health insurance markets to be.

The "free market" approach to health insurance caused the mess we're in right now: affordable insurance is useless, useful insurance is unaffordable, and millions are uninsured as a result.

People buy insurance that offers the lowest rates. Who offers the lowest rates? Insurance providers in states that allow them to drop people when they get sick and refuse to insure people with pre-existing conditions. Insurance providers in states that prohibit this cannot compete. So insurance providers race to the bottom. Young, healthy people either carry no insurance or buy cheap insurance, and older, less healthy people must either be able to afford expensive plans that won't drop them, or do without. The end result: the affordable insurance is useless, the useful insurance is unaffordable, and millions are uninsured.

Free markets can take care of themselves, say the Republicans. That is, until they need $4.6 trillion in bailouts at taxpayer expense. Then they can't. We can safely add health insurance to the list of right-wing dogma that takes a sharp detour from reality. Health insurance needed this kind of regulation very badly.

It takes away a persons right to choose not to have health care if they so desire.

Not according to the Supreme Court. If a person wants to go without health insurance, he pays up at tax time and goes without. The penalty is essentially a tax on the uninsured.

Of course, if we think about the real world, the people who choose not to have health care eventually end up in hospital at the taxpayers expense anyway...

Exactly. That's why the uninsured (instead of the rest of us) pay up if they choose to go without. You'd think Republicans would love something like that. I mean, enough to invent ObamaCare themselves and really get behind it.

It's free enough for me. The Health Insurance Exchanges (HIX)...

That's like being forced to select a religion and "none" not being an option. That's the downside.

That's like being forced to select a religion and "none" not being an option. That's the downside.

"None" is an option. The option that's off the table is (as you pointed out) choosing not to have health insurance at taxpayer expense. Is that a downside? Maybe. I don't think so, though.

I do like the upside: 30 million non-elderly Americans get insured (table 3, page 20) and taxpayers save $171 billion over ten years (table 2, bottom line, last column).

Naturally, the GOP hates it. The Republican governors of 19 states have refused or will likely refuse federal money for the Medicaid expansion under ObamaCare. (It's better for millions to go uninsured in their states, apparently.) The Republican controlled House of Representatives has (pointlessly) voted 40 times to repeal ObamaCare. Republicans are encouraging people not to buy health insurance and threatening to shut down the federal government.

Nevertheless, every indication is that ObamaCare will be a success. That, and the GOP will end up with egg on its head for inventing a national health care reform plan that works, then disowning it and fighting to ensure its failure because Obama went along with it. More upside.

This issue is what lead to me becoming Atheist. The downside is that one has to look out for his neighbor, a concept lost among Christians and most other religions.

As a recently converted Secular Humanist, I welcome participating in this type of co-op. If I pay in more in than I take out, I'll rest assured that I did the right thing by my neighbor.

Fuck Christianity and their self-serving religion!

I'm an atheist, too, but that characterization is a little unfair to Christianity. The actual teaching of Jesus suggest a socialist society. Christians do a lot of charity work. They operate a huge proportion of the hospitals in the US. The Catholic Church alone operates 13% of American hospitals, and while you might have to tolerate a visit from a priest or nun while admitted, they turn no one away for religious reasons. 

We should stick to the idea that they are wrong on the existence of God. That they don't care about people is, at best, a stereotype or gross generalization.

Any time that the profit motive is introduced, then the companies providing the insurance look for ways to maximize their profit and not serve the people who are relying on them to pay for medical procedures.  The profit motive must be removed, and if that means that the private insurance companies go out of business, then so be it and good riddance.

Yeah, and according to the Republicans and conservatives, the free market keeps prices as low as possible. 

Obviously, there's something wrong with their theory. 

Perhaps the state insurance agencies have removed true competition and effectively shouldered some companies out.

However, I think the main fly in the ointment is that only someone who is basically a full-time expert can really understand the choices well enough to make an intelligent choice.

Beyond that, with private insurers you always have to make some blind guesses as to what your insurance needs will be. Overall limits, caps on certain kinds of claims, copays, and excluisions, for example.

A national single-payer program could eliminate those. And yes, keeping costs down would likely involve medical experts deciding which treatments and procedures make sense.

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