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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...then it will be illegal to procure that medicine which has been cut off.

It would be illegal to procure treatment one can get on one's own simply because one can't get it in the socialized system? I don't see that as a probably restriction in a socialized system much less a necessary one. If a system had that provision, I'd want them to be able to justify it to me.

And then I'd get the treatment across the border in the next country.

Drug companies must pay to have drugs approved, something which usually costs millions of dollars (and substantially more for first time approval). Why would they do this if there is a very limited market? Unapproved drugs are per definition illegal and thus unavailable, and there's the potential of prison of smuggled across the border. Though this will most likely be a temporary problem as drug companies will just stop inventing expensive drugs.

As an example, when I was working in the Czech Republic I was enrolled in the mandatory insurance there (VZP). The migraine medicine I use, Imigran, was not available there because it is expensive. I therefore had to smuggle it from Norway, which is a bit of a pain in the ass and certainly not particularly economic. 

Going abroad is hardly an optimal solution to the problem, and certainly does not work as a counter argument that restricted drug availability is a downside to a socialized healthcare service. Also, it does nothing to alleviate the problem of one health care system for the rich and one for the poor.

That is, in effect, the reality of our system in Canada. It does seem that there is some movement, resisted strongly by the socialized medicine adherents, to allowing some private access.

I agree with your point of view, Unseen, but those who have the power to impose aren't necessarily subject to those principles.

Not that I'd be complaining about this, but won't it in turn raise independent/individual/non-obamacare insurance premiums in most states? By like a lot?

Well, let's see. Plan A cover more people the insurance companies don't want to cover and rates go up. Plan B throw those same people under the bus so rates can be lower for the people they do want to cover.

At this point, the need for a national single-payer system should be coming into focus.

Agreed. And actually, my state is one where the independent premiums will actually lower some 30% (somehow-- I don't know how that works).

Agreed. And actually, my state is one where the independent premiums will actually lower some 30% (somehow-- I don't know how that works).

It works because of the 'history, mandate, and subsidies' triumvirate in ObamaCare. It starts with 'history': the popular idea that Americans with pre-existing medical conditions should have access to health insurance.

History: Government requires private insurance companies to issue policies regardless of the individual’s medical history. Healthy people drop their insurance, leaving a bad risk pool, premiums climb, and more healthy people drop out.

Mandate: Avoid the downward spiral by getting healthy Americans to buy into the risk pool. That's the individual mandate in ObamaCare. The voluntarily uninsured pay a tax penalty.

Subsidies: Since insurance is unaffordable for some Americans, subsidies make the insurance affordable for everyone.

The savings is realized from (1) the gigantic pools of insured which drive down rates, (2) the tax on the voluntarily uninsured, (3) people drawing less from Medicare and Medicaid and more from private insurance, (4) reducing expensive emergency care in hospital emergency rooms as a primary source of care for the uninsured, and (5) the state and federal exchanges where insurance providers must compete with each other to sell insurance directly to consumers. These among other things.

The downside to affordable healthcare is profits go down. That's the jist of it. We have a capitalist healthcare system, and it kills people. 8,000 people die a year from preventable, treatable, and curable diseases. Not diseases like cancer, but diseases like the common cold and influenza. Health care costs are one of the biggest causes of homelessness in this country. People lose their homes and jobs because of a heart attack, a stroke, or a seizure.

Like him or hate him, I don't care. Michael Moore's movie Sicko has more truth in it than you would really like to believe. From companies taking out Dead Peasant insurance on their employees, to poor people being drugged and put into a cab and sent down town to a homeless shelter to cut costs. My fiance currently lives in England. He pays into NHS, and he gets to see a doctor for free, and any meds he needs are about £7.85 which is currently $12.27. It doesn't matter if it's an anti-fungal cream, or cancer medication. The follow up to this little revelation is usually something about the poor pharmaceutical companies that put so much effort into developing these drugs. I understand wanting to get paid for something you make, but if you're honestly saying that we should put a corporation's profit margin before a person's life, then your priorities are horribly skewed.

From a governmental standpoint (Not a political standpoint) If something is required to live, then it should be provided, at least to a minimal extent. Food, housing, education, healthcare, transportation, all of these things are required to live in this world, and therefor should be provided at best for free, but at least for a minimal charge. It's the government's responsibility to keep you alive, it's your responsibility to make your life better. This is what is known as the social safety net. Yes it's expensive to maintain, but it's even more expensive and dangerous to not have it at all.

Have you evidence for this assertion: "Michael Moore's movie Sicko has more truth in it than you would really like to believe." It would be interesting to know how you assess the degree to which someone else would really like to beleive.

If the meds cost more than GBP7.85 (sorry, don't have the symbol) to develop, produce, and distribute then from whence comes the extra money? Stating as a matter of principle that corporate profits should not come before a person's life seems "innocent" of economics. Do you have your retirement savings invested in funds which do not make money? Does your organization's pension plans invest in money losing endeavors? I'll be not.

Government should function by imposing onto the taxpayers that which is required to fulfull the obligations which support society's values. I may have missed that discussion in Canada but am not aware that it has taken place. This seems at the root of these issues because we have no agreement as to principles, vision and values.

As for profits or expenditure in general, one would have to be incredibly out of touch with reality to assert that any amount of resources are to be expended in support of one individual. What seems to take place when these questions are asked is that one wing of society seeks to apply a moral label without justification. Would it be reasonable to spend ...pick a number....say,  $10,000,000 to extend my life by 5 years? IMO, that would be incredibly stupid were it public money.

That $10,000,000 would far more responsibly be expended in producing more value to many other people. I'm 65 years old so would you assert that I should take the place of a 24 year old mother of two in the life boat? I doubt that any sentient being needs answer that question.

So, what is needed in Canada, US, UK, etc. is for a coherent policy to be developed based on vision and values shared by their own society, and for which the consequences are shared. What generally happens is that one segment demonizes the other for resisting the coopting of resources. "If it saves one life, it will be worth it!" is so dreamily stupid as to be a conversation stopper.

We need to unlink health insurance from employment. The way that happened was fairly accidental anyway. But today, self-employed people, if they can afford health insurance at all, have to pay the full rate, by which I mean also including the part a corporate employee's employer would be paying.

If everyone bought health insurance the way self-employed people do, with no help from their companies, believe me there'd be an almost instant revamping of the health care system.

We need to unlink health care from a profit-based system. Capitalist market forces simply don't work in health care. In some ways, since those buying health care are almost inevitably ill-informed and ignorant of their actual future needs, there's no way health care purchases can be made rational the way other purchases can be.

We also need to link payouts to results and not pay by procedure. Paying by procedure creates a dysfunctonal incentive structure. Paying by results would mean wanting to make sure the prescribed procedures are effective. The higher the percentage of good results, the more money the doctor or hospital makes. That is a functional incentive.

For once, I somewhat agree with you, Unseen. I've always believed that Capitalism and Socialism are tools, not magical cure alls for your economic woes. Capitalism is a claw hammer. It's great for building a patio to enjoy your new barbeque, but it turns into a bloody mess if you try to take it into an operating room. Socialism on the other hand is a scalpel. Absolutely useless for building things, but when you're sick, and need to see a doctor, it can save your life.

I have an instructor with a lot of quality assurance experience in nursing, including consulting work. She's quite certain that the sudden influx of newly covered patients is going to badly overload the system. I predict she's correct about that, and we know for sure we're going to get earfuls of anecdotes from those who are already sounding off hateful about the system.

But I also suspect, if the system doesn't get dismantled first, that improved health in people who'll get access to care will bring down the cost of future, urgent care they would otherwise need. The real problem is, it might take 10 years to see then cost benefit, as people who've been sick for decades will remain costly to treat.


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