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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So you are advocating that the rich deserve better medical treatment than the poor?

Here I thought that was the system you didn't want...  

They may deserve it less, but in a free society it's hard to force the rich to accept lowest common denominator health care when they can afford better.

Right now,  the goal should be simply to get people currently out of the system basic and adequate health care. Having good health should be a right not a privilege.

That is assuming the rich will have anywhere to turn if every country adopts socialized medicine, unless you are being extremely nationalistic and don't think every country deserves affordable healthcare. On the other hand, a loss of the US market will severely diminish the incentive to shell out billions in medical R&D, so a fully socialized US healthcare market will most likely mean less medicine. For sure the US need a more fine meshed safety net, but throwing the baby out with the bath water is hardly the best option available.

I don't really see why it's bad that some people who are willing to and have the ability to pay extra for healthcare are allowed to do so, even in Norway I have private employer provided healthcare insurance. In fact, over the last decade or so, since private healthcare was somewhat allowed, private health insurance has increased tenfold. A couple of months ago we used it on an employee with a shoulder problem, she was back at work after 5 weeks when we initially envisioned her being on sick leave for 6-8 months. We were pleased with not having to pay double salary for half a year, and she was ecstatic not to bore herself to death at home while waiting for treatment. 

(My apologies for derailing your thread to a privatized vs socialized medicine debate.)

Right now, it's possible for rich people to go to countries with socialized medicine to get served outside that country's socialized system. Simply because a country has socialized health care, it doesn't follow that there is no private clinics.

There are times when I wish I had proofread my reply before posting it. If I had, I would have changed "is" to "are" in that last sentence. Dumb!

Dumb!

Naw, 'tiz all relative, grasshopper.

a loss of the US market will severely diminish the incentive to shell out billions in medical R&D

I agree with this. It seems we should come to a mixed system, where people with money can pay for more advanced care, in the same way that first adopters of technology pay more for the first versions of new technology. A problem with this approach may be that commercialized research can monopolize the rights to the new science/tech, and keep prices high.

I haven't thought enough about this, but years ago I envisioned integrating healthcare for pre-adults (at least) into school systems. It would start with a combination of health education and care, with perhaps an affiliated medical facility nearby for deeper consulting and treatment. Gov't funded research at higher education institutions should pretty much continue, as is, with the public owning the newest health technology, at least for pre-adults.

Then, adult care could be less subsidized and more privatized... and more complicated. I think it would benefit the public system in the long run to focus on and invest in younger people. I realize this leaves the question of later life care unanswered, but at least we'd be front-loading the system with healthier people, before they get older.

There are many among us, here in Canada, insist that health care must be identical for all. They hold, not that no one should receive less than a certain level of care, but rather that no one should be able to obtain more than a defined level which is provided by the public system.

This is one of the fundamental differences in vision or values which so badly divides the health care dialogue here.

That seems to be precisely you assertion, Arcus.  Besides, the quality of healthcare is not in question, only the current criteria for access to health care.

You may then wish to read what you wrote and what I wrote again.

In a socialized medicine system there will be a politically decided cutoff point for cost of medicine, as well as what medicine is approved or not, and then it will be illegal to procure that medicine which has been cut off.

In a privatized medicine system it will be an insurance company decided cutoff for the cost of medicine based on the insurance plan the individual has chosen, and then it will be expensive to procure that medicine which is beyond the plan. 

...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.

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