New blow to the US Affordable Care Act (Obamacare).

[kandrathe]

I think you're overlooking a significant if not larger segment, those for whom affordability is not the barrier, but pre-existing conditions.

Well, yes. But, wouldn't you agree that this group is probably in the "more costly" category (at least for insurance rates)? Their health care costs remain, however their contribution towards paying for it is removed.

Hm, these people are working more for the health insurance than the job, so we're replacing them with more motivated and productive workers? Gosh, that helps drain the pool of involuntarily unemployed, gets people off the government assistance programs, and boosts the economy all 'round. Sounds like a win to me!

Although, just because you are not collecting unemployment checks, does not exempt you from other social programs. It would be an ideal world if everyone were healthy, and loved getting up to head off to work everyday. Like the seven dwarfs I guess. No one is actually "drained" -- if you are under 65 you are counted as "discouraged". I'm not sure how being discouraged gets you off government assistance, or boosts the economy. A person who needs the job to pay for their insurance I would consider motivated. More like trapped, and so in that it frees people, I do think its a good thing. It's not that I disapprove of people getting the "good things" here, like accepting preexisting conditions, more coverage, etc. Our topic though is whether the ACA helps make things more affordable, or if perhaps "Affordable Care Act" is yet another law whose title is more of a misnomer, like "The Patriot Act".

For example on addressing affordability, we could just offer people who qualify (old, poor, whatever) a $5000, (or, even the OECD avg.) per year health insurance voucher. Take it to whomever you want to do business with, or augment it with some of your own money if you like. This in effect "fixes" the price that government would pay for services and forces the industry and consumers to figure out how to package health care consumption into that package. It constrains costs, but still leverages competition to create innovative health care delivery.

What is crazy about our "insurance" now with the ACA is that from an insurance risk POV, individual health is irrelevant to the cost of any individuals insurance. It's not that I advocate trying to control behaviors, just that what we have now is no longer something that looks like other types of insurance. Imagine if car insurance were grouped like this.

Or, how about we focus on accelerating and simplifying the process of getting new treatments to market. Part of what is killing us on drug prices is the ten year delivery cycle. The way it works is just crazy, and it needs an enema.

Or, why here in the US we don't "grow our own" health care workers and instead need to import from all over the world. Perhaps look at why we've throttled the number of doctors we train, and all the barriers we've put on foreign doctors coming to the US. If you want cheap health care, focus on the supply and demand issues.

Compared to every other industrialized nation, we have poorer outcomes, and higher costs by double. The point being in the US we've built both a private and public insurance system, and through HMO and group health insurance laws have made them complicated and expensive to administer. Having both, and separating them from consumer choices creates havoc with pricing.

[kandrathe]

In addendum to my last post; we actually have three medical systems in the US. I forgot about the Veterans Affairs run medical system. Nobody sums it up better than Jon Stewart. I would extend the voucher system from the government here as well. Give soldiers the means to get their treatments from wherever they like. Don't make them queue up for months waiting for treatments from VA medical facilities.

Atlantic Article : Neither Public Nor Private The hopeful bit from that article is, "Although the ACA imposes additional regulations on our financing system, it also contains within it initiatives that could in the end significantly reduce regulation. We need to keep making progress along these paths."

Essentially, a significant reason why out costs are spiraling out of control is that the medical industry gets paid according to the number of services they deliver, and is fairly heedless of outcomes, or of patient satisfaction. Therefore they are given incentives (and fear of malpractice) to over treat everyone, knowing that the patient will get more than they need, see little of the costs and some 3rd party will pay for the bulk of it.

This last week, a bill that had 96 of 100 Senators support failed (by majority leader Sen. Reid) to get to the floor, due to Sen. Hatch attaching a repeal of the unpopular Medical Device tax enacted by the ACA. NPR: A Tax Bill Killed By the Push and Pull of Politics On The Hill. This is a big deal here in Minnesota, where both our Dem. Senators stand (with the majority of Minnesotans) against the Medical Device tax, but would be at risk of losing their base party support if they opposed it right before election time.

[LavCat]

Us old people are on Medicare.

So sorry. How do you deal with the donut hole? My wife is struggling to help her dying mother with the complexities of Medicare and health care in California. The bottom line is that they have pretty much just let her die, and did as little as was possible. It seems to me like additional insurance above Medicare is required.

I apologize. When I first replied to this post I was poor enough to receive supplemental health, which meant I paid nothing for prescriptions. Now that I am a wealthy social security recipient I no longer qualify.

Tonight I fell into the donut hole. I had no idea that one of my medications was eight hundred and some dollars a month.

[kandrathe]

I apologize. When I first replied to this post I was poor enough to receive supplemental health, which meant I paid nothing for prescriptions. Now that I am a wealthy social security recipient I no longer qualify.

Tonight I fell into the donut hole. I had no idea that one of my medications was eight hundred and some dollars a month.

We are debating the academic benefits of our two son's use of both a time released Intuniv and Adderall versus the monthly cost. The generic is 10% the cost of the name brand ($30 vs $350 per month). But, I hear you. Not all medicine is available in generic form (in the US). I don't have a donut hole, yet. I have a high family, and per person deductible ($6000 iirc). Due to my wife's medical costs, she burns through the deductible plus the kids medicine from January to April. It's almost as if I had no insurance at all in those months -- all out of pocket until I hit the cap. Then I end up trying to catch up on the unpaid medical bills over the summer, and spend the fall saving up for the big hit in the spring.