Thanks for responding, I will try answering these as best I could.
Death Panels is a comment people say to scare away from a conversation. Stop using it as it is useless.
In this case, it was used sarcastically to highlight that you (and Classical_Liberal) were the one trying to use the threat of rationed care as an argument against ACA reforms. Maybe that wasn't your intent, but it sure did sound like you were saying that the ACA will fail because rationed care is a terrible thing. This is exactly what Republicans means when they used to shout "Death Panels!" on TV every night.
No, ACA and AHCA and any other CA will fail until we address the demand and cost of healthcare. The only way to contain cost with government subsidized health care is to ration it and I fully agree with that. Unfortunately I do not see that happening. There is talk about trying to contain utilization, but no talk in containing some of the regulations that incentivize utilization as well as talk about decreasing the risk of litigation. I also see no discussion in using older tried and true therapies over novel more expensive options. I see no discussion over and of life care. I see no discussion about removing the insurance middle man from low cost therapies, interventions and diagnostics.
there is no ceiling to how much it can and will cost. Until we combat the above, there is no healthcare plan that will fix the issue. ACA will fail just like AHCA or whatever bullshit congress passes.
How do you feel about the Medicaid/Medicare model, where they use a fixed price list? The most efficient way that the ACA reduced healthcare spending in the US was to move more people onto the Medicaid model.
You are correct taking someone who pays cash or has health insurance and moving them to Medicaid which is a payment system that reimburses less will decrease cost overall, but increase cost to the government. Also prior to the medicaid expansion those who were self pay who did not pay for care are now being subsidized by government as well. These measures increase the cost of healthcare to the government which goes back to the argument regarding who pays for care as opposed to the actual cost of care. Lastly, medicaid reimburses less than what it costs to take care of the patient which is the reason why so many private doctors take a limited number of medicaid patients some take none at all. At the very least reimbursement should provide some profit to the entities providing care, but to do that the cost of providing care must decrease which would provide the necessary profit to make the proposition enticing.
The ACA did nothing to combat actual cost of care,
Except move millions of people onto expanded Medicaid? And mandate preventative screening services, which reduce long term costs. And cap insurance company profits. And mandate individuals to have coverage, to cut EMTALA losses. And ACOs and the IPAB. And set up new fraud prevention programs.
Wait, that's a whole bunch of things that the ACA did to combat the actual cost of care! It's almost like you were deliberately lying!
I agree the ACA could have done more, on this front. But it's clearly not "nothing".
Great response,
1) Moving millions off from self pay did indeed decrease the cost of healthcare to the individual but increased the cost of care overall by the US citizens through taxation. Not a horrible thing, but again this does not decrease to cost of care.
2) Mandating preventative screening is an awesome law which I fully agree with and in the long term ideally should decrease the cost of care.
3) Caping insurance profits looks good, but profits can be divided out in other ways hiding actual profit. Actually take a look at the profits of insurance companies over the last 4 years. They are increasing, not decreasing.
4) Mandating healthy people to get coverage increases cost of care for them to help subsidize the cost to the individuals. It does not actually decrease how much it costs to treat each individual.
5) Fraud prevention is terrific and in all honesty I have not evaluated their success or failure. Actually I have heard nothing from this.
6) ACOs are a great idea incentivizing decreased cost through better outcomes. I am part of an ACO and think it has some potential. We have decreased cost on a few disease processes via our ACO and indeed I believe it did decrease the cost of care for those patients. What ACOs do is take financial risk away from the insurance companies and direct it towards the providers. It may be one of the reasons insurance company profits have gone up.
Some of the above have helped curb cost a little, others increase cost. Either way it is not enough. Insurance companies are still the middle man in the process, there is absolutely no transparency in cost, regulations still exist and even more added that actually increase the cost of administering care. Physicians are still expected to provide the latest most expensive therapies in a more than timely manor or get poor satisfaction scores which leads to less reimbursement. Or worse, risk litigation. Until we can say no to care, ration it to those who can not afford it, as well as make the cost transparent to those who could, prices will continue to rise just like they do in our higher education industry.
We give up 12 years of our lives for this pursuit
Are you counting college? And part of high school?
Well shit, by that logic I gave up 23 years of my life to getting the required education for my PhD. Except not a single one of those years felt like a loss, because for each and every one of them I was exactly where I wanted to be. You were too. Don't get all dramatic about it. No one forced you to go to school.
4 years college, 4 years med school and 4 years residency. A PhD is very time consuming but most PhDs do not consume 70-90 hours a week like during medical school and residency for 8 years of their life. Unless you live it, you just won't accept it or understand it. Some are good at having a life during med school and residency while most just live in a book or at the hospital for those 8 years. As for college physicians are competing among the very top of the US and to do so requires being better than most of your class. Some are naturally smart and get good grades while most only know living in books with minimal fun in their lives. Let us just agree to disagree that we do not understand each other and just not bother to discuss this topic.
Physicians are on the top of the list for suicide rates
That has very little to do with their quality of life, and much to do with their access to easy and painless ways to die. It's not like there are 35 year old doctors shooting themselves in the face in quiet moments of despair. But there sure are a lot of retired ex-doctors who recognize that their time has come, and don't want to be a burden on their families and finances, and quietly excuse themselves from life.
There are several studies on this, physicians are on the top of the list because the life is very difficult and not everyone could hack it. How they commit suicide makes no difference with the rate which is much higher than most other professions. Again, unless you see it and live it, you just won't get it. It's okay, but the facts are real and I prefer you do not belittle them.
We are being duped by our insurance industry to discuss who will pay for healthcare. Like pawns we just keep squabbling about the wrong thing while they keep profiting.
I think we're being duped by doctors (and the health care industry in general) into discussing who will pay. Doctors have just as much to lose as do insurance companies, in the switch to single payer. They are personally invested in maintaining those artificially high prices, because that's how they afford all of those fancy cars and golf memberships. You may be the rare exception who wants to make less money as a doctor, but that's certainly not the position of most docs.
It is not the physicians. Physicians used to make a lot more money 20-30 years ago before all this healthcare bullshit that we see today. They still talk about it as the "golden age of medicine." I do not know a single doctor who would love to get rid of the bureaucracy and add transparency to what they do. Take away all the bullshit I do no a daily basis and I can double the amount of patients I see which would make me more money even if reimbursement is less. I really believe it is the insurance industry with the deepest pockets that controls our congress, not the disorganized physicians.
Single payer: We do have a single payer system for the poor and the old. It exists and it is currently broken because little is done to address cost as I described above. I am all for a single payer system for the poor since we need some safety net, but this system needs to be less expensive, not by decreasing reimbursement, but decreasing how much it costs to provide that care. You cut the cost of care by having transparency in price, eliminate the insurance middle man from low cost events such as monthly meds, doctors visits, imaging, and so forth. Eliminate reimbursement hoops we need to jump though as well as cut useless regulations and lastly allow insurance be insurance for catastrophic events. The poor get their safety net, the middle class gets lower cost care, and the rich can afford whatever the hell they want. Everybody wins except the insurance companies and all their employees.