What comes after the ACA?

[pecunia]

If government spends money on curing the sick, is it a handout or an investment?

[John Galt incarnate!]

If government spends money on curing the sick, is it a handout or an investment?

In the first instance a governmental expenditure to cure a disease  is an investment for the reason that a cure obviates  continued spending to treat  the disease or provide palliative care.

A disease cured is a disease gone.

Secondarily, it is axiomatic that disease-free people have higher  labor force participation than sick people.

[dresden]

If government spends money on curing the sick, is it a handout or an investment?

Healthcare is subsidized for virtually all Americans.  For whatever odd reason they are only talking about getting rid of subsidies for a small portion of the population representing 5% of the total healthcare subsidies to folks under 65.  Since getting rid of the ACA would also get rid of the taxes it wouldn't result in any net savings at all since the last time I checked the taxes were greater than the subsidies.

I am not sure why the republican party decided to declare war on gig workers and self-employed small businesses, but it definitely influences my voting significantly.  This is the first time I ever voted straight democrat in my entire life.

Trump might still win the electoral college despite losing the popular vote, but eventually it will catch up with the republican party when all the trump voters lose their healthcare.

[pecunia]

https://www.cbsnews.com/news/amy-coney-barrett-supreme-court-justice-sworn-in/

She has been confirmed.  She and her cronies on the court may be coming for your health care.

In response to why the Republicans want to take it away, I just figure they don't like poor people in general.  In general, they don't seem to do much for the average Joe and Jane these days.  I think this may change because I suspect they will get an ass whooping in the next election.  I hope it will be a time of self reflection for the GOP.

[GuitarStv]

https://www.cbsnews.com/news/amy-coney-barrett-supreme-court-justice-sworn-in/

She has been confirmed.  She and her cronies on the court may be coming for your health care.

In response to why the Republicans want to take it away, I just figure they don't like poor people in general.  In general, they don't seem to do much for the average Joe and Jane these days.  I think this may change because I suspect they will get an ass whooping in the next election.  I hope it will be a time of self reflection for the GOP.

"Why are you a Republican?"

"Because I hate poor people. I hate them, Donna. They're all so poor, and many of 'em talk funny, and don't have proper table manners... my father slaved away at the Fortune 500 company he inherited so that I could go to Choate, Brown and Harvard and see that this country isn't overrun by poor people and lesbians."

[Exflyboy]

So the Dems (a lady on the TV last night referred to them as "Demon Rats"*) have to flip a total of 4 seat in the Senate according to the Polls to get a majority.

12 seats are apparently within grasp of the Dems so hopefully this ACA thing will be a non issue.. AAND the Repubs will get an ass-whooping of their lives which may force them to not put up their crazy uncle in the future!

To say I'm a little anxious and stressed over this whole thing is an understatement!

*She had most of her teeth so thats a plus.

[maizefolk]

So the Dems (a lady on the TV last night referred to them as "Demon Rats"*) have to flip a total of 4 seat in the Senate according to the Polls to get a majority.

12 seats are apparently within grasp of the Dems so hopefully this ACA thing will be a non issue..

Technically the dems only need a net of three flips. The reason everyone is talking about four is that they're on track to lose in Alabama. Not that anyone is surprised by that, I just don't want Doug Jones to be forgotten about. -1 (-4 for control)

Arizona, Colorado, Maine look really good, although I don't want to jinx it. +3  (-1 for control)

It would not be surprising if the democratic nominees win in Iowa and/or North Carolina +2 (+1 for control).

It's at least plausible the democrats could win one or both seats in Georgia and in Montana +3 (+4 for control).

So that's one near certain loss, three near certain gains, and five plausible additional gains. The other four senate seats that I'm guessing are on that list of 12 could flip, but given the polling so far it would be much more surprising if the democratic won. From most to least likely (in my personal random-person-on-the-internet reading of the polls): Alaska, South Carolina, Kansas, and Texas.

I'll feel happily surprised by anything above a net gain of five. Eight wins, for a net gain of seven and a four seat majority in the senate, would be a really really good night. I just don't want people to get their expectations set too high and feel bad about what would normally be a really good outcome.

[wenchsenior]

So the Dems (a lady on the TV last night referred to them as "Demon Rats"*) have to flip a total of 4 seat in the Senate according to the Polls to get a majority.

12 seats are apparently within grasp of the Dems so hopefully this ACA thing will be a non issue..

Technically the dems only need a net of three flips. The reason everyone is talking about four is that they're on track to lose in Alabama. Not that anyone is surprised by that, I just don't want Doug Jones to be forgotten about. -1 (-4 for control)

Arizona, Colorado, Maine look really good, although I don't want to jinx it. +3  (-1 for control)

It would not be surprising if the democratic nominees win in Iowa and/or North Carolina +2 (+1 for control).

It's at least plausible the democrats could win one or both seats in Georgia and in Montana +3 (+4 for control).

So that's one near certain loss, three near certain gains, and five plausible additional gains. The other four senate seats that I'm guessing are on that list of 12 could flip, but given the polling so far it would be much more surprising if the democratic won. From most to least likely (in my personal random-person-on-the-internet reading of the polls): Alaska, South Carolina, Kansas, and Texas.

I'll feel happily surprised by anything above a net gain of five. Eight wins, for a net gain of seven and a four seat majority in the senate, would be a really really good night. I just don't want people to get their expectations set too high and feel bad about what would normally be a really good outcome.

Anything above five seats would make me ECSTATIC.  FiveThirtyEight has current odds of Dems gaining control of the Senate at 74%, which is far too low for my comfort, though far higher than I ever expected to see this year.

If Lindsay Graham loses his seat, I will be beyond ecstatic and into....whatever the next level of happiness is LOL.

[Exflyboy]

Even better if they got McConnell

[bmjohnson35]

Between the media and social media, I'm concerned that we won't be able to break out of this "us" vs. "them" polarization that has consumed society. It's ironic that technology is used to feed our ego and affirm our beliefs, instead of helping us to think more critically. 

I understand why people may feel passionate about voting Trump out of office, but I can't understand the faith in one party vs. the other as being able to cure our ills.  Both parties are backed by the same corporate sponsors.  Every presidential election is "the most important election of our generation", according to the media and general political propaganda machine during that time. I don't vote the party line and I try to research candidates and amendments prior to voting during an election.  Unfortunately, my faith and/or belief that it makes much difference diminishes as I get older.   
 

Until we know the outcome of the upcoming Supreme Court ruling(s) on the ACA later this year, how can we speculate on the future of healthcare in the US?   

[wenchsenior]

Even better if they got McConnell

Oh sure, but I try to root only for things that the polls are indicating are a possibility. There's no indication McConnell's in any trouble in his re-election bid. He's averaging an 8-10 point lead in polls, well outside the error window.

[JGS1980]

Both parties take corporate money, but only one party proposes limits to corporate money and corporate power. If you remember, Citizens United Supreme Court case (republican dominates decision) was for a Hillary Clinton negative propaganda documentary was funded by a corporate entity and WAS NOT technically considered a political donation.  Now corporate money = free speech.

[dresden]

https://www.cbsnews.com/news/amy-coney-barrett-supreme-court-justice-sworn-in/

She has been confirmed.  She and her cronies on the court may be coming for your health care.

In response to why the Republicans want to take it away, I just figure they don't like poor people in general.  In general, they don't seem to do much for the average Joe and Jane these days.  I think this may change because I suspect they will get an ass whooping in the next election.  I hope it will be a time of self reflection for the GOP.

  To me the healthcare position is puzzling.  They had 4 years to rewrite or improve it and call it "Trump Care". They didn't do that and instead focus on repealing it in the middle of a pandemic in an election year - effectively giving 20 million people a reason to vote out Trump and the republicans.  As an independent I liked the idea of getting rid of the mandate, but not all the positive portions of the law.

Secondly the ACA primarily helps gig workers, self employed and to a very small extent early retirees.  These aren't people that are all or even mostly democrats.  Many republics and independents fall into this category.  And with the ACA making up only 5% of the total healthcare subsidies for folks under 65 - why is this even an area to focus on - simply because Obama pushed for the it?  Ridiculous.

[pecunia]

Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

[former player]

Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

It's not a fear of creeping Socialism, it's a fear of losing their big corporate oil and drugs donors.

[Wolfpack Mustachian]

Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.

[ctuser1]

Secondly the ACA primarily helps gig workers, self employed and to a very small extent early retirees.

For the sake or correctness, this is not true.

I have always worked for megacorps. Before 2009, my plan had a lifetime maximum. It was tailored to younger population, and your kids were off the plan as soon as they turn 18. There was also not a single healthcare plan outside work that would not drop my like a hot potato, or death spiral the plan as soon as I developed some complicated and expensive diseases (i.e. they were not "insurance").

The ONLY people who has not been 'helped' by ACA are those that want to freeload off of "free" EMTALA emergency room care when they get in a bind.

[GuitarStv]

Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.

The argument about bad government is persuasive largely because of the damage that small government conservatives tend to do to the institution every time they achieve power.  If you get into a position of leadership in an institution that you've been arguing is non-functional for ages, you are presented with a unique opportunity to create the government that you believe exists.

Conservatism (particularly the nihilistic libertarian branch of it) has given people good reason to expect little from their government.  There are a great many success stories of government run health care around the world.  There's no valid reason that America couldn't be another.

[pecunia]

Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.

The argument about bad government is persuasive largely because of the damage that small government conservatives tend to do to the institution every time they achieve power.  If you get into a position of leadership in an institution that you've been arguing is non-functional for ages, you are presented with a unique opportunity to create the government that you believe exists.

Conservatism (particularly the nihilistic libertarian branch of it) has given people good reason to expect little from their government.  There are a great many success stories of government run health care around the world.  There's no valid reason that America couldn't be another.

This is true.  I have noticed they defund even successful programs as soon as they get the chance.  A recent well known example is the US Postal Service.  Trump put one of his buddies in charge and he tried to mess it up.  You are right that they sabotage stuff when they get the chance.  This is not in the public interest.  Any public medical programs definitely need oversight to be protected from these strange idealists.

[rantk81]

I read an article last night that was railing on how terrible the ACA/Obamacare is.
These articles often cite several reasons, such as:

- There aren't many choices to pick from on the Exchange!  (Well, pre-ACA, there were precisely ZERO plans to choose from on the "Exchange"!)

- My doctor network is very small.  (Pre-ACA, plans could have small doctor networks too.  But the ACA mandated that emergent care must be covered, even outside the network.  I don't think this was a guarantee Pre-ACA.)

- My income is low, but my out of pocket costs are too high!  (Usually people who weren't informed enough to make sure they chose a "Silver" plan, so that they received reduced cost-sharing out of pocket costs.)

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)


In my mind, it's really disturbing how ill-informed people are on basic facts.

[John Galt incarnate!]

I read an article last night that was railing on how terrible the ACA/Obamacare is.
These articles often cite several reasons, such as:

- There aren't many choices to pick from on the Exchange!  (Well, pre-ACA, there were precisely ZERO plans to choose from on the "Exchange"!)

- My doctor network is very small.  (Pre-ACA, plans could have small doctor networks too.  But the ACA mandated that emergent care must be covered, even outside the network.  I don't think this was a guarantee Pre-ACA.)

- My income is low, but my out of pocket costs are too high!  (Usually people who weren't informed enough to make sure they chose a "Silver" plan, so that they received reduced cost-sharing out of pocket costs.)

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)


In my mind, it's really disturbing how ill-informed people are on basic facts.

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

[rantk81]

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

If we were fortunate enough to get a single payer health care system, there would no-doubt be an initial spike of health care utilization -- due to the fact that many people with "pent up demand" who are probably not receiving care right now due to not being able to afford the cost of care.  If people finally getting their needed care is "excessive", then I don't think we'll agree on much.

As a society, we either believe that health care should be an entitlement for anyone who needs to be taken care of, OR as a society, we would be willing to withhold care from people who do not have the funds to afford it.  I know which camp I'm in.

[sherr]

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)

I've encountered this one in-person here in NC. A Republican I know was complaining about how awful the ACA was because they knew someone exactly in that position, didn't earn enough to qualify for a subsidy, not poor enough for Medicaid. Yeah, because that's the gap that your politicians intentionally created. Congratulations, you've now seen your vote in action hurting people you care about.

[John Galt incarnate!]

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

If we were fortunate enough to get a single payer health care system, there would no-doubt be an initial spike of health care utilization -- due to the fact that many people with "pent up demand" who are probably not receiving care right now due to not being able to afford the cost of care.
 
Of course.
I think a bit of  the spike would be attributable merely to the novelty of "free" healthcare.


 If people finally getting their needed care is "excessive", then I don't think we'll agree on much.

As a society, we either believe that health care should be an entitlement for anyone who needs to be taken care of, OR as a society, we would be willing to withhold care from people who do not have the funds to afford it.  I know which camp I'm in.

I would oppose the inhumanity of denial of healthcare to the indigent.

[GuitarStv]

I read an article last night that was railing on how terrible the ACA/Obamacare is.
These articles often cite several reasons, such as:

- There aren't many choices to pick from on the Exchange!  (Well, pre-ACA, there were precisely ZERO plans to choose from on the "Exchange"!)

- My doctor network is very small.  (Pre-ACA, plans could have small doctor networks too.  But the ACA mandated that emergent care must be covered, even outside the network.  I don't think this was a guarantee Pre-ACA.)

- My income is low, but my out of pocket costs are too high!  (Usually people who weren't informed enough to make sure they chose a "Silver" plan, so that they received reduced cost-sharing out of pocket costs.)

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)


In my mind, it's really disturbing how ill-informed people are on basic facts.

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

Why does this matter?

Do ill-informed people with insurance (where they pay nothing out of pocket) consume health care services excessively today?  If not, then there's not going to be a problem with public care . . . and if so, then let's talk about costs.  Health care in the US is among the most expensive in the world . . . considerably more expensive for similar levels of care than the UKs NIH or Canada's health care system for example.  If you're worried about total costs, I'd expect that this would end up being a wash with the savings you gain from removing levels of bureaucracy from the current health care system.

Even if there is 'excessive consumption' of health care, it would likely be a short lived phenomenon.  At least that is the case in every other country offering public care.  Hanging out in a hospital waiting room just isn't all that appealing if you don't need to be there - even if you're not paying for the privilege.

[John Galt incarnate!]

 If you're worried about total costs, I'd expect that this would end up being a wash with the savings you gain from removing levels of bureaucracy from the current health care system.

This occurred to me too.

[Exflyboy]

Well the 32 out of 33 developed nations with their single payer systems.. I wonder how many of those are dying to get great system like us Americans?

"Best in the World, we have nothing to learn from anybody else, we are the greatest"

I can tell you growing up in the UK, the last thing you wanted to do was spend half the night in the Casualty (ER).. In fact getting my Dad to go see the Doctor is like pulling teeth.

[Wolfpack Mustachian]

Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.

The argument about bad government is persuasive largely because of the damage that small government conservatives tend to do to the institution every time they achieve power.  If you get into a position of leadership in an institution that you've been arguing is non-functional for ages, you are presented with a unique opportunity to create the government that you believe exists.

Conservatism (particularly the nihilistic libertarian branch of it) has given people good reason to expect little from their government.  There are a great many success stories of government run health care around the world.  There's no valid reason that America couldn't be another.

Some of it's from media. Some of it is from situations where conservatives have sabotaged things. Some of it's from legitimate issues that you can't just easily pin on conservatives creating bad government (issues with the VA is one that comes to mind as something that soured people on a government program). It's a gamut of issues, and yes what you said is certainly part of it.

[katsiki]

I read an article last night that was railing on how terrible the ACA/Obamacare is.
These articles often cite several reasons, such as:

- There aren't many choices to pick from on the Exchange!  (Well, pre-ACA, there were precisely ZERO plans to choose from on the "Exchange"!)

- My doctor network is very small.  (Pre-ACA, plans could have small doctor networks too.  But the ACA mandated that emergent care must be covered, even outside the network.  I don't think this was a guarantee Pre-ACA.)

- My income is low, but my out of pocket costs are too high!  (Usually people who weren't informed enough to make sure they chose a "Silver" plan, so that they received reduced cost-sharing out of pocket costs.)

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)


In my mind, it's really disturbing how ill-informed people are on basic facts.

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

Why does this matter?

Do ill-informed people with insurance (where they pay nothing out of pocket) consume health care services excessively today?  If not, then there's not going to be a problem with public care . . . and if so, then let's talk about costs.  Health care in the US is among the most expensive in the world . . . considerably more expensive for similar levels of care than the UKs NIH or Canada's health care system for example.  If you're worried about total costs, I'd expect that this would end up being a wash with the savings you gain from removing levels of bureaucracy from the current health care system.

Even if there is 'excessive consumption' of health care, it would likely be a short lived phenomenon.  At least that is the case in every other country offering public care.  Hanging out in a hospital waiting room just isn't all that appealing if you don't need to be there - even if you're not paying for the privilege.

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

[stoaX]

I read an article last night that was railing on how terrible the ACA/Obamacare is.
These articles often cite several reasons, such as:

- There aren't many choices to pick from on the Exchange!  (Well, pre-ACA, there were precisely ZERO plans to choose from on the "Exchange"!)

- My doctor network is very small.  (Pre-ACA, plans could have small doctor networks too.  But the ACA mandated that emergent care must be covered, even outside the network.  I don't think this was a guarantee Pre-ACA.)

- My income is low, but my out of pocket costs are too high!  (Usually people who weren't informed enough to make sure they chose a "Silver" plan, so that they received reduced cost-sharing out of pocket costs.)

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)


In my mind, it's really disturbing how ill-informed people are on basic facts.

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

Why does this matter?

Do ill-informed people with insurance (where they pay nothing out of pocket) consume health care services excessively today?  If not, then there's not going to be a problem with public care . . . and if so, then let's talk about costs.  Health care in the US is among the most expensive in the world . . . considerably more expensive for similar levels of care than the UKs NIH or Canada's health care system for example.  If you're worried about total costs, I'd expect that this would end up being a wash with the savings you gain from removing levels of bureaucracy from the current health care system.

Even if there is 'excessive consumption' of health care, it would likely be a short lived phenomenon.  At least that is the case in every other country offering public care.  Hanging out in a hospital waiting room just isn't all that appealing if you don't need to be there - even if you're not paying for the privilege.

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

[Wolfpack Mustachian]

I read an article last night that was railing on how terrible the ACA/Obamacare is.
These articles often cite several reasons, such as:

- There aren't many choices to pick from on the Exchange!  (Well, pre-ACA, there were precisely ZERO plans to choose from on the "Exchange"!)

- My doctor network is very small.  (Pre-ACA, plans could have small doctor networks too.  But the ACA mandated that emergent care must be covered, even outside the network.  I don't think this was a guarantee Pre-ACA.)

- My income is low, but my out of pocket costs are too high!  (Usually people who weren't informed enough to make sure they chose a "Silver" plan, so that they received reduced cost-sharing out of pocket costs.)

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)

- I don't earn enough to qualify for a subsidy, and my state did not expand Medicaid.  (Well, you can blame your Republican politicians in control of your state govt for that.)


In my mind, it's really disturbing how ill-informed people are on basic facts.

If a single-payer healthcare system is established will ill-informed people consume it excessively  because of their misperception that healthcare  is "free"?

Why does this matter?

Do ill-informed people with insurance (where they pay nothing out of pocket) consume health care services excessively today?  If not, then there's not going to be a problem with public care . . . and if so, then let's talk about costs.  Health care in the US is among the most expensive in the world . . . considerably more expensive for similar levels of care than the UKs NIH or Canada's health care system for example.  If you're worried about total costs, I'd expect that this would end up being a wash with the savings you gain from removing levels of bureaucracy from the current health care system.

Even if there is 'excessive consumption' of health care, it would likely be a short lived phenomenon.  At least that is the case in every other country offering public care.  Hanging out in a hospital waiting room just isn't all that appealing if you don't need to be there - even if you're not paying for the privilege.

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

[bacchi]

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

From a quick google search, there is no copay for the NHS. @Exflyboy ?

Is this similar to when they drug tested welfare recipients in Florida and it cost way more than they saved? Sure, a few people overuse the services but it's so few that why bother with a copay at all?

https://www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/

Other research – not least the famous RAND health insurance experiment carried out in the 1980s – has shown that charges that are not based on ability to pay have a detrimental impact on demand from the very people who need care most – older people and the poor.

[DaMa]

Medicare has a $1400 deductible for inpatient care and a $200 deductible + 20% coinsurance for most everything else.  That's a significant cost that will reduce excessive medical care in Medicare-4-All.

[jim555]

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

Its not correct.  NHS is free at the point of use.

[Paul der Krake]

The NHS is the extreme example of single payer. The vast majority of countries have a much more hybrid system with modest copays  of twenty bucks or whatever to discourage over-consumption. But everyone struggles with it to one degree or another.

[katsiki]

The NHS is the extreme example of single payer. The vast majority of countries have a much more hybrid system with modest copays  of twenty bucks or whatever to discourage over-consumption. But everyone struggles with it to one degree or another.

Curious about your definition of hybrid, @Paul der Krake .   Care to explain further?

[Paul der Krake]

The NHS is the extreme example of single payer. The vast majority of countries have a much more hybrid system with modest copays  of twenty bucks or whatever to discourage over-consumption. But everyone struggles with it to one degree or another.

Curious about your definition of hybrid, @Paul der Krake .   Care to explain further?

Anything that involves cost sharing, or supplementary private insurance, is hybrid. Yes that leaves open a lot of options, which is the point. If you look at the top 20 developed countries, none of them have an exactly similar scheme. The NHS is the "purest" single payer system, but even Brits have the option to contract for supplemental coverage, a common perk for white collar professionals. If single payer is "government pays for everything", then anything that isn't that is by definition, hybrid.

I've used other examples at some point in the last 100 pages of this thread, but I encourage you to look up specific countries instead of relying on overly broad statements like "the rest of the world". Everybody seasons their salad differently.

[Exflyboy]

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

From a quick google search, there is no copay for the NHS. @Exflyboy ?

Is this similar to when they drug tested welfare recipients in Florida and it cost way more than they saved? Sure, a few people overuse the services but it's so few that why bother with a copay at all?

https://www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/

Other research – not least the famous RAND health insurance experiment carried out in the 1980s – has shown that charges that are not based on ability to pay have a detrimental impact on demand from the very people who need care most – older people and the poor.

There is a copay for prescription drugs under the NHS. Currently thats around $12/per prescription. There are a number of groups that are exempt from paying this though.. Pensioners, students, low income folks etc.

Everything else is free at the point of use. Last tie I looked the UK spent $3500/person for HC.. The US is nearer $10,000.

The NHS covers medical and dental plus vision for kids and people with glaucoma.

There is also a thriving private market in the UK for elective procedures that can be bought through private hospitals.

[jim555]

Scotland, Wales and Northern Ireland have no fees for prescriptions.

[katsiki]

The NHS is the extreme example of single payer. The vast majority of countries have a much more hybrid system with modest copays  of twenty bucks or whatever to discourage over-consumption. But everyone struggles with it to one degree or another.

Curious about your definition of hybrid, @Paul der Krake .   Care to explain further?

Anything that involves cost sharing, or supplementary private insurance, is hybrid. Yes that leaves open a lot of options, which is the point. If you look at the top 20 developed countries, none of them have an exactly similar scheme. The NHS is the "purest" single payer system, but even Brits have the option to contract for supplemental coverage, a common perk for white collar professionals. If single payer is "government pays for everything", then anything that isn't that is by definition, hybrid.

I've used other examples at some point in the last 100 pages of this thread, but I encourage you to look up specific countries instead of relying on overly broad statements like "the rest of the world". Everybody seasons their salad differently.

Thank you.  I am familiar with what is available in a couple of European countries which is part of why I asked the question.

[pecunia]

Maybe folks in the US shouldn't use Europe as an example.  Since there are some examples of us slowly winding down to third world status, perhaps a comparison to some of the South American countries may be more apt.

[Exflyboy]

Maybe folks in the US shouldn't use Europe as an example.  Since there are some examples of us slowly winding down to third world status, perhaps a comparison to some of the South American countries may be more apt.

Well apparently we'll become like Venezuela if Biden gets in.. Personally I think it might be an upgrade!

[Monkey Uncle]

Well the 32 out of 33 developed nations with their single payer systems.. I wonder how many of those are dying to get great system like us Americans?

"Best in the World, we have nothing to learn from anybody else, we are the greatest"

I can tell you growing up in the UK, the last thing you wanted to do was spend half the night in the Casualty (ER).. In fact getting my Dad to go see the Doctor is like pulling teeth.

Yes, inadequate capacity is a form of rationing.  It is inevitable in a system where care is free at the point of use.  I'm not necessarily suggesting it is a totally bad thing, but we as a country need to be aware that that is where we are headed if we institute a Bernie-style government run free-for-everyone type system.

[Wolfpack Mustachian]

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

From a quick google search, there is no copay for the NHS. @Exflyboy ?

Is this similar to when they drug tested welfare recipients in Florida and it cost way more than they saved? Sure, a few people overuse the services but it's so few that why bother with a copay at all?

https://www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/

Other research – not least the famous RAND health insurance experiment carried out in the 1980s – has shown that charges that are not based on ability to pay have a detrimental impact on demand from the very people who need care most – older people and the poor.

There is a copay for prescription drugs under the NHS. Currently thats around $12/per prescription. There are a number of groups that are exempt from paying this though.. Pensioners, students, low income folks etc.

Everything else is free at the point of use. Last tie I looked the UK spent $3500/person for HC.. The US is nearer $10,000.

The NHS covers medical and dental plus vision for kids and people with glaucoma.

There is also a thriving private market in the UK for elective procedures that can be bought through private hospitals.

Just curious, how elective is elective? Are we talking plastic surgery and lasik or, I dunno, hip replacements and other stuff that won't kill you but really help?

[AdrianC]

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)
...
In my mind, it's really disturbing how ill-informed people are on basic facts.

In 2020 for our family of 5, if we have an AGI of $120,680 we get a PTC of $9,228. If we make $120,685 we get a PTC of $0.

That's the subsidy cliff. Biden's ACA 2.0 is supposed to fix it. But it is a legitimate complaint. Then there's the deductibles and copays.

We've been skirting with the cliff since the ACA became law. In 2018 I bought $2k worth of laptop that I didn't really need so I could save >$8k on health insurance. That's a nutty system.

(This is for a 2020 Bronze Plan - Family of 5 - Premium $1434/month, $17,213/year before subsidy. Deductible $7,700 individual/$15,400 family.)

[Roadrunner53]

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)
...
In my mind, it's really disturbing how ill-informed people are on basic facts.

In 2020 for our family of 5, if we have an AGI of $120,680 we get a PTC of $9,228. If we make $120,685 we get a PTC of $0.

That's the subsidy cliff. Biden's ACA 2.0 is supposed to fix it. But it is a legitimate complaint. Then there's the deductibles and copays.

We've been skirting with the cliff since the ACA became law. In 2018 I bought $2k worth of laptop that I didn't really need so I could save >$8k on health insurance. That's a nutty system.

(This is for a 2020 Bronze Plan - Family of 5 - Premium $1434/month, $17,213/year before subsidy. Deductible $7,700 individual/$15,400 family.)

How did buying a laptop save you $8K in health insurance? Just curious!

[former player]

Well the 32 out of 33 developed nations with their single payer systems.. I wonder how many of those are dying to get great system like us Americans?

"Best in the World, we have nothing to learn from anybody else, we are the greatest"

I can tell you growing up in the UK, the last thing you wanted to do was spend half the night in the Casualty (ER).. In fact getting my Dad to go see the Doctor is like pulling teeth.

Yes, inadequate capacity is a form of rationing.  It is inevitable in a system where care is free at the point of use.  I'm not necessarily suggesting it is a totally bad thing, but we as a country need to be aware that that is where we are headed if we institute a Bernie-style government run free-for-everyone type system.

The USA also has inadequate capacity.  Not usually in the locations favoured by or for the sort of people who post on a forum like this, but for the poor, the rural, indigenous people and people of colour, and the uninsured and underinsured.

Because demand for health care can be more or less infinite it's a matter of choosing what form of rationing you prefer.  Objectively the outcomes from the UK system are better overall than those for the USA.  But of course if you have great insurance and live in a big metropolitan area with lots of health care provision you will probably think otherwise.

[former player]

- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)
...
In my mind, it's really disturbing how ill-informed people are on basic facts.

In 2020 for our family of 5, if we have an AGI of $120,680 we get a PTC of $9,228. If we make $120,685 we get a PTC of $0.

That's the subsidy cliff. Biden's ACA 2.0 is supposed to fix it. But it is a legitimate complaint. Then there's the deductibles and copays.

We've been skirting with the cliff since the ACA became law. In 2018 I bought $2k worth of laptop that I didn't really need so I could save >$8k on health insurance. That's a nutty system.

(This is for a 2020 Bronze Plan - Family of 5 - Premium $1434/month, $17,213/year before subsidy. Deductible $7,700 individual/$15,400 family.)

How did buying a laptop save you $8K in health insurance? Just curious!

Self-employe tax write-off moving someone into a different subsidy category would be my guess.  Not something available to the employed.

[former player]

I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

From a quick google search, there is no copay for the NHS. @Exflyboy ?

Is this similar to when they drug tested welfare recipients in Florida and it cost way more than they saved? Sure, a few people overuse the services but it's so few that why bother with a copay at all?

https://www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/

Other research – not least the famous RAND health insurance experiment carried out in the 1980s – has shown that charges that are not based on ability to pay have a detrimental impact on demand from the very people who need care most – older people and the poor.

There is a copay for prescription drugs under the NHS. Currently thats around $12/per prescription. There are a number of groups that are exempt from paying this though.. Pensioners, students, low income folks etc.

Everything else is free at the point of use. Last tie I looked the UK spent $3500/person for HC.. The US is nearer $10,000.

The NHS covers medical and dental plus vision for kids and people with glaucoma.

There is also a thriving private market in the UK for elective procedures that can be bought through private hospitals.

Just curious, how elective is elective? Are we talking plastic surgery and lasik or, I dunno, hip replacements and other stuff that won't kill you but really help?

The NHS does do hip and knee replacements for emergencies and for quality of life, although you might have to wait and possibly lose weight (outcomes for joint replacements are much better for the less obese, so better value for money).  It does plastic surgery but at the severe need level rather than the purely cosmetic.  Lasik is almost certainly going to be private, with both eyes costing about £3k for someone who does not have private insurance.

The NHS mostly runs its own hospitals and clinics but does buy in some provision from the private sector, so your NHS hip replacement might be done in a private hospital by a private doctor - although the private doctor probably works part time in the NHS hospital next door.

More information here: https://www.england.nhs.uk/

[jrhampt]

On the topic of excess consumption...who are these people who want to spend all their time at various doctors?