I'm kinda tired of hearing that pre-ACA healthcare "only worked for the rich." That's utter bullshit unless you have an absurdly generous definition of rich. It worked for 60-70% of the population. I'm not arguing that that's enough. But the ACA maybe works for 63-73% of the population, give or take. It's not a big improvement in the number of adequately covered people, the standards are worse for people who are covered, and costs have increased substantially in spite of some ridiculous arguments to the contrary. People that argue that costs have been mitigated are ignoring Federal expenditures dedicated to connecting people with insurance, which have run to many billions.

I'm not personally going to argue with you about whether healthcare is a fundamental right. In a country like this that can afford it we should absolutely make sure that everyone has access. The problem is that I don't buy the argument that the ACA has made any meaningful strides in that direction. And I absolutely do think that on balance we were better off before the ACA was enacted.

great comments all....to dahs...thank you for the response..i do realize the crossover and crazystengle has recently mentioned that as well.....neverthelesss we need a model of universal healthcare and it will take some getting used to once it is implemented......capitalism isnt perfect but we work with it......democracy is still an experiment and a work in progress...we will never give up on it...universal healthcare will not be perfect but it is the future and we need to embrace it universally the sooner the better.

Another thing that was in my long deleted post earlier that was an important point. You always hear the ACA's proponents discussing its merits in terms of the numbers of people covered or the numbers of people satisfied with their coverage or coverage options. These are all well and good. Peace of mind is nice.

The fact that opponents of the ACA have allowed to be far too easily swept under the rug is that perception isn't reality here. People are not better off. Before uncleal goes off on me, let me point out that I'm not saying that nobody is better off. I'm saying that in the aggregate people are not better off. Mortality rates are not down. In fact, they're up. Moreover, on both a state and county level there is a demonstrable positive correlation between the number of people adding new state- or federally-supported coverage since the ACA went into force and mortality rates. In other words - in places where more people gained coverage from the ACA, death rates increased. This is almost certainly a correlative rather than a causative effect. The increases in mortality can be almost entirely attributed to drug-related deaths resulting from the increased access of poorer Americans to opioids in recent years. Poorer communities are most impacted by this, and also contribute the most people to ACA-related coverage. They're certainly not dying because of their coverage. But they're also not not dying because of their coverage. I haven't seen a single credible study that found a shred of evidence that people are less likely to die or have other negative health outcomes as a result of the ACA. All the statistics are, as I mentioned above, about coverage and feelings about coverage. The reality is that we're spending a lot of money to not help people live longer or better lives.

Which probably has a lot to do with the fact that government-sanctioned coverage doesn't really help unless you're headed to the ER anyway. And the ER always helped you when you needed them. I would like to see some statistics on medically-related personal bankruptcies. There ostensibly should be an improvement there. But that's far from the change that proponents of the act would like to be hyping.

i think there is an instinctive understanding that the flawed aca is our baby steps toward a single payer system and we must continue forward..we have to put a man on the moon..trump just slipped a comment that the Australian system is superior...from the mouth of babes.

Posted by dino27 on 5/4/2017 9:28:00 PM (view original):
i think there is an instinctive understanding that the flawed aca is our baby steps toward a single payer system and we must continue forward..we have to put a man on the moon..trump just slipped a comment that the Australian system is superior...from the mouth of babes.

We are far better off with a competitive market based system, rather than anything resembling single payer. I don't want government completely in charge of every aspect of it.

We have a new entitlement. Republicans have mostly figured out that it is political suicide to try to pry it out of people's hands now that they have it. But they want a competitive market. That will go a long way to keeping costs affordable.

I don't want a government office telling me my appointment time, who my doctor is, and why I have to wait months to see a doctor, or have surgery.

I'm not convinced the ACA realistically brings us meaningfully closer to a single-payer system. The American population has been fairly evenly split on whether they support a single-payer system for decades and there doesn't seem to be a lot of movement. It's not strictly a battle for the hearts and minds of the people. The hardest part of transitioning to a single-payer system is integrating the existing systems. Nonprofits aren't so hard to absorb, but much of our healthcare system is run for-profit. How do you handle not just integrating the hospitals and physicians, but reimbursing shareholders of publicly-traded hospital groups, insurance providers, HMOs, etc? Aetna is a Fortune 100 company. How do you tell that company and all their shareholders that the government will be undermining the overwhelming majority of their business? Do you try to involve employees of insurance companies into the new single-payer system, and how can you do that without infringing on the corporate rights of those organizations? There are a huge number of logistical issues in a country of this size that the ACA in no way addresses.

It isn't necessary to go single payer. You will never convince me that sucking on the government's teet is ever going to be better than a free market system. If common sense government policies are in place, but limited in scope, I can live with that, so long as I have quality care, and choices I am comfortable with...

hospitals are the biggest fans of the aca and would likewise be of true universal healthcare....they get paid........the bill that passed today could decimate many hospitals in rural areas.

Posted by DoctorKz on 5/4/2017 10:00:00 PM (view original):
It isn't necessary to go single payer. You will never convince me that sucking on the government's teet is ever going to be better than a free market system. If common sense government policies are in place, but limited in scope, I can live with that, so long as I have quality care, and choices I am comfortable with...

And you'll never convince me that actual guaranteed healthcare for all is worse than a mindless swarming plethora of a market for a necessary service.

The free market is a great idea for things in which nonparticipation is feasible. Nonparticipation is not a thing in healthcare. (The whole "healthy people" concept is bullshit, because healthy people can still get in a car accident and need coverage. Or, you know, find lead in their water. Yes, I'm still mad that Flint still doesn't have clean water.)

I start from the position that healthcare is a human right. If you're not interested in ensuring that that right is met I have nothing to say to you.

pro life.

Frankly, this is a situation where I start to feel like people in here are advocating for my death, and I'm sort of done debating it.

Single-payer is optimal. Until we get meaningful progress towards that, you can have my Obamacare when you take it from my cold, dead hand. Because that's what you'll be doing. Maybe you've played with us in league, maybe not, but putting a human face to this -- the half of this account that makes just about all of the non-draft-pick posts -- a 25-year-old from San Diego with a bachelor's degree in math -- is just about all I can do at this point.

I'm tired. I admit it. I'm tired of having to convince people that my right to life is equal to their right to money. Again and again and again.

I am unlikely to survive 2018 on the House "Trumpcare" bill. That's the simple truth, and that's where I have to start. Millions of people are in the same position as me. This will kill people. Perhaps I will be one of them. Perhaps I won't. The fact that I have to worry about this is scary. It's just as scary as it was back in 2009 when I was nearing 18 and wondering if I'd be able to have healthcare in the long run. Granted, I knew I'd be on my parents' plan through college, but what then? Obamacare saved me -- I couldn't be denied coverage for pre-existing conditions. It also allowed me to stay on my parents' plan post-college -- but this was going to be the last year of that anyway. I was going to be hitting Covered California next year. Now I'm worried I might not be able to.

Will the other half of this account have to bury his 26 year old son? I hope not... my Dad at least gets coverage from work, so he will make it, I hope, despite his plethora of health problems...

...oh wait, he's a federal government employee. That thing that Republicans keep trying to destroy. Maybe they'll take that away from Dad too. And he'll die. And then the Marines won't have clean water, because Trump is a moron who puts a blind hiring freeze on and won't replace essential positions.

The cycle swirls on...

Posted by uncleal on 5/4/2017 10:39:00 PM (view original):

Posted by DoctorKz on 5/4/2017 10:00:00 PM (view original):
It isn't necessary to go single payer. You will never convince me that sucking on the government's teet is ever going to be better than a free market system. If common sense government policies are in place, but limited in scope, I can live with that, so long as I have quality care, and choices I am comfortable with...

And you'll never convince me that actual guaranteed healthcare for all is worse than a mindless swarming plethora of a market for a necessary service.

The free market is a great idea for things in which nonparticipation is feasible. Nonparticipation is not a thing in healthcare. (The whole "healthy people" concept is bullshit, because healthy people can still get in a car accident and need coverage. Or, you know, find lead in their water. Yes, I'm still mad that Flint still doesn't have clean water.)

I start from the position that healthcare is a human right. If you're not interested in ensuring that that right is met I have nothing to say to you.

I am not against helping those that need a boost. But having a bureaucratic government run program involving my Healthcare doesn't exactly thrill me. When has the government ever provided anything that exceeded your expectations? We have already seen what a mess those smartest kids in the room can deliver. Long on promise, but well short on results. Not to mention without me having a say in the matter...

The pre existing conditions will be a high risk pool, subsidized. That should remain in place. Keeping kids up till age 26 also.

This round of legislation is not the end result. Having to use reconciliation requires stages of implementation. I want them to get it right. All Americans should have access, affordable, portable, with choices. That is far from what we have now.

You can make the argument sound as pretty as you like. There aren't fewer people dying since the ACA passed. This is a fact. I don't know what your conditions are. I can't tell you you're wrong. I hope you're wrong because I don't want to see anybody dying needlessly. And I'm sure as hell not defending the House bill.

But you aren't making a logical argument. You're making an emotional argument. The root of your actual point is "Health care is a right. Everybody should have healthcare. Therefore, single payer is the best way to handle our healthcare system." Those are 2 almost entirely unrelated things you're presenting as a logical progression. It's not. There are other ways of handling healthcare. Single-payer hasn't worked all that well in Canada, and while it has worked well in Taiwan it has been prohibitively expensive. You translate what Taiwan spends on Healthcare to the US GDP/population and propose that spending you get laughed out of town. Even left-leaning Democrats don't think we can spend hundreds of billions more per year on healthcare. So neither of the existing single-payer systems provides a roadmap to a feasible solution in the near future in this country. Hybrid public/private systems are much more cost-effective. The ACA is just a bad example.

As far as pre-existing conditions go, my solution would be to remove price protections but preserve coverage protections. Then provide a federal subsidy for individual payers with pre-existing conditions to make their effective price equivalent to a "healthy" person. The insuree doesn't see a price hike associated with their condition(s), and the government can negotiate directly with the insurance companies for what added premiums they should be paying to subsidize the coverage. This shifts the burden for pre-existing conditions from the general population of insured people to the tax-paying public. Right now, people paying for personal coverage are bearing an undue portion of the burden, and they tend to be on the lower end of the income spectrum. If you shift the burden to the taxpayers, it shifts more of the burden to wealthier people. I can see why many Republicans wouldn't like it, and I'm not a fan of increased Federal spending, but from my perspective this solves a lot of problems and provides a more equitable distribution of the cost of healthcare for people with pre-existing conditions without resorting to a single-payer system.

Posted by dino27 on 5/4/2017 10:36:00 PM (view original):
hospitals are the biggest fans of the aca and would likewise be of true universal healthcare....they get paid........the bill that passed today could decimate many hospitals in rural areas.

Why should I care if hospitals like it? What about what I like? What works for me? Insurers and doctors opting out, narrowing my access and choices?