Well, my Dad is a staunch Democrat and a physician and he has been wanting to see the ACA abolished since before it went into effect. In fact, the provisions of the ACA put my parents' office out of business. But our 2 data points don't necessarily reflect any kind of meaningful consensus from the fields.

im very sorry to hear about your dad...how did it hurt him.....
my agent was always critical of aca...it was surprising to hear her comments today...she has been involved with health ins for more then 20 years..

My parents couldn't afford to comply with the EMR requirements, particularly in light of the reduction in Federal reimbursement levels. I mean, they could have, but it would have taken long enough to break even on the down payments for new software and hardware to render it not worth the investment. If they'd been younger they would have made it work.

sorry to hear about your parents' plight.

My personal opposition to the ACA is largely on the grounds that when I needed government assistance for coverage I found my options to be functionally worthless. I finished grad school outside of the exchange period so I wasn't free to purchase any insurance I wanted (since my fiance made plenty of money to pay for it) but was forced to take one of only a handful of options available as a result of change of circumstances. These were all in whole or in part state-sponsored. They also all had massive annual deductibles - the lowest was $3000. Again, if I needed care, I could afford that expense. But most people seeking state-sponsored insurance are not in that specific situation and actually don't have cash on hand. In their cases, that deductible effectively means they still don't have access to preventative care. You have to pay most or all of the cost of a standard physical. Functionally, all that coverage did was keep me from going bankrupt if I wound up in the Emergency Room. If you want to increase governmental subsidies for ERs in areas with large uninsured or low-income populations, you can do that directly without the massive overhead of the administrative systems required by the ACA.

To recap:
1) the exchange period, which has almost no functional benefit, removed my ability to access quality healthcare at the time I needed it
2) the state-sponsored options available to me did not functionally provide access to preventative care
3) this ineffective system is costing billions to administer

for many people 250/month being the deductible and maybe 150-200 per month in premium is very good compared the the options they had before..unless you have an aetna or some super elite coverage everyone has high deductibles of 1000 and up...for many the deductible only applies to hospital and not preventive care.....if you start with a good concept a bipartisan effort could make it work...the dems had wanted to fix aca since it began.

I typed a very long response to that but I lost it when I backspaced and my browser decided I wanted that to indicate the back button. Maybe I'll type it back out tonight.

Most critical point is that while you are 100% right it is almost equally irrelevant. $250/month deductible (roughly double that for a family plan) is almost certainly better than a lot of people had access to before the ACA. But it still represents money that the vast majority of those people don't have available. They still can't use it because they still can't afford it. The fact that your 15th visit to the doctor in a calendar year is now free doesn't mean a whole lot to people who can't afford the first 14.

Not to mention the fact that doctors don't want to see them. Even before the ACA, only about 70% of physicians accepted new Medicaid patients. That number is even lower for exclusively primary care docs, and repeated phone surveys have indicated that the realistic rate of new patient acceptance is actually lower (that is, physicians report accepting new Medicaid patients, but never "have appointments available" for callers claiming to have Medicaid and seeking new patient visits). The government knew this and decided that they should still put 10s of millions of additional people on Medicaid and equivalent plans. Duh.

the ACA has a double sided sword of unfairness because it has raised employer sponsered healthcare beyond most ability to purchase or the employer even to offer it in my case my monthly premiums are 785 a month with a 6000 deductible for my wife and I almost 16000 a year before aetna pays a dime sure there is a small amount of preventive coverage but even that had uncovered parts to them. i had a physical in jan suppose to be free ended up costing me 617 because my doctor ran uncovered test and there is no way in advance to know what is covered and what is not. under the current system we have talked about divorce for cheaper insurance coverage (connie cant work and would go on medicare while my single insurance would drop to 400 a month with a 3000 deductible) that idea sickens me but what am i suppose to do sell my house and use my equity so i can afford health insurance. we as american can find a better way

if Canada has a system that works and the public likes why cant we.

Two things:

1) Canada's system doesn't work all that well. Recent studies I've seen do rank Canada as slightly better than the United States in aggregate, but significantly below European countries with greater private sector components of their healthcare systems. The general consensus seems to be that the UK system is working the best right now.

2) Canada's system is also highly dependent on having access to the United States nearby for the vast majority of Canadian citizens. This is so often overlooked by the people advocating a Canadian-style system. The US system naturally draws the best and brightest physicians from around the world, as they can be paid quite highly for their talent here. And Canadians do take advantage of that. Over 1% of all Canadian healthcare visits occur outside the country (incidents in which Canadian citizens leave the country explicitly to receive medical care). The numbers are significantly higher for risky or critical specialties like neurosurgery and cardiology. The Canadian system is really good for low-income people, but it leaves a lot to be desired on the high end. Quality and wait times for specialists are a consistent problem. Given that the majority of Americans had high quality insurance before the ACA was enacted, more people stand to lose from conversion to the Canadian system than stand to gain.

An important distinction is that the people who gain gain a lot more than the people who lose lose. Changing to something resembling the Canadian system would probably improve American healthcare at least marginally. But it would sit poorly with a lot of people, and it's far from a best-case scenario. Not sure why so many people from the left 20-30% of the political spectrum seem so latched on to a country that's well below average amongst the world's wealthiest countries as a role model for healthcare.

Even the ACA is already costing the well-insured. And I'm not just talking about costs, which have been a mixed bag. But in order to help mitigate the costs, care recommendations have been almost universally reduced so that insurers don't have to cover as many screenings. Mammograms are now covered every other year instead of every year. Colorectal cancer screening stops at age 75. PAP tests are now only recommended (and covered, in many cases) once every 3 years. The list goes on. Implicit in these changes is the tacit acceptance that more people will inevitably die as a result of reduced screening, but the number is small enough to be justified by the reduction in costs. And then the proponents of the ACA can point to a reduction in the growth rate of healthcare costs and proclaim a victory.

A small irony in this is that one party is tacitly willing to accept environmental harms in favor of economic benefit, while the other is willing to tacitly overlook negative healthcare outcomes in favor of reducing costs. And both of them can't stop railing at each other over it.

Posted by rjj4191 on 5/4/2017 6:52:00 PM (view original):
the ACA has a double sided sword of unfairness because it has raised employer sponsered healthcare beyond most ability to purchase or the employer even to offer it in my case my monthly premiums are 785 a month with a 6000 deductible for my wife and I almost 16000 a year before aetna pays a dime sure there is a small amount of preventive coverage but even that had uncovered parts to them. i had a physical in jan suppose to be free ended up costing me 617 because my doctor ran uncovered test and there is no way in advance to know what is covered and what is not. under the current system we have talked about divorce for cheaper insurance coverage (connie cant work and would go on medicare while my single insurance would drop to 400 a month with a 3000 deductible) that idea sickens me but what am i suppose to do sell my house and use my equity so i can afford health insurance. we as american can find a better way

Yes we can. If you think this is it, you're nuts.

On the one hand, all I know is that if I can be denied coverage for pre-existing conditions you won't see much of me around here... or anywhere else for that matter...

We're still the only developed country that fails to provide healthcare for all citizens. Assertions that single-payer can't be done are simply not credible to me. Everyone else manages it. Are there problems with other systems? Sure there are. But we can, you know, work on that, see what's going right and wrong, and improve on it. In a functioning system, we'd agree on the basic principle -- that more people need healthcare, not less -- then get to work and settle the details on how to implement a working healthcare system, in the chambers of Congress. And for that matter, if we found problems in the implementation, we'd get back to work and try to seriously fix it. I think discussions on which elements from what countries, or even our own new ideas, to implement, would be good discussions to have. But we can't have those discussions, because Republicans just want to destroy our healthcare, returning it to the way it was pre-ACA, which likely would have me... frankly, I wouldn't be surprised if I were dead due to lack of affordable coverage for conditions I have. The idea that insurance was "high quality" pre-ACA is... bullshit, unless you were rich. It worked for the rich, did **** all for everyone else. Is that what you want? Well, if you're rich, maybe, but also **** you.

Of course Democrats are in a position where they have to "protect the ACA", even though it does have problems, because the only alternatives being considered are, frankly, evil. Single-payer would be clearly superior. But it was never put on the table.

I am, frankly, over the idea of discussing healthcare with people that don't believe healthcare is a human right. You're never going to convince me otherwise, and all it's going to do is **** me off that you basically think I should die because I have expensive medical conditions.

The ACA doesn't work because the model is wrong. You don't depend on healthy people to buy insurance only when the time comes that they need it. And if your co-pays and deductibles are so high that you can't afford to use your coverage. That, and people were lied to, that you can keep your coverage and your doctor. Yes it could be fixed. Good luck with the idiots coming together to fix it.
You also largely have a market not having to compete for your business. Imagine a system like auto insurance, one that is portable, you can buy across state lines, and more groups of people getting together to have buying power. Almost all of this is targeted to be in the AHCA. Having to use reconciliation complicates this even further. What Trump, Ryan and the others are trying to do is no small task. Especially with not everyone on the same page...rather than infighting, just get it done. If they would get 80-90 percent of it done, they could get the rest done over the next few years. And they can all take credit for improving something in dire need of help. It will almost certainly implode if they don't....