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posted by n1 on Sunday April 06 2014, @10:09AM   Printer-friendly
from the sign-this-form-and-we-can-cure-the-hemorrhage-with-a-money-extraction dept.

The Affordable Care Act (ACA) open enrollment period for US Soylentis has ended. The website was plagued by problems from its launch and even had issues on the the last day.

So, did any Soylentis actually use healthcare.gov to sign up and how has your experience been with the Obamacare system so far?

For those that don't know, from Wikipedia:

The ACA was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. It introduced a number of mechanisms - including mandates, subsidies, and insurance exchanges - meant to increase coverage and affordability. The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex. Additional reforms aimed to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of healthcare. The Congressional Budget Office projected that the ACA will lower both future deficits and Medicare spending.

 
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  • (Score: 2) by khallow on Tuesday April 08 2014, @07:22PM

    by khallow (3766) Subscriber Badge on Tuesday April 08 2014, @07:22PM (#28385) Journal

    But I'm just showing that your claim that private services do better at a lower cost is false.

    How? None of the other national services have to provide what private insurance in the US has to provide. Keep in mind that private insurance doesn't have control over costs (and the ability to deny people health care without legal consequence) like a nationally run health care system.

    As to "a wealth transfer from heathly people to sick people" - a more reasonable thing is hard to imagine.

    How about not doing that? Healthy people do things other than generate consumable wealth while merely waiting to become one of the sick. Ultimately, you should be responsible for your own health care since it is your decisions which greatest effect your life. And your personal self-interest which cares the most about your life. The process of shifting the onus of health care onto others who had little control over consumption of health care created the overly expensive system that is in place now in the US. Note that while other countries are not near as bad, they are all getting worse with their health care consuming more of their overall economic activity.

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  • (Score: 1) by BasilBrush on Sunday April 20 2014, @05:15PM

    by BasilBrush (3994) on Sunday April 20 2014, @05:15PM (#33651)

    "How?"

    Again by showing you other countries that do better. US healthcare is by far the most expensive in the world, and yet still leaves many people without necessary medical treatment. What's not to understand about how poor that is. And Again, the reason is that it's run mostly for profits, not for the good of the people.

    "Ultimately, you should be responsible for your own health care since it is your decisions which greatest effect your life."

    What about children? What about those born with physical or mental handicaps that mean they are never in a position to earn money to pay for their healthcare. And why on earth do people who have become rich through the many abusive business possibilities deserve better health treatment than people who do worthy jobs that don't earn much money?

    Your belief that people should finance their own healthcare, such that those without much money don't get treatment, is indefensible. In fact it's evil.

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    • (Score: 2) by khallow on Tuesday April 22 2014, @01:04AM

      by khallow (3766) Subscriber Badge on Tuesday April 22 2014, @01:04AM (#34219) Journal

      Again by showing you other countries that do better. US healthcare is by far the most expensive in the world, and yet still leaves many people without necessary medical treatment. What's not to understand about how poor that is. And Again, the reason is that it's run mostly for profits, not for the good of the people.

      They don't do what US health insurance does or covers. They don't have the political problems to the same degree either, at least not yet.
       
       

      What about children? What about those born with physical or mental handicaps that mean they are never in a position to earn money to pay for their healthcare. And why on earth do people who have become rich through the many abusive business possibilities deserve better health treatment than people who do worthy jobs that don't earn much money?

      So what fraction of the population is that? Here, they're claiming that the percentage of people in the US who are "children" (people under 18 in age) is 24% and dropping. And most of those are covered by parents' health insurance. Physical and mental disabilities at birth are fairly rare too. And what has the person with the "worthy job" done to deserve the level of health care you think he deserves?
       
       

      Your belief that people should finance their own healthcare, such that those without much money don't get treatment, is indefensible. In fact it's evil.

      So who's paying for your moral certainty? One of the big universal problems with health care is that it is trivial for everyone to collectively consume more than they put in via taxes. All those other health care systems attempt to fix this by limiting the health care they give to people - like the worker with a "worthy job" that doesn't earn very much money. A lot of people will pay any price (especially, if someone else is paying!) to stay alive just a little bit longer. But that doesn't have much value to society and so it doesn't happen.

      This is a common problem in the US. For example, Medicare recipients are promised something like 3-4 times as much spending on their medical care as they put into the system. The health insurance markets created by Obamacare have, despite the tax/fine penalty of the individual mandate, strong incentives for health people to stay out of the market and for sick people to get in. That ultimately means that more health care costs will be paid out than insurance premiums paid in and yet another drain on the US federal government finances.

      Another is that a lot of health care is theater - it does provide a measurable increase in lifespan (especially early and midlife medical care), but in the last part of life not one commensurate with the money put in. And at some point, death is the predictable short term outcome no matter how much money you throw in. Yet those times at least in the US are also the most expensive health care periods of a person's life. Similar issues happen in other health care systems. They generally solve this by doing a certain amount of theater to provide the illusion of caring.

      A third problem is why should we value someone's health more than they do?

      By paying for your own health care, you neatly solve all these issues. You can't get more health care than you pay for. You can get health care theater, if that's what you want and have the money for. And you can choose to value your health as you see fit.

      But by inserting our dubious morality into this game, we lose the upper bound on health care costs and these other restrictions. All of the developed world health care systems suffer from huge health care inflation - the US just happens to be the worst case, not the only case.

      Ultimately, I see the current US health care scheme and similar giveaways as bribes to coax voters in going along with the current corruption throughout the developed world. The corporate world gets their squeeze and you get yours. Everyone is happy and the powers-that-be stay the powers-that-be.

      • (Score: 1) by BasilBrush on Tuesday April 22 2014, @07:33PM

        by BasilBrush (3994) on Tuesday April 22 2014, @07:33PM (#34539)

        You're waffling. Overtreatment and undertreatment are identifiable issues in all healthcare systems, but probably the worst in the US system.

        It's really simple. The US has the most expensive healthcare in the world, yet it is the only developed nation that doesn't insure everyone. And the outcomes in the US are far from the best in the world. It's impossible to believe that the US way is the best.

        By paying for your own health care, you neatly solve all these issues.

        You don't solve ANY problems that way. Need for medical treatment and ability to pay is terribly ill-matched. In fact it's closer to an inverse relationship. It's the worst way of making a healthcare provision.

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        • (Score: 2) by khallow on Wednesday April 23 2014, @01:07AM

          by khallow (3766) Subscriber Badge on Wednesday April 23 2014, @01:07AM (#34660) Journal

          It's really simple. The US has the most expensive healthcare in the world, yet it is the only developed nation that doesn't insure everyone. And the outcomes in the US are far from the best in the world. It's impossible to believe that the US way is the best.It's really simple. The US has the most expensive healthcare in the world, yet it is the only developed nation that doesn't insure everyone. And the outcomes in the US are far from the best in the world. It's impossible to believe that the US way is the best.

          Ok, who in this thread believes US health care is the best? You?

          Obviously, the US health care system has huge problems that recently grew even more under Obamacare. But it's the people who value universal coverage over cost effective health care who dug this hole deeper. I'm not set to give them another opportunity to make matter even worse than they already are.
           
           

          By paying for your own health care, you neatly solve all these issues.

          You don't solve ANY problems that way. Need for medical treatment and ability to pay is terribly ill-matched. In fact it's closer to an inverse relationship. It's the worst way of making a healthcare provision.

          I stated three such problems. Just because you choose to ignore them, doesn't make them go away. First, need for medical treatment and ability to pay is an excellent match and much more simple than your "really simple" and irrelevant observation (just because the US system is much more broken than other health care systems doesn't mean that private insurance or a mostly free market can't operate better than what we currently have).

          The fundamental problem with every national health plan and one which the US system has in spades is that they encourage demand by insulating the consumer from the consequences of their consumption. It's the classic collective check problem. A group can decide to pay for a meal in two ways. First, each person pays for their food separately or second, they pay a fixed portion of the collective check. The latter results in higher consumption. For example, if ten people orders meals separately, then every dollar a single person reduces their meal cost by becomes a dollar saved by that person. But if everyone pays a share of the total, then that person only saves themselves $0.10. There is less incentive to control consumption.

          If we just pay for everyone's health care with one single check, then there is only a microscopic incentive for anyone to reduce their health care consumption. Note that this lesson was completely ignored by Obamacare which among other things fixes the cost of health insurance for subsidized purchasers to a percentage of income. Outside of the one-time deductible, there is no connection between consumer and the cost of the health care services they consume. If the cost of health insurance goes up, the subsidized person pays no more.

          And we already have a preview of how the US would deal with single payer in the combination of Medicare and Medicaid. The former pays out 3-4 times what it gets. The latter is becoming the new uninsured with reduced health care coverage from even a few years ago. Combined the two programs threaten the future of the US even though the US doesn't yet have universal coverage.

          And finally, the costs keep growing as the moral obligations do. Every developed world country has health care costs growing faster than GDP. What will control costs? What will provide health care when the system breaks from attempting to provide health care below cost?

          • (Score: 1) by BasilBrush on Wednesday April 23 2014, @05:11PM

            by BasilBrush (3994) on Wednesday April 23 2014, @05:11PM (#35008)

            I stated three such problems. Just because you choose to ignore them

            It's not that I ignored them, but you are waffling. All the things you mentioned work BETTER in other systems. There is less over-treatment (because doctors are less like businessmen). There is less under-treatement (Because there are fewer people that don't qualify for treatment, because they don't have insurance, or it's a preexisting condition.)

            It's the classic collective check problem. A group can decide to pay for a meal in two ways.

            People choose what to eat at a restaurant. In most cases they don't choose to be ill or disabled. Things that can bring down the demand for healthcare, such as restrictions on smoking or schemes to encourage healthy eating or discourage unhealthy foodstuffs, people of your political persuasion also oppose.

            Everything I said about the US healthcare system applied before Obamacare. Obamacare is a compromise, and improved the lack of access to healthcare which was the worst feature of it. The best system is state provided insurance that covers everyone.

            And finally, the costs keep growing as the moral obligations do. Every developed world country has health care costs growing faster than GDP. What will control costs?

            It's not just the moral obligations that improve, but advances in science enable people to be kept alive or healthy more than they used to. It's costing more but delivering more benefit.

            But since the cost is your concern, let me repeat once more. The US system is the most expensive in the world. It's 2.5 times as expensive as the state provided UK healthcare system. And the outcomes are no better.

            Let me qualify that:
            The US life expectancy is 79.8. The UK life expectancy is 81.
            US Obesity is higher (36% vs 25%).
            Despite the stereotype, UK teeth are healthier, with more frequent dental check-ups.
            Death from heart disease is higher in the US (80.5 per 100,000 vs 68.8)

            Again, this from a country spending 40% on healthcare of what the United States does. With no one having to worry about how they are going to pay for medical insurance plans - they are all already covered.

            The problem with the American system? All the profits that capitalists are taking out of it. Most of the money you pay in insurance goes into the shareholders pockets. And rather a lot of the money they pay to hospitals too. That's the reason there was so much opposition to Obamacare. The people who are making profits out of it fear moving towards a system where they are cut out of the loop, and they can't be parasites any more.

            And finally one the stupidest thing about the American System - at least prior to ObamaCare. If you already have a pre-existing condition, you couldn't get insurance. And thus very often couldn't get treatment. A more fundamental breaking of a healthcare system it would be hard to imagine.

            But people get used to what they have. The US healthcare system looks rational to you because it's the one you are used to. The rest of the world can see it's fucking insane.

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            • (Score: 2) by khallow on Friday May 02 2014, @04:40PM

              by khallow (3766) Subscriber Badge on Friday May 02 2014, @04:40PM (#38957) Journal

              I apologize for the lateness of the reply, I've been away from the internet for a couple of weeks.
               
               

              All the things you mentioned work BETTER in other systems.

              "Work better" than one of the worst developed world health systems is such a ringing endorsement. I stand by my previous statements. Everyone's systems are bad and growing worse, the US just happens to be digging the hole far faster than the other ones.
               
               

              People choose what to eat at a restaurant. In most cases they don't choose to be ill or disabled. Things that can bring down the demand for healthcare, such as restrictions on smoking or schemes to encourage healthy eating or discourage unhealthy foodstuffs, people of your political persuasion also oppose.

              First, people can't choose not to eat. Even if we didn't grant that, you don't bring up a relevant point. The dynamic remains the same whether it's a restaurant or health care consumption. Second, you assert that things like smoking increase the demand for health care. But so does living longer. The only thing that reduces the demand for health care is killing the people who would get sick. Or if you're economically practical, killing them once the present value of their expected future health costs exceed the present value of their expected future labor. That incidentally also favors rich people. It also indicates that smokers may be a lot cheaper than you claim for a health care system.
               
               

              Everything I said about the US healthcare system applied before Obamacare. Obamacare is a compromise, and improved the lack of access to healthcare which was the worst feature of it. The best system is state provided insurance that covers everyone.

              It's interesting how much of today's health care problems can be traced to perception. You think that "access to health care" (whatever that is supposed to mean) is important. But what's the quality of that health care? Who is paying for it? And will these attempts to improve coverage even work to improve your hypothetical metric over the next few years? For example, the proponents of Obamacare radically scaled back their expectations for 2014-2015 enrollment and they're including a lot of people who got dumped on Medicaid.
               
               

              And finally one the stupidest thing about the American System - at least prior to ObamaCare. If you already have a pre-existing condition, you couldn't get insurance. And thus very often couldn't get treatment. A more fundamental breaking of a healthcare system it would be hard to imagine.

              It's worth noting that a number of people were able to buy insurance even though they had preexisting conditions, say via health insurance provided as part of a spouse's employment. And once, you're on such insurance, it transfers.

              Second, what's broken about it? Insurance is for things that haven't happened yet. A preexisting condition already happened. And I imagine that if the person with the preexisting condition were actually willing to pay the proper insurance costs for having that preexisting condition and were able to legally buy insurance at that price, then they'd be able to buy health insurance. Or they could self-insure. But that gets to your unwillingness to base health care on peoples' ability to pay.

              Look, I already know that at some point, my health care costs will exceed my ability to pay for those costs even as insurance. I am comfortable with only getting a certain level of health care that I can afford. I'll die anyway, and I'd rather die at a point which doesn't bankrupt myself, my family, or my society.

          • (Score: 1) by BasilBrush on Wednesday April 23 2014, @05:27PM

            by BasilBrush (3994) on Wednesday April 23 2014, @05:27PM (#35016)

            I think this sums it up pretty well. Health care systems ordered according to how good they are by the World Health Organisation.

            US is 37th on the list whilst being the most expensive.
            UK is 18th whilst being the 26th most expensive.

            http://en.wikipedia.org/wiki/World_Health_Organiza tion_ranking_of_health_systems_in_2000 [wikipedia.org]

            (Note it's quite old, so you can't blame Obamacare.)

            "Socialist" single payer state healthcare works so much better than the many-payer commercial insurance route.

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