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.
(Score: 2) by khallow on Tuesday April 22 2014, @01:04AM
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.
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?
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
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.
Hurrah! Quoting works now!
(Score: 2) by khallow on Wednesday April 23 2014, @01:07AM
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.
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
Hurrah! Quoting works now!
(Score: 2) by khallow on Friday May 02 2014, @04:40PM
I apologize for the lateness of the reply, I've been away from the internet for a couple of weeks.
"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.
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.
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.
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
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.
Hurrah! Quoting works now!