[RD] Romneycare (aka Affordable Care Act, ACA, Obamacare) Failed Because It Didn’t Have Enough Taxes

[Gori the Grey]

But it's OK for the government to say, no we aren't going to pay to start an 85 year old man on dialysis, or no we aren't going to pay to do heart surgery on a 90 year old woman. Now granted, I want to be somewhat careful what I wish for, because my wife's job is largely dependent on doing pointless therapy on old people that the government picks up the tab for, but it's insane sometimes that the elderly just go in and out of hospitals constantly, for no apparent increase in quality of life, and little to no additional life added on. Hearts and kidneys fail after a while. It's OK to let them.

No. It's not okay. Those are the "death panels" that the right conjured up in resistance to the ACA.

That's why it has to be a cultural movement, of people themselves individually learning how to die, not a political imposition.

 

[rah]

But who makes the decision. Sometimes that treatment for a 70 year old will help him live comfortable till he's 100 and sometimes it will just extend it to 71. We know what happens when people start talking death panels.

xpost

 

[BvBPL]

You could very substantially reduce the cost of health care if you stopped treating people aggressively at the end of their lives. Our health care spending is right in line with the rest of the world, up until patients reach the age of 55 or so, at which point it skyrockets where everywhere else, costs go up slightly but remain relatively flat.

That chart does not so much reflect an increase in the cost of continuing the lives of people who are close to dying as it shows that keeping an aged population healthy is much more expensive in the United States than elsewhere. This is because of the high cost of drugs in the US relative to other nations.
That chart isn’t about aggressive treatment. It is about the high cost of normal treatment here in the US.

 

[EgonSpengler]

@metalhead I'm not sure how much that graph tells you to be honest. The US is uniformly more expensive, and young people get very different types of health care (fixing up a broken arm) where it is more difficult to be inefficient.

That chart does not so much reflect an increase in the cost of continuing the lives of people who are close to dying as it shows that keeping an aged population healthy is much more expensive in the United States than elsewhere. This is because of the high cost of drugs in the US relative to other nations.
That chart isn’t about aggressive treatment. It is about the high cost of normal treatment here in the US.

Not only is our healthcare more expensive than comparable countries, it's not any better. In some cases it's measurably worse. Some data from The Commonwealth Fund (with which I'm unfamiliar, so cannot vouch for):

Cost of an appendectomy in 2013, in USD:
USA $13,910
Switzerland $9,845
New Zealand $6,645
Australia $5,177
Netherlands $4,995

Life expectancy, at birth, in 2013: Out of 13 OECD countries listed, the US ranks 13th.
Japan - 83.4
OECD median - 81.2
USA - 78.8

Percentage of population aged 65+: Again, the US ranks 13th of 13.
Japan - 25.1
OECD median - 17.0
USA - 14.1

The US ranks very well in the percentage of the population who are daily smokers. Of course our obesity rate makes up the difference. Oh, and our infant mortality rate is simply humiliating.

 

[EgonSpengler]

Spreading the risk reduces insurance rates.

Well, only if there's proper competition. A friend likes to say that, when it came to healthcare, we couldn't decide between a free-market system and a socialized system, so we compromised and took the worst of both. Anyway, my point earlier was that health care and health insurance aren't the same thing, but they're often conflated.

 

[warpus]

It's not like other western countries just let their seniors die. Seniors in Canada end up at the hospital all the time too, and I'm sure in England and France and so on as well. Something must be missing in the details.

 

[EgonSpengler]

It's not like other western countries just let their seniors die. Seniors in Canada end up at the hospital all the time too, and I'm sure in England and France and so on as well. Something must be missing in the details.

All of those countries you named have longer average lifespans than the United States. So for all the extra money we spend on healthcare, it doesn't even work.

 

[warpus]

So you'd think that since people here live longer, that they would use up more healthcare $. Right? And I get that healthcare is a lot more expensive in the U.S., but that graph is awfully geometric looking. It really shoots up after 55 or so.

 

[Cutlass]

It's not like other western countries just let their seniors die. Seniors in Canada end up at the hospital all the time too, and I'm sure in England and France and so on as well. Something must be missing in the details.

What's missing is that the answer is not either/or, the real answer is 'all of the above'.

It's not just keeping the elderly healthy despite high drug costs, and not just excessive terminal care. It's not one or the other, we do both. And we severely over prescribe medicine. Why? Because doing so puts money in the pockets of the prescribing doctors. And then we pay far too much for each medication. Why? Because "free market principles" have been applied to the drug industry to the point where it doesn't in any sense resemble a free market. And then Republicans passed a law banning the government from even asking for lower prices. And we conduct far too many technology expensive tests. Why? Again, because that puts money in the pockets of the doctors ordering the tests. And we pay far too much for insurance. Why? Because we made the insurance industry a for profit industry rather than a public or non profit one. And we pay far too much for this, and far too much for that, for similar reasons.

In short, we've made the worst choices in every respect.

And if you think you're going to fix anything by putting the 'market' forward and rolling back the government, well that's nothing but the worship of crony capitalism speaking.

 

[AppleDumplingHead]

I'm not a fan of state healthcare, because I don't think it's the government's job. I'm unconcerned by the argument "other countries do it". I think people die, it's a sad fact of life, and dealing with that fact is part of what makes us grow.

That said, we went on this program years ago, I wasn't fond of it, but it hasn't reached its projected fruition yet. Stopping it now would, if the theories are true, only hurt us because we've done much of the payment up front, and the balance to the budget is supposed to come with time. I think since we're in the midst of the damn thing, we should see it out 8 more years or we've wasted money "doing something less than half way".

 

[warpus]

What's missing is that the answer is not either/or, the real answer is 'all of the above'.

It's not just keeping the elderly healthy despite high drug costs, and not just excessive terminal care. It's not one or the other, we do both. And we severely over prescribe medicine. Why? Because doing so puts money in the pockets of the prescribing doctors. And then we pay far too much for each medication. Why? Because "free market principles" have been applied to the drug industry to the point where it doesn't in any sense resemble a free market. And then Republicans passed a law banning the government from even asking for lower prices. And we conduct far too many technology expensive tests. Why? Again, because that puts money in the pockets of the doctors ordering the tests. And we pay far too much for insurance. Why? Because we made the insurance industry a for profit industry rather than a public or non profit one. And we pay far too much for this, and far too much for that, for similar reasons.

In short, we've made the worst choices in every respect.

Yeah all of these are problems, but why do they affect those over 55 to such a dramatically different degree than those who are younger, at least compared to other western countries? The line on that graph for the U.S. is pretty much the same as the lines of other western countries. But you reach 55 and it just shoots up like crazy.

 

[cardgame]

Affordable Care Act

Yes, not quick enough.

Yes, a higher penalty would have probably helped make more signup, but it would have had to be 3 or 4 times higher.

Now if that money had been distributed to the insurance companies with the percentage determined by the pool percentage that did sign up, the insurance companies wouldn't have lost as much money and probably wouldn't have had to raise their rates or just drop out. People would scream that we were subsidizing the insurance companies but by fining those that didn't sign up was supposed to lower the risk to the insurance companies which it plainly did not.

You know the actual best way to lower the price of insurance?

Nationalize the system and make it a non-profit. Remove the middlemen leeches who are taking all of our money. Minus the beneficial effects of our extensive R&D industry, capitalism has utterly poisoned healthcare.

 

[BvBPL]

Well, only if there's proper competition. A friend likes to say that, when it came to healthcare, we couldn't decide between a free-market system and a socialized system, so we compromised and took the worst of both. Anyway, my point earlier was that health care and health insurance aren't the same thing, but they're often conflated.

Sure. I'm just not sure what about my initial post caused you to address that.

 

[Cutlass]

Yeah all of these are problems, but why do they affect those over 55 to such a dramatically different degree than those who are younger, at least compared to other western countries? The line on that graph for the U.S. is pretty much the same as the lines of other western countries. But you reach 55 and it just shoots up like crazy.

Because that's when the health issues that they can cash in on the most start occurring.

 

[onejayhawk]

Something is very wrong. I agree with metalhead.

J

 

[FriendlyFire]

Applied to Ryan’s “Better Way” plan, this offers some interesting lessons. Ryan’s ACA replacement plan still offers guaranteed issue (or a form), but removes the penalty for non-coverage. This means Ryan’s plan is likely to accelerate the inflation of health insurances costs that we saw under the ACA.

Uninsured pre-condition can still buy healthcare insurance plans but those plan will cost like 60,000 or whatever the insurance company will set so it dosnt lose money when it takes on a sick person
Which is kinda dumb because people are buying healthcare, getting surgery they need and then leaving healthcare afterwards which causes prices to increase for everyone else.
Making the insurance price so high for prexisiting conditions is one way to solve this but then poor people with preexisting conditions are screwed like before.

 

[Lexicus]

You know the actual best way to lower the price of insurance?

Nationalize the system and make it a non-profit. Remove the middlemen leeches who are taking all of our money. Minus the beneficial effects of our extensive R&D industry, capitalism has utterly poisoned healthcare.

No need to qualify that, the R&D stuff could be vastly improved with a salutary dose of socialism.

 

[cardgame]

Well, I'm not saying it will suffer. But the R&D portion has been been generally pretty good, I feel. Obviously not perfect, but...

 

[warpus]

Because that's when the health issues that they can cash in on the most start occurring.

But that doesn't explain why this doesn't happen in other western countries though, that's what I'm after. What's so different about the American system that rates are almost identical up until people turn 55?

It's almost as if all variables are equal and then suddenly when people turn 55 something changes in America but doesn't in Europe or Canada (or Australia, etc.). What is it, though?

 

[metalhead]

From the limited amount of reading I've done, most of it is due to the fact that drugs here are often several times more expensive here as opposed to elsewhere, and they are over-prescribed. It's practically cliche at this point that getting old in America means taking a large variety of pills each and every day. My own personal opinion is that doctors shouldn't prescribe pills for things that people can treat on their own with diet and exercise, and the fact that our life expectancy is middling is testament to the fact that our approach is not the best.

For example, my father-in-law is on a statin and blood pressure medication. When he gets on a kick of eating better and exercising, his numbers get into a healthy range on their own and he doesn't need the pills. I can't for the life of me figure out why he should get the pills when he isn't keen on taking care of himself.

But who makes the decision. Sometimes that treatment for a 70 year old will help him live comfortable till he's 100 and sometimes it will just extend it to 71. We know what happens when people start talking death panels.

Doctors. Doctors are the ones in position to examine a patient, look at the condition, and tell families that sorry, Grandma's days are numbered and treatment will be intrusive and expensive and at best will extend her life a few weeks, so here's the number of a really good palliative care and hospice company so her last weeks will be comfortable and she can die peacefully at home. We'll treat her if you really want, but you have to pay the entire cost up front and out-of-pocket.

A more complete approach where NOT treating disease is assessed and presented as a viable alternative would greatly benefit patients, particularly in end-of-life decisions.