Will Obamacare succeed where term limits failed?

[Montmorency]

The total cost of care cannot be lower and must be significantly higher.

Nonsense. The list of treatments, tests, medications, etc. that are identical from country to country yet 5, 10, 20, or more times as expensive in the United States is of untold length. The fact of the matter is that there is a price-race between hospitals and insurance agencies and that obliterating the highly-inflated costs of the medical sector would easily permit the underfunded individuals that ACA purports to service to obtain affordable insurance on their own initiative.

Costs for health care cannot go down and must go up.

No, no, and no. This is an extremely dangerous position to take - just pay, and pay, and pay, and who cares why it costs so much or where the money is going, just keep paying!

[Xiahou]

No, no, and no. This is an extremely dangerous position to take - just pay, and pay, and pay, and who cares why it costs so much or where the money is going, just keep paying!

That's the whole premise of insurance. Who cares what it costs? It's not my money!

It's not surprising that costs spiral upwards when you setup perverse incentives like this....

[Seamus Fermanagh]

Nonsense. The list of treatments, tests, medications, etc. that are identical from country to country yet 5, 10, 20, or more times as expensive in the United States is of untold length. The fact of the matter is that there is a price-race between hospitals and insurance agencies and that obliterating the highly-inflated costs of the medical sector would easily permit the underfunded individuals that ACA purports to service to obtain affordable insurance on their own initiative.
....
No, no, and no. This is an extremely dangerous position to take - just pay, and pay, and pay, and who cares why it costs so much or where the money is going, just keep paying!

My comments were directed at the current system as modified by the ACA. What you are suggesting would involve a far more sweeping alteration than what is scheduled to occur. Perhaps we will head that way in time, but that is not the impact this law, as currently constituted, will have.

[Montmorency]

Fair enough, though I don't see why

Costs for health care cannot go down and must go up.

would be justified even in a narrow context.

It really is an alarming thought.

[Seamus Fermanagh]

Of course it is alarming. That's one of the reasons so many on the political right in the USA oppose it -- and I am not talking about the fruit bat fringe.

The basic idea is that more people will be provided service (the purpose of the act in the first place). That greater total amount of service will require more health care spending overall, even if there is somewhat less spending on a per capita basis (which is being argued).

Can that be altered? Yes.


To alter it in a substantial way would require:

1) A decrease in services.

2) An alteration in the services provided (shift to preventative for example).

3) An alteration in the population's behavior (overeating, under-exercising, & tobacco use).

4) Price controls on various elements of the health care system, notably salaries for medical licensed health care providers.

or some combination of 1-4.

#1 runs counter to the stated goal of making health care better for all, while 3 & 4 are problematic in implementation under our current system of governance. 3 & 4 would really only become possible under a full-on national health care system.


I should note here that any number of those on America's political left, along with some issue-by-issue types among the moderates, are angry with the situation and with the ACA precisely because it does NOT take the necessary steps to shift us to a true national health care system. I suspect that they're frustrated as well precisely because they believe that nothing less than such a system could truly influence the largest components of American Health Care costs: Poor lifestyle choices, Physician and specialist salaries, and Medical malpractice/insurance therefrom.

[Lemur]

Poor lifestyle choices, Physician and specialist salaries, and Medical malpractice/insurance therefrom.

To which I would add the biggest rotting apple in the barrel: Unrealistic pricing.

You don't see many $500 hammers like you did in the old days of government contracting, but now you see plenty of $800 bags of saline solution that cost $1 to manufacture and distribute.

Price gouging, like so many government functions, has been privatized.

[Montmorency]

Unfortunately I doubt that the long-term trend would look much different with a continuation of the (former) status quo. The ACA isn't enough, but it's conceivable that overall the net is at least a little benefit. It could also be argued for as a component of a minimalist program - after all, the TPers weren't just spontaneously generated by the mooting of health-care reform...

notably salaries for medical licensed health care providers.

First, get at the chargemasters and the admin layers. If services rendered become much cheaper, insurers will in turn be left without an excuse to maintain high premiums. Physician and specialist salaries are not so harmful as the rest.

An alteration in the services provided (shift to preventative for example).

Simultaneously with discouragement of reflexive recourse to maximalist end-of-life care.

Consider not commissioning 6-figures in services to keep gramps vegging along for another few weeks or months.

[Montmorency]

Furthermore: Get providers to treat tried-and-true technologies and procedures with more respect, as opposed to pushing the latest pricy-yet-ineffective 'device of wonder' on credulous or bewildered patients. It makes no sense to invest hugely in expensive-but-unproven techs, especially with short-term obsolescence being the norm, unless it's all just a marketing trick on the part of hospitals, far closer to rock-walls and multimedia centers at colleges than anything else...

This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

[Seamus Fermanagh]

To which I would add the biggest rotting apple in the barrel: Unrealistic pricing.

You don't see many $500 hammers like you did in the old days of government contracting, but now you see plenty of $800 bags of saline solution that cost $1 to manufacture and distribute.

Price gouging, like so many government functions, has been privatized.

Most of which is nothing but a game. The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels. Insurance pays 32. The whole thing is a damn shell game.

[Lemur]

The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels.

There's truth in what you say, but the bolded bit is ... shall we say an extremely generous interpretation of hospital behavior.

[Proletariat]

But the loser of the game is the self covered or out of pocket customer. They get the full 800$ charge for salt water in a plastic wrap and are charged 2 dollars each Tylenol administered when a bottle of hundreds costs under a few dollars at Costco. The problem of the insane pricing and the 'charge list' charade was examined in Time magazine a year back really well. It's what's wrong with healthcare and no one gets into it. Much more important than tort reform second maybe only to national health care or public option decision. That its just standard to not be told what any of the arbitrary or jacked up charges are being leveled at you by your healthcare provider is maddening. No one would accept buying software or food this way. So the freemarket works there in a way it can't in healthcare.

What I've learned as a therapist in the US army, some hospitals and some nursing centers for ten years. We're all being fleeced.

Most of which is nothing but a game. The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels. Insurance pays 32. The whole thing is a damn shell game.