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Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

nejm.org

41–50 of 88 posts

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#41
post #25

Earlier quoted context omitted.

Choosing to not be insured is unsustainable for our economy the moment you have an issue and need a doctor.

so i shouldnt have the right to choose?

You should have the right. But you also should not get any kind of treatment under any circumstances if you don't pay upfront.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#42
post #25

Earlier quoted context omitted.

Choosing to not be insured is unsustainable for our economy the moment you have an issue and need a doctor.

so i shouldnt have the right to choose?

As long as the rest of us don't have the right to let you die on the sidewalk outside the ER, no, I'm afraid you shouldn't have the right to choose not to participate.

If you want to go off the grid, you need to go ALL the way off the grid. Otherwise you're just another moocher.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#43

It's a wonderful idea. Free healthcare for all. Sadly, it simply isn't sustainable financially. I think in the next 10 years alone it was supposed to cost tax payers 10 trillion and that money can't literally be printed fast enough and the debt our country holds, extremely unsustainable. If they did it cheaper or more cost effective, I would say yes, but financially, you can't.

It's not free healthcare for all. It's healthcare paid for the taxpayers, by the taxpayers. And if the costs go up - it's because perhaps healthcare is better as a not-for-profit system rather than a for-profit system. Pretty hard to negotiate which hospital gives you the better deal when you're having a heart attack. And I say this from a position of love in New Zealand - I wish you had normal government healthcare,…

An ACA thread always seems like a good time to throw in a plug for socialized medicine, but I do want to remind everyone:

Many people think that without ACA, the US healthcare market is free, which is why it has so many problems. This could not be further from reality. We have more government distortions in our healthcare market than countries with completely socialized healthcare. For example:

Medicare: socialized medicare for the elderly, which alone creates more distortion than a universal program would cause by inflating demand/prices for non-qualifying citizens.

Medicaid: socialized healthcare for specially qualifying poor people, which creates the same distortion as Medicare.

An oppressive FDA: which, coupled with overly-powered IP laws, grants de-facto monopolies in the medical product industry. We have an incredibly expensive and subjective medical equipment pre-approval process (as compared to a less-terrible FDA that would just be in charge of labeling, preventing fraud, and maintaining accountability in the event of incidents). Then there's the length and flexibility of patent protections in our current system (maybe we could cut those protection times in half, and patent trolling would not be a lucrative industry).

Oppressive occupational licensing: It's way too hard to become a doctor of any kind, even the kinds that don't manually put things into your heart. This will be a major battle as AI comes to the point where it can better diagnose conditions and largely replace generic/non-specialized pediatrics. Of course, the government will not make this easy.

Plus a slew of more minor things like malpractice regulation, and now the ACA (which is not so minor, and which will apparently be replaced with something similar).

If we cleaned up/removed all of the problems in the above and replaced it with single payer, it would be OK and we would have something similar to New Zealand/other countries with long wait times, not as much access to specialists, slow innovation, and a system where the government gets to decide who gets the last liver transplant and who dies. That would be a less distorted market than we have today, but ONLY if accompanied by fixing the aforementioned problems.

Or we could try going the free-ish market approach and try to find a much freer balance with the FDA/USDA/occupational-licensing/scrap Medicare/Medicaid,etc., which we do not currently have AT ALL. And maybe even declare health insurance fraudulent and pay everything out of pocket (accident insurance makes more sense as a hedge against risk, which is what insurance is supposed to be, whereas all people are expected to develop health problems at some point, with a probability approaching one).

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#44

It's a wonderful idea. Free healthcare for all. Sadly, it simply isn't sustainable financially. I think in the next 10 years alone it was supposed to cost tax payers 10 trillion and that money can't literally be printed fast enough and the debt our country holds, extremely unsustainable. If they did it cheaper or more cost effective, I would say yes, but financially, you can't.

Please point me to the non-partisan, non-hack, non-goldbug study that tells you that the US cannot support its current debt load. The feeding frenzy at every new treasury auction tells me that there's plenty of space yet for us to issue debt. Serious claims require serious proof.

It isn't that no one will buy the debt, it's that the interest on the debt hurts the country. Every dollar in interest the government pays is a dollar it has to take from taxpayers and then not spend to the taxpayers' benefit.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#45

It's a wonderful idea. Free healthcare for all. Sadly, it simply isn't sustainable financially. I think in the next 10 years alone it was supposed to cost tax payers 10 trillion and that money can't literally be printed fast enough and the debt our country holds, extremely unsustainable. If they did it cheaper or more cost effective, I would say yes, but financially, you can't.

Do you mean the $10 trillion cost from repealing? Here is republican senator Rand Paul on the huge budgetary expense of ACA repeal https://m.youtube.com/watch?v=6AuIwR00T5g

At 1:20 he says he's in favor of repealing ACA He doesn't like how it's being done.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#46
post #40

Earlier quoted context omitted.

They might not, but they are probably lobbied by doctors, hospital administrators, and insurance executives, all of whom are likely to at least skim the top medical journals.

I don't think any of these groups care much about affordable Care.

Our HMO we used at old job hated ACA. At least their representative told us that informally. Another doctor I know also does not like. Someone who is self-employed with a pre-existing condition really likes it. It was hard for them to get insurance before.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#47
post #43

Earlier quoted context omitted.

It's not free healthcare for all. It's healthcare paid for the taxpayers, by the taxpayers. And if the costs go up - it's because perhaps healthcare is better as a not-for-profit system rather than a for-profit system. Pretty hard to negotiate which hospital gives you the better deal when you're having a heart attack. And I say this from a position of love in New Zealand - I wish you had normal government healthcare,…

An ACA thread always seems like a good time to throw in a plug for socialized medicine, but I do want to remind everyone: Many people think that without ACA, the US healthcare market is free, which is why it has so many problems. This could not be further from reality. We have more government distortions in our healthcare market than countries with completely socialized healthcare. For example: Medicare: socialized m…

Medicaid spending mostly goes to the elderly, disabled and children:

http://kff.org/medicaid/state-indicator/medicaid-spending-by...

(When people have no money left, Medicaid pays for nursing home care)

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#48
post #46
post #40

Earlier quoted context omitted.

I don't think any of these groups care much about affordable Care.

Our HMO we used at old job hated ACA. At least their representative told us that informally. Another doctor I know also does not like. Someone who is self-employed with a pre-existing condition really likes it. It was hard for them to get insurance before.

The US system certainly makes a lot of money for providers and insurances. Otherwise it would be cheaper. The money must be going somewhere. These people don't want change.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#49
post #21

Thanks to the ACA, a larger share of Americans have health insurance than ever before because its compulsory. this shouldn't an argument for the ACAs effectiveness. I have to buy car insurance if i choose to drive a car on public roads. i have to pay income tax if i have income. now, by birth, i automatically owe the state. i'd like my freedom and right to choose back please. the fact this isn't the main argument fro…

You pay for private insurance or you pay for public insurance via taxes. Any other solution is unworkable and you are a free rider.

The fact that we have to buy such expensive insurance is what burns me. Before ACA my family had good options for an individual plan (I'm self employed). Now we must pay $20K/year, and don't even get much benefit until we've spent another $5K out of pocket. The scope is what I don't like.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#50

I doubt anyone in Congress or the White House working to repeal the ACA reads the New England Journal of Medicine.

They might not, but they are probably lobbied by doctors, hospital administrators, and insurance executives, all of whom are likely to at least skim the top medical journals.

A good chunk of the rich that foot the bill for a lot of the ACA subsidies[2], the same ones that pump money into PACs and would see money coming back into their pockets if the ACA was repealed [1], also have a vested interest in saying "meh, those journals are full of crap".

1. http://www.slate.com/blogs/moneybox/2017/01/12/obamacare_rep...

Edit: 2. If this is bullshit I sincerely want to know so I can understand all sides.

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