What is the Obamacare 'replace'? (Page 2)

This is just my opinion but I believe that free market principles fail to combat costs in the health care industry.  Put Apple against Google?  Sure, that works.  If I don't like Apple's offering I go elsewhere.  Or I skip it altogether.

But when someone is dying, suddenly they're willing to do or pay anything to be taken care of.  And the pharmaceutical and insurance industries know it.  That's why I mentioned the Medicare thing - because it is built-in leverage (old people vote a lot; Medicare isn't going anywhere) -- without necessarily going to single-payer.

This really isn't that hard - the rest of the world has figured out that governments can and should stand up to these industry giants.

n=1  -- I had an emergency in Canada last year.  I think my total bill before insurance was around $1k, including a 30 min ambulance ride and ER.  The last time I had an ambulance ride in the U.S. was 2 miles to the hospital and billed at around $5k.  For just the ambulance.  Yes insurance covered that but it's a great example of the b.s. pricing that Rogillio is talking about.

$1k Canadian dollars haha.  Even better.

One of the things I have learned over the years is that health care, like almost everything else in life, is not equal for everyone.  I think more people need to learn that.

I recently lost my best friend to cancer.  He had decent insurance, and he got the standard care and treatment from his local hospital.  It was interesting for me to watch because my brother currently has terminal liver cancer......and he has decent insurance, and a lot of money, so he's at the Sloan Kettering institute getting cutting edge care.  A year ago he was given 6 months to live, but through some of the best cancer care available on the planet, he is now cancer free and his prognosis is much brighter......5-10 years, but that comes with the idea that more and better treatment will be developed during that time frame and then who knows?  He picked up and moved to New York when he was diagnosed.  Rented a 6K/month apartment nearly next door to the Cancer Center, and lived there a year.  The type of treatment available to him was not even an option for my friend who died.......the cutting edge type treatments are just not available at your local hospital (for the most part).

I agree that nobody should be without health care in our country, but we're not all going to get equal care.  That's life.  We changed to a more expensive plan so that we could have access to the best orthopedics in our area.  That's important to our active and athletic family.  We feel fortunate that we could afford the more expensive plan.  But we had orthopedic care before, as do the people who still see those doctors that we had been seeing.  I don't think the care is equal at all, but paying a bit more is part of the deal.  That's life.  You either can or you can't and you make life decisions based on what's important to you.  Better health care or a new car for instance.  An Iphone or a cheaper phone. Steak or hamburger.  Eating out or cooking at home.  These types of decisions are endless and were a staple of life when I was growing up.  Now everyone thinks they have a right to what everyone else has, cost be damned.  No, that's NOT life. 

Healthcare will never be equal for all.....like everything else in life.  Your life decisions will carry a bigger weight on your type of care (and most everything else) then anything the govt. comes up with.

Yep, and the "masses" are happy because it's covered by their INSURANCE.  It's not better care then going to the ER with no insurance.....in fact, it's an easy argument that the care is actually worse.  That brings me back to my original comment on this thread.  The ACA was good for insurance companies, and a huge gain for drug companies......nobody can convince me that the level of care was increased. 

Sure it's a worse deal for someone with a sniffle.  But I'd rather have them chipping in their co-pay and keeping the ER clear for people who are, you know, dying.

And then the other big thing IMO - goes back to what Rogillio was saying.  The *primary* goal of insurance should be to cover the random catastrophic stuff.  I don't know what you group under "level of care" but getting more people insured is good on this point.  Because a) someone faced with disaster now doesn't have to mortgage his house or take on a debt that might pass to his or her family.  And b) because putting people under an insurer does a way better job of handling liability claims, etc, which are a drain on our medical system.

Do I think insurance companies are scummy and shafting us?  Well sure, that's what they do.

I have heard the "mortgage the house" to pay for medical care thing for many years.  I don't know if I buy into that.  I have no doubt that relatively few people got into financial trouble over medical bills that they basically had no choice in amassing......but this idea of a large amount of people basically be being put out in the street over medical care is an urban myth.  As far as I can tell......the "best" thing the ACA did was give people access to cheaper medicine.....and I'm a looooong way from thinking that was a great thing under the current addiction climate.

As I said.  I think that making insurance available to everyone is a good thing.  The idea that all will be miraculously saved is quite another thing. The idea that all will have equal access to the same good care is just absolutely wrong.

I guess to rephrase - insurance is all about a distributed burden.  We each pay in a little to protect against the *chance* of something really bad happening.

The problem in the U.S. is that everything is "really bad" nowadays.  If medical pricing was more transparent and equal for those paying cash vs. those using insurance, then we wouldn't need insurance to pay for every little thing.

There!  I agree 100%.

It's a fine balance.  You want doctors to be free to make a full and confident diagnosis with the proper tools.  I'm an athletic guy... when I had a pulmonary embolism, I was biking 20 miles the next day.  But after still "not feeling right" I went to urgent care.  That doctor easily could've sent me home but he went down the checklist, and I was also fortunate they had a CT scan on-site, and basically saved my life.

Yeah, more agreement.....it IS a fine line, and the orthopedic is a bad example IMO.  Then again, we don't have any surgery-happy docs that we see.  BUT....back when we had poor orthopedic care we once had surgery set up for one of our kids over what turned out to be a ganglion cyst.  The second opinion doctor was incredulous that doc #1 wanted to operate.

Like I said before, me3dical care isn't all GOOD medical care, and having insurance doesn't necessarily mean you get good care.

I'm hoping that one of tenets of any "replace" focuses on patient outcomes vs. patient encounters as a reimbursement trigger. 

If I take my car into the shop to get a squeak fixed, and they do stuff that doesn't fix it and charge me $500, I'm taking the damn thing back and demanding they fix it (I know that's oversimplifying a bit).

In our current healthcare system, if I'm sick, I go to the doctor.  They do some tests and prescribe a treatment.  The treatment doesn't work.  I get a bill for the visit and maybe the treatment and some combination of my insurance and me pays the bill.  The treatment doesn't work.  I go back to the same doctor, and they prescribe a different course of treatment.  I get ANOTHER bill.  Somehow I'm not upset at all.

How does THAT make sense?