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Author Topic: ACA  (Read 8907 times)

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Offline Ephiral

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Re: ACA
« Reply #175 on: April 02, 2014, 03:13:24 PM »
...and you think that 99.5% is somehow worse than the current situation in the US? Or that countries like Australia, Canada, France, Sweden, and the UK must be excluding huge portions of their population (since every one of them beats the US on life expectancy, infant mortality, cost per capita, and government spending on health care)? I humbly submit that you are mistaken. Yes, the good/fast/cheap rule applies, but  the current situation in the US is not what we should be measuring from - it is not a useful baseline or a neutral point. It is poor, exclusionary, and expensive as hell.

Offline Valthazar

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Re: ACA
« Reply #176 on: April 02, 2014, 03:36:56 PM »
I think you are misunderstanding me, I'm saying that 99.5% medical coverage in Switzerland is way better than how things are done in the US.  Americans can learn a lot from the Swiss since they have managed to achieve essentially universal coverage through a privatized model.  I'm saying it is more feasible for the US to switch to a Swiss-style system at this point, than it is to switch to a single-payer system.

The Swiss system is identical to the US.  If you look about 2-3 posts back, I explain why I think it is a great system.

Offline Ephiral

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Re: ACA
« Reply #177 on: April 02, 2014, 03:45:59 PM »
What I'm confused about: You've stated that the US can improve quality and cost, but only by reducing access. I'm having a hard time finding an example of a modern, industrialized nation that doesn't beat the US on all three points - so clearly it is possible to do so. What makes you think that the US is exceptional in this, that it can only achieve adequate and sanely-priced health care by excluding huge swathes of its population?

Offline Valthazar

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Re: ACA
« Reply #178 on: April 02, 2014, 04:37:01 PM »
I never said the US was exceptional in its delivery of healthcare, which is why I said we should be more like Switzerland.  Like you have pointed out, there are many flaws with the American model.  For some of us though, it does offer exceptional quality that we couldn't find in other countries.  I wouldn't be able to afford similar insurance through 3rd party private insurers in a single-payer system, nor would I be able to retain similar insurance under ACA (though I have chosen to take an alternative plan to maintain similar coverage).
« Last Edit: April 02, 2014, 04:40:20 PM by Valthazar »

Offline Ephiral

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Re: ACA
« Reply #179 on: April 02, 2014, 04:58:03 PM »
So if the US isn't exceptional, it is in fact possible to deliver better, more accessible, cheaper health care than it has been - none of those points need to be sacrificed at all. Just making that clear.

Offline Kythia

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Re: ACA
« Reply #180 on: April 02, 2014, 08:51:09 PM »
For some of us though, it does offer exceptional quality that we couldn't find in other countries. 

I'm intrigued by this.  Obviously I don't want specific details of your insurance policy (actually, I do because I'm incredibly nosy.  Rephrase that to "obviously I don't expect specific details of...") but is there any way you can expand on that a little without giving away anything too personal?  What sort of exceptional quality care are you (potentially) getting?

Offline Valthazar

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Re: ACA
« Reply #181 on: April 02, 2014, 11:03:51 PM »
I'm intrigued by this.  Obviously I don't want specific details of your insurance policy (actually, I do because I'm incredibly nosy.  Rephrase that to "obviously I don't expect specific details of...") but is there any way you can expand on that a little without giving away anything too personal?  What sort of exceptional quality care are you (potentially) getting?

I should have said quality for the cost.  For the amount I was paying as monthly premium, I was very impressed with type of coverage I was receiving, given my current tax bracket.  I'm in a preferred provider plan, meaning that while my premiums may be slightly higher than an HMO, I'm covered to visit specialists within my network without a referral.  My company offers me $175 towards my health insurance, and since I'm young, healthy, and not married, I get it pretty much for free.  I chose a plan that suited my specific needs (my plan didn't cover mental health services and addiction treatment, for example), which helped to cut down significantly on my premium.  It was also limited in preventive services coverage, which I preferred, since I could go for preventive services like physicals, immunizations, and other screenings whenever and wherever I wanted on my own schedule - so long as I paid out-of-pocket.  I exercise regularly and eat healthy, so I always liked this, since I really have no reason to check my cholesterol or blood pressure yearly at this point in my life.  When I did go in for a preventive service like physicals or screenings (which was about once per 2-3 years), I generally paid $250-300 out of pocket at that time.  Going to the primary care doctor with a genuine ailment, however, was not billed as a preventive service, and thus covered.  In my personal case, I had an insurance plan that was tailored to my needs, and hedged against any unfortunate emergency, long-term care situations as well. 

However, this policy expired, and now I'm paying a higher premium for a new plan from the same company, with added services that I'll never even use.  Luckily I can still afford it, but with the ACA, insurance companies are not permitted to charge a copay with any of these preventive services, so they are automatically provided as part of the insurance coverage in full - funded through my premiums.  For my purposes, this is a pointless waste, since I do not require depression screening, HIV screening, or alcohol misuse screening in my insurance plan.  Even if I did need any of these services in the future, I would prefer to simply pay it out-of-pocket on a one-time basis.

While our ages/incomes/tax rates obviously vary, my insurance situation is actually very similar to Phaia, who posted earlier in this thread.
« Last Edit: April 02, 2014, 11:08:27 PM by Valthazar »

Offline Jazra

Re: ACA
« Reply #182 on: April 03, 2014, 02:59:59 PM »
A lot of comments have been made with many good points. I'm just going to express my feelings about the ACA without a lot of support. First, for me, it's been mostly good. I am trying to build two businesses that I started while holding down 75% of a full time job as a paralegal. No health benefits for me and I'm not rolling in cash. So I get a subsidy, which makes health insurance about 25% cheaper than it was before. On the other hand, my new "improved" plan doesn't cover two medications I was taking so if I were to take those medications, my total health insurance outlay would actually be quite a bit higher. I just stopped taking them and will sort it out with my doctor when I next see her. And I did keep my doctor. Hey, but I do like that I'm in a PPO rather than an HMO now.

So those are my biases. What I think is the ACA is a hybrid monstrosity of capitalism and socialism. Ideally, I'd much prefer a single payer system where we squeeze the profit motive out of the bulk of healthcare. But keep in mind, healthcare was already horribly regulated by the US government before the ACA came into effect. It's not like we already had a pure capitalistic health care system.

Let's see. Other thoughts. I don't care about the web site. That's poor implementation of the law and it's being fixed. I also accept that when you implement a new bureaucracy this big, there's going to be a lot of wrinkles to be ironed out. In the end, I had insurance before. I have insurance now. My new insurance is arguably a bit better than my new insurance, but it's not perfect.

C'est la vie.

Offline consortium11

Re: ACA
« Reply #183 on: April 04, 2014, 05:41:28 AM »
I'm intrigued by this.  Obviously I don't want specific details of your insurance policy (actually, I do because I'm incredibly nosy.  Rephrase that to "obviously I don't expect specific details of...") but is there any way you can expand on that a little without giving away anything too personal?  What sort of exceptional quality care are you (potentially) getting?

While there's some dispute as to the figures (notably the the US uses more tests and uses them earlier) I believe that cancer (primarily breast and prostrate) treatment in the US is generally considered superior to at least the UK and most of the rest of Europe.

It falls into a pattern which I think is fairly well established; if (and there's a huge if there) someone can afford it, the US offers one of, if not, the best healthcare services in the world. The issue is that so few can afford it and many of those who technically can will have to make huge sacrifices to fund it. To use the quality/cost/access aspect the US is high on quality (at least at the top end) but costs far too much (both individually and as a whole) and partially because of that struggles on access while the NHS for example may not have quite as high a quality (at least at the top end) but has far better access and better costs (both individually and as a whole).

Offline Kythia

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Re: ACA
« Reply #184 on: April 04, 2014, 05:52:31 AM »
Yeah, I was looking into it a bit myself.  My thinking was around medical tourism though - obviously the US is a massive net exporter of medical tourists and my understanding was that a lot of that was driven by cost.  Essentially, it seemed to me people were feeling they could get an equivalent quality of care somewhere else for much cheaper.