The way it works here is you are required to get insurance. You buy it yourself. They can’t discriminate against pre-existing conditions for basic plans, but they can for extra plans like travel insurance, single room hospitalization stay insurance, natural remedies insurance etc.

There are subsidies for poor people.

It works prett well though there has been a recent trend of American style price increases

“The way it works here is you are required to get insurance. You buy it yourself. They can’t discriminate against pre-existing conditions for basic plans, but they can for extra plans like travel insurance, single room hospitalization stay insurance, natural remedies insurance etc.”

I’m sure that was exactly what Obamacare was intended to be but with the giveaways to the insurance industry, the medical field, and the trial lawyers we ended up with some a whole lot more expensive and less useful..

Basically a mess. This was baked into the cake because of the fundamental fraud required to get it through congress to begin with.

If they call it "insurance", they are lying to you. We have to do something else, starting with honesty and accountability.

The issue now is the advent of genetic testing making it better for companies to estimate risk, which will again make it better for individuals to join a pool.

I have extremely long-lived people on my mom's side (all my grandmother's siblings lived into their 80s, and my grandmother and her brother made late 90s or early 100s.) and I have cancer like mad on my Dad's. I probably had genetic factors for anxiety disorders, as well. All of which said genetically, I'm a bad risk. So companies could price me very well with a genetic test, but I might not be able to afford it.

Janie4— Listen to this podcast.

The freak truth about the metrics in modern business for such things is that it's nothing personal...

Well, not always.

"Previously, many people stayed in a job for a lifetime."

That is a myth. A common one but still not true. How much people job hop has varied over time. But if you want to find a time where most people did stay in a job for life you are looking more at the middle ages. When you are a serf and you are allowed to do one thing or die people don't change jobs much.

How many of these issues come out of a big problem that was never solved by the mess that was the "Affordable" Care Act?

The ACA was a solution to a problem that did not exist.

Obama came into office as people were expressing concerns about rising premium costs, not quality of care or access to care. The ACA attempted to solve the access to care non-problem and ended up increasing premium costs - the very thing people didn't want.

Nothing about the ACA indicated anyone had given any of the problems any real thought. There were no innovative solutions proposed. Merely the government bludgeon of forcing everyone to pay into a pool and hitting employers the hardest; of pandering to the emotions of voters. How many sob stories did we hear as the bill was being tossed around?

A true solution to the issue of universally-accessible, yet still affordable, healthcare in the US is going to require better thinking than government has been able to come up with recently - because it will require the government to step out of it, to make healthcare a market transaction.

Too often, advocates for universal healthcare talk about a "right to healthcare." But what they describe in their rants is a right to good health, which doesn't exist. Some people are gonna get sick and some are gonna die. No amount of money thrown at a healthcare system can change nature.

The issue now is the advent of genetic testing making it better for companies to estimate risk, which will again make it better for individuals to join a pool.

Wouldn't that also give the insurance companies more justifications for denying someone?

I still believe socialized medicine would be the best thing. Insurance companies don't work. Like all businesses, they are profit driven. Their motives are simply to get the most money from you that they can, and to pay as little as possible. They have entire staffs dedicated to finding ways to avoid paying for your care. Not to mention the opulent lifestyles that the CEOs absolutely must have. Insurance companies are not motivated by the goodness of their hearts. They are in this to make money, and paying for your health care conflicts with that goal.

Patrick, you act like socialized medicine doesn't have it's down sides as well. Yes insurance companies are not motivated by the goodness of their hearts. But neither are government bureaucrats. Look at the veterans affairs and all the problems they have. Instead of being in the business to make money and keep making money by keeping their customers happy instead you have petty office politicking and empire building. Instead of 'This is too expensive for us. If you want it pay for it yourself.' you get 'Someone you've never met thought this would be important. I'm afraid you'll have to die. No you cannot pay, you must die.'

As Conan points out there is no golden solution. But the best outcome appears to be limiting insurance to actual insurance and not prepaid health care. If we only insure catastrophic events the cost is minimal and the preexisting condition issue goes away. For ongoing palliative care people need to pay for themselves. Putting someone else in the middle only increases costs. For those who cannot afford to support themselves medicine isn't different from other cases like this. Charity from either the government or private groups and individuals just like you have for other poverty issues appears to work best.

In that sense Obamacare was completely the wrong solution. (and it showed) Obamacare outlawed catastrophic insurance. Obama called it 'junk insurance'. Instead the cheapest option was over $15k/year in premiums and you had to spend over $12k in deductible to get any benefits. That's a minimum of $27k to see any use out of it. The median US household income is around $63k/year. I.e. you had to spend 43% of your income to see any benefit. And that was the cheapest option. Prices only went up from there. So the solution was to have tax money pay for the difference. Except taxes come from those same people. Obamacare was entirely based on having someone else pay for everyone's bills. But that doesn't work. Once you figure out you are the sucker who is supposed to pay for everyone you get out of the game. Hence the Obamacare death spiral where the people paying figured out they were getting a raw deal and stopped paying, resulting in higher costs for those remaining, and a new way of suckers opting out leading to ever higher costs.

Israelis suffered under socialized medecine until free-market reforms were introduced. Access to healthcare and quality of care have both improved, despite this country absorbing waves of immigrants.

We have a hybrid system in which the government underwrites - but does not fund completely - a basket of basic services. Everyone except the truly destitute must pay *something* for medical care - an important feature.

HMOs are free to sell plans with more coverage than the basic basket. Doctors are free to open private clinics, and many of the experts build a practice on a combination of private customers and HMO-affiliated patients. Many of the HMO plans include partial funding of private-sector consultations and procedures. In addition to hospitals built by the HMOs there is one private hospital chain and several chains of clinics and emergency-care walkins. Most of these have deals worked out with the large HMOs for at least partial reimbursement.

Long-term palliative care and assisted living are separate insurance plans. HMOs offer these as well as insurance companies, giving good deals to those who are in the HMO.

As a widely applicable procedure becomes more common (or a medicine goes off patent) it is placed in the basket of basic services. The classic example of this is laser eye surgery - which began as an expensive procedure that made a lot of money for the doctors who invested in bringing it to Israel, and now has come down in price and is included by some HMOs in their packages. As technology automates the procedure and makes it even cheaper, it will enter the basket of basic services. The same trajectory brought MRI and other expensive medical technology to Israel.

This system works really well - much better than socialized medecine did. And it is not connected to work in any way.

Socialized medicine? emphasis mine.

https://www.cagw.org/thewastewatcher/va-scandal-refuses-end

The 2014 scandal at the Phoenix Veterans Affairs hospital, where several veterans died after being placed on a secret waiting list and others languished for months without care, was just the first of a series of bombshell revelations. Since then, the VA’s Office of Inspector General (OIG) has found VA hospitals from Georgia to Texas were maintaining cruelly long waiting lists. An April 7, 2016, USA Today report detailed that VA employees in 19 states and Puerto Rico regularly “zeroed out” wait times, hiding the true length of delays, and VA supervisors themselves ordered the fabrication of wait times at medical facilities in seven states.

In some of those cases, the fabricated wait times were used to justify performance bonuses awarded to the very same administrators.

That big still-unsolved problem? The way health care has been and continues to be tied to the workplace.

No, the big, still-unsolved problem, is that my workplace provided healthcare comes in lieu of salary, but since it doesn't show up on my W-2, isn't subject to federal or state income taxes.

In contrast to someone who pays out of pocket — their effective cost is their top dollar rate more than mine.

That is an admission against interest, by the way.

I know a couple (artists) who by joining an artists association were able to get health insurance at reasonable rates all their lives (freelance since 1970). They were able to do this before Obama care banned association plans. So employers or the gov are NOT the only 2 options.
Interestingly, even when the Obamacare mandate was in effect, lots of people still did not have coverage because they didn't want to or could not, so the whole idea was bogus.

Patrick, you act like socialized medicine doesn't have it's down sides as well. Yes insurance companies are not motivated by the goodness of their hearts. But neither are government bureaucrats. Look at the veterans affairs and all the problems they have.

I've used the VA healthcare, and honestly, I have little to complain about. They once did an elective surgery for me with required a general anesthetic (repairing a deviated septum) while in the process of removing basal cell carcinoma from the back of my neck.

When they were unable to see me in a reasonable timeframe, outside referrals have been handled promptly.

I suspect the inadequacies of the VA healthcare system are greatly exaggerated. Sure, they have problems, but I haven't actually heard of any problems from anyone at the Bay Pines VA hospital where I went.

I wouldn't call socialized medicine the golden solution. We have far greater problems to address in bringing down the cost first.

Here's John Greene's take as to why healthcare in the U.S. is so expensive.

Take it with a grain of salt. Based on my own interactions with him, admitting even a trivial factual error is an irredeemable loss of face for John Greene, and frankly, I think he'd sooner die.

But the fact of the matter is, if the government is determined to get more revenue, they can simply raise taxes (something they have never shown any moral reservations about doing). They don't need to withhold care from us to gain revenue.

Private insurance companies simply don't have that option. They are paid out of insurance premiums. The government bureaucracy is paid out of taxes.

I think the VA is different all over. I've got a brother-in-law who has to fight the VA in Oregon for everything. He finally got a referral to an outside doctor and the VA is balking at paying the bill.

The government can raise taxes, not necessarily tax revenue, but yes taxes. But that doesn't matter. The government isn't motivated by profit margin as you point out Patrick. Instead they follow other incentives. And that is the heart of the problem with government care. The issues IRA points out aren't exaggerations. If anything they are understated. But as Conan points out things aren't uniform. You may get excellent care while another area gets no care at all.

Look at other areas where the government has a monopoly to reference how a monopoly in medicine would work. Public schools in some areas are great. Others are horrible. And there is a bad correlation between spending and education outcomes, i.e. the more you spend the worse the school gets. If your kid has a problem with a teacher it makes sense to sell your house and move to a different district. Actually fixing problems is pretty much impossible. When graded based on outcomes happened numerous scandals hit where schools were falsifying records to get their raises.

All of that sounds almost exactly like what happens at the VA.

All of the issues you've raised are at my link above.

I will say, in February we went skiing at Chamonix and due to awful snow two members of our party were treated for breaks... 86euros to fix a broken wrist, outpatient. My Mom had a more serious knee injury, and had to be hospitalised and operated, but upon return to Boston the MGH doctors there praised the work of the French doctors.

Wait was ok... there were a lot of ski injuries in Sallanches hospital because as I said the snow sucked.

The hospitals were shabby, with cracks in the wall and stuff, but otherwise we were all quite impressed with the French system of socialised medicine.

Maybe they throw more money at Sallanches due to all the ski tourists, I don't know.

"If the way we got health care in this country was to do as I did -- pay personally, sans employer, the way most people probably do for car insurance, would these people not have these sad stories to tell?"

It would be competitively priced. like car insurance, but there would still be fools who would elect not to have it. Unfortunately, the only way to fully incentivize people to get health insurance is to let those who choose not to carry insurance bleed out on the sidewalk in front of the emergency room when they get hurt.

Vision corrective surgery is. for the most part. an out of pocket payment for the patient. No insurance, no subsidies, entirely private, free market. Since its inception. the quality has steadily increased and the price has steadily decreased. Funny how that happens.