Leslie

Yes. That's the whole point.

scrubbedexpat099

https://www.nytimes.com/2019/02/21/u...WRgYhIUJo7Es7M

Wonder what will be next.

Steerpike

I had to look up what type of system the Germans have; this page gives a nice overview of the three major types of insurance at play in Europe, and says that Germany has a form of "privatized but regulated' healthcare. https://www.griffinbenefits.com/empl...in-europe-work

Given the similarities between that system and the current US system, it does make some sense to use that as a model, especially since the German system ranks not too far from the top of European countries in terms of population satisfaction with healthcare (Germany = #9, UK = #15). https://en.wikipedia.org/wiki/Healthcare_in_Europe

Changing over to any new system will not be easy. I don't like to jump on the 'Government is incompetent' bandwagon ("Just look at the DMV" syndrome), but it has to be remembered just how difficult it was for the Obama administration to implement the 'marketplace' website for Obamacare; over a year to get something as relatively simple as a shopping site working. Considering how much 'change' would be involved in eliminating private insurance, and figuring out the revenue models, this could be a lot to bite off.

As a matter of interest, the Swiss system has been touted as the best option for the US; the Swiss system ranks #2 in Europe according to the site above, and it too utilizes private insurance, not unlike the current ACA. It may be unrealistic, however, to compare the US to Switzerland; Switzerland has only 8m people and has very low unemployment and poverty rates.

Hiro11

In my opinion, any healthcare solution that doesn't address reduction of healthcare costs is just going to result in more inefficiency and/or shortages. In fact, I'd say the primary focus of any healthcare policy should be to reduce the cost of healthcare. So far, the vast majority of solutions proposed have focused on expanding access without addressing costs. To me, this is exactly the wrong tack to take: expanding access without lowering costs will simply make the problem worse.

One way to lower costs is to introduce price controls. Throughout history, price controls have resulted in shortages. A better option is to make the cost of healthcare transparent to the consumer. This will force to consumer to make more reasonable judgments about their healthcare. I would argue that the employer-sponsored healthcare system in place in the US is one of the major factors that has driven up healthcare costs precisely because healthcare consumers don't have any motive to reduce healthcare consumption.

Using myself as an example: I'm healthy and I exercise daily. My BMI is 23, I don't smoke and I hardly drink. And yet, any time I've interacted with a medical professional recently, my visit has been larded up with tests and procedures of dubious value. I have to believe this is because I'm lucky enough to have excellent PPO insurance. For example: I was in a minor traffic accident 18 months ago that resulted in almost $17,000 of medical care even though I did not have serious injuries. I paid maybe $800 of this out of pocket. Ridiculously, a doctor even suggested an unnecessary $5,000 MRI that would have added more to this cost. Regarding the cost, the doctor even said to me at te time "you have good insurance, better safe than sorry". I rejected the idea only because I knew I was fine and I didn't want to deal with the hassle. Every medical office I went to through this process was a palace with gleaming hardwood and granite, every employee in fine clothes, every wrist sporting a Rolex. I was handed beautifully bound materials detailing my care. I was signed up for numerous (unnecessary) physical therapy sessions. It was too much. This was an eye opening experience for me. Perhaps if I were on the hook for more of the out of pocket expense, I would have been a bit more careful about what I opted to do.

Getting people to pay more directly for their healthcare is politically a non-starter, so my argument will never fly. It's much more politically expedient to just tell people that big brother will pick up the tab and then impose price controls. Shortages, lack of innovation, poorer service and no real improvement in outcomes are all the likely results. In my opinion.

Hotscot

'This will force to consumer to make more reasonable judgments about their healthcare.'

Doesn't really help in an accident though, or if you're in an area with limited specialties.

Giantaxe

Jon Stewart's last appearance on the Daily Show was early August 2016, a little over a month after Trump declared. He had already decided to leave before that declaration. I remember wondering whether he was regretting having quit given Trump then decided to run, but he left the show because he tired of the impact it was having on his family life. The flip side is that someone like Colbert has become a staple of what I suspect Stewart would have done had he stuck around.

scrubbedexpat099

Jon Stewart saw and commented on the idiocy of both sides, my guess is that he was aware of the intolerance coming and did not want to go the way of Colbert.

Giantaxe

Tell me about it. Partner ended up in the emergency room at SF General last month. Bill: $13k for five hours there. No problem, me thinks, because California has a balance billing protection that stops hospitals billing in emergency room situations past what the insurance company paid ($3k). But, unknown to me (i) SF General doesn't negotiate contracts with any insurance company because 90%+ of their patients are Medicaid/Medicare/indigent so treatment was "out of network"; and (ii) California's balance billing law doesn't apply to those with insurance from self-insured employers as they are covered by federal not state law. So they can legally balance bill me for the $10k. Wtf? How is a consumer supposed to know this stuff, especially in an emergency situation?

Now whether we end up having to pay this $10k is an open issue. This hospital's billing practices have become a big issue here and they currently have put a hold on balance billing for 90 days due to pressure from city government. No idea what's going to happen at the end of that time period. But it does bring into focus that it's well nigh impossible for consumers to make rational decisions on health costs.

BritInParis

It was one of my few ‘must-watch’ shows. I think I lasted less than a month with Trevor Noah. The partisanship was ramped up and, fatally, it stopped being funny and just turned into a virtue signalling fest.

A real shame as Stewart was one of only a few voices in mainstream US media calling for calm, debate and assuming good faith rather than going off at the deep end. The rally he organised in DC seems a lifetime ago now. I had expected him to continue in this vein but he just disappeared out of the public eye. Given all that’s happened probably the best for his sanity but we’re poorer for it.

scrubbedexpat099

I do not blame him, and I am not sure there is a space for that sort of thing in the modern media.

scrubbedexpat099

I thought that was a SF Government Hospital?

Giantaxe

It is. It is also SF's designated trauma centre.

Steerpike

I had an experience somewhat similar to yours back in 2013; a 'supposed' heart-attack. Turned out they found nothing despite extensive (expensive!) tests and 2 nights in the hospital (they kept me in one night longer just because their heart specialist wasn't available until the following day, and liability issues prevented them from letting me go home for the evening and returning the next day - despite the fact that I lived walking distance from the hospital and had a ride!). I remember marveling at the 'quality' of the hospital - lovely marble-lined reception areas, and my (solo) hospital room was nothing but extravagant. A nurse came by every two hours or so to check on me and take readings. When all was done, and I was declared fit as a fiddle, they still insisted on me being wheeled out to the curb rather than letting me walk under my own steam, despite my 'perfect' condition. I think the bill was in the region of $30k and I paid virtually none of it, thanks to great insurance. Had I been paying for it, I would have raised hell about the unnecessary elements.

More recently, I had a routine colonoscopy. Armed with plenty of knowledge about how the billing for such things can be tricky, I did everything in my power ahead of time to ensure this procedure was covered by my insurance (as a preventative procedure, being 55+), and yet after the fact, I was billed an outrageous amount and spent months arguing with both the practice and the insurance companies (who pointed fingers at each other relating to the 'coding' of the procedure). Bottom line is, it's next to impossible to ever find out what anything is going to actually cost you ahead of time. A great analogy someone used was, imagine if you were to go into your grocery store and there were no prices on anything; you picked up everything you needed, and only found out the bill after you've already gone home and consumed the goods.

I wouldn't blame the current situation on employer-provided insurance, though - the fault here lies simply with the lack of transparency of cost regardless of how your insurance is provided. Is an ACA person any less affected by this lack of price awareness, or even a Medicare patient? Knowing the cost of something is crucial.

Having said all that - people in the UK are blissfully ignorant of the cost of any care they receive, but I guess the UK does have heavy price controls so the awareness is less important.

Giantaxe

Noah isn't that funny imo. His delivery is just... weird.

Giantaxe

I had exactly the same experience with my colonoscopy done a year ago. "Preventive' (covered) versus "Diagnostic" (not covered) for "free" under the ACA. In fact, the facility billed with different codes from the doctor performing the test. It took until a month ago to get the last (over) billing issue resolved. And in fairness to my insurer, they did fight my corner on this.