I would argue that whether the system was better before or after is the issue. Had her employer dropped her health insurance before the ACA which would have been their right for whatever reason, she really would have been up a creak trying to find private insurance with most likely a pre-existing condition that would make even the barest coverage either unaffordable or completely useless.

You implied that Obama was to blame for an employer action that has nothing to do with the ACA. In fact, you specifically wondered whether this was an "unintended consequence" of the law.

Again, their action has nothing to do with "taking advantage of the law as it was written". The law is irrelevant to their actions, much as you would like to claim that it isn't. There isn't something new in the law that suddenly allows employers to turn full-time workers into part-time workers so as to avoid providing them with benefits. This action is all on the employer.

Sure it's disingenuous. The ACA comes along and suddenlly this employer converts a bunch of full time workers into part-time. You don't think it at least leaves the impression that these workers lost their coverage because of the ACA? When you're in the store the next time, why don't you ask this employee whether she thinks she lost her coverage because of the ACA?

On this I completely agree. Unfortunately, there simply isn't the political support to do it. The party in power would prefer simply to repeal the ACA (it's voted to do so in the House over 50 times).

You're right that the ACA changed everything. The question I'm posing is whether the current system is good. I say it isn't because the current law encourages employers to do what Weis Market did. This woman now has to work more hours and has to buy her own coverage. The coverage available to her is probably almost useless if she can't afford the deductibles under her plan. Assuming she has the Bronze Plan (I didn't ask her) she would have a deductible of about $5,000 a year. Thus, she has to pay that much before her plan starts to pay 60% of her medical costs after she's already paid the first $5,000 and she would have to pay 40% of all her remaining medical costs.

As a conservative (you all know I'm that) I'm very concerned about this. I have come around to the view that we need a single payer system - much as my liberal friends. Health care should not be provided by employers (this is a relic of the labour shortages of WWII) and individuals should not have to buy their own coverages. My concern is how it would be adequately financed, which is why I keep raising the question of how the NHS is funded. I suppose every system in the world is "underfunded" so that is not really part of my question. We should aim to make the US Healthcare system less of a "pain in the arse."

"Service is world class" - only where it is world class.

There are a lot of hospitals around here where we are. Back along, after I had been in a car accident, my doc told me to go to the ER - she was not in a position to help me out as doing so would give the insurance company reason to disallow any claims. She told me not to go to the nearest ER as that was 'bad'...

I know it's all relative, and on that note, does it matter if service is world class or not, or just that it is good enough?

We've had to use ER and other medical services a fair bit since coming here over 4 years ago. Are there lots of resources, compared to the NHS? Absolutely. Does it really make a difference? I suspect in some locations, and with some conditions it absolutely does. Is the NHS underfunded? I don't know, but I would argue that the finances are poorly managed. As, actually, I believe they are in the US. Why do I say that? Because every medical services provider has a large pool of people taking care of billing etc, cross billing, chasing non payments and all the other admin crap - and that's before we get on to overheads arising from dealing with negligence and related claims...

If we could take the best of both types of system, we'd be a lot closer to perfection (I nearly wrote 'heaven' instead of 'perfection', then realized that could be misconstrued!!)

Underfunded is, to a certain extent, a personal opinion rather than one that could be scientifically determined. Did everybody get the treatment they wanted last year? Let's say 99.9% did, but the remaining 0.1% didn't, because the NHS determined it wasn't medically necessary or wouldn't provide any quality of life improvement. The majority of the first 99.9 probably think the NHS was "ok"; the 0.1% probably think it's underfunded.

Now, our health insurance in the US, switching from very good Kaiser Permanente to fairly crap Prime/Keenan, I think our current one is underfunded - but that's not the right word - because they refuse to prescribe certain drugs, and make us travel 60 miles to see a child psychologist for our son, even though there are local specialists who could handle it. They've chosen the cheapest possible option for them, which makes it expensive for us (fuel and time).

Six month waiting list in the UK? If it was urgent you'd be seen the same day. If you're waiting that long then it's not ideal but it's also clearly not urgent. I'd much rather a priority waiting system than specialists/surgeons hanging around idle, waiting for customers.

Depends on the plan. A lot of bronze plans I have seen include copay only regular visits up to a certain number per year before you need to touch the deductible.

My main point was that the aca is an excuse for the employer to act like a Dick. The law supported this action before just as it supports it now. Nothing has changed except the victim can now still get coverage.

Exactly. There is nothing in the ACA that "encourages" employers to make full time workers with benefits into part time workers without. That is all on this employer.

Additionally, this employee's ACA plan does actually cover a bunch of preventive stuff without charge.

Where Flavius is right is that tying health insurance to employment is nutty. Whether the solurtion is go single payer (which I doubt could happen politically in this country) or to have everyone buy insurance through a marketplace I am not sure of.

I think simply getting rid of the pricing scam, gratuitous denials of claims, not giving an indication of cost in advance, superfluous treatments and tests etc would go a long way to bringing costs down, without necessarily having to get in to the argument over nationalization, government take over etc - although that latter claim has been made a lot by the Right in the US since Obama began pushing what became the ACA, even though the claim is bollox.

They have to peddle that line or realise they are paying for the Emperor's new clothes.

Apparently BUPA has almost 4 million customers in the UK (of the 63.8 million pop). I understand that the attraction is that if the GP clears his patient for a procedure, the privately insured patient can be set up almost immediately for the procedure, rather than waiting 3 -4 months as with NHS. Usually the treatment takes place in a private hospital, and where it is to be done in an NHS facility, the private patient can frequently "jump the line." BUPA and the others are usually an employer benefit, but private plans average about £45 a month. My 80 year-old aunt had a BUPA plan.

My take is that the NHS provides good basic service and that 90% are personally satisfied with it, but approval in polling runs 50 - 65%.

My earlier questions regarding funding have the following answers: £97 billion to NHS England, representing about £1,900 ($2,900) per person vs. $8,900 in the US. it is a line item in the budget, and not the biggest. England spends about 8.2% of GDP on health care vs. almost 18% in US. 21% of the NHS England budget goes for mental health care (is that, perhaps reflected on this site?) Conclusion: UK gets bigger bang for the buck than the US with its system. US healthcare is overburdened with treatment of obesity-related health issues.

Finally, as a lawyer, I can tell you that the greatest single cost savings that could be enacted with US healthcare would be limitation of recoveries in malpractice cases. That didn't happen with the enactment of the ACA because the plaintiff's lawyers were the greatest single contributors to the folks who legislated the ACA and The One who signed it into law.

It is not 'basic service'.

I repeat, Americans have to say that or their crappy house of cards would come tumbling down.

Part of the reason that so many people in the UK have private healthcare is that it is provided by their multinational employer as part of their benefits package. It is rarely a priority when considering a job offer, but it is still provided by many companies, perhaps because getting their staff past waiting lists and back to work quicker is in the employer's own interest.

It's probably worth considering that the NHS is an extremely mature, well-debugged program that was instituted long before mass-media (and the influence of it on politics), and is probably the single most efficient system on the planet. That's not to say it's perfect, but it's extremely cheap for what it delivers.

You can argue that the US healthcare system is nothing more than a conspiracy of profiteering, but that would presume that it is equally as efficient as the NHS. It isn't anywhere near so - it's a mish-mash of different private systems that have never been implemented as a single programme, and very, very costly. Naturally, there is profiteering going on, but that's not its biggest problem. It's inefficient. period. And that makes it expensive. Period.

And although at least there has finally been legislation in efforts to make it more accessible to all, the US system is not going become the NHS anytime soon. It will require building a public healthcare system from the ground up, and that will require not only political will (at least there finally is a little of that), but also a massive reduction of the "fear of change", massive investment, and about 20 years of debugging.

In the mean time, all that can realistically be expected is to make incremental changes slowly and gradually. At least something's been started. But it's not likely to be the NHS in our lifetime.

I agree with some of that, but it contains some very definitive statements. Have you ever personally experienced the US healthcare system?

"Basic"? It provides a full service.

I suspect if the ones that disapprove experienced the American healthcare system first hand, the numbers that disapprove would diminish significantly.