I still think we should go all the way to single-payer. Other countries have had such success with this model that it's becoming very difficult to argue that it's inherently flawed (rather than the other way around). If the US health industry had to compete directly with any of these systems, it would go out of business tomorrow, since they offer similar care (in terms of outcome rates) at half the price per person. That doesn't even include the effects on entrepreneurship and employment!
While the ACA did little to fix the "US health care costs twice as much and doesn't deliver better outcomes" problem, it does have a good shot at fixing the preexisting condition and individual insurance debacles.
When you have eliminated the implausible, whatever remains, however distasteful, must be endorsed.
The Nixon proposal is an interesting one in retrospect. In some ways it's "left" of PPACA, despite at the time being opposed by Democrats, who preferred a real public plan and criticized Nixon's as a sellout to insurance companies. Although it wasn't single-payer, one of Nixon's proposed compromises would've actually included a public plan as an opt-in possibility (but not the default), reminiscent of the "public option" that more liberal Democrats unsuccessfully tried to include in PPACA.
[1] http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c...
The British NHS discovered that by not feeding hospitalized patients they could realize tremendous savings in food, shortened length of hospital stay, followup costs, etc.
> half the price per person
Health care spending will dramatically increase under Obamacare. Americans spend a lot on health care as a lifestyle choice. Obamacare is nothing more than an attempt to recreate the housing bubble using health care.
Last decade they bought votes with easy mortgages. After all, even an idiot could see that home ownership was a sound investment. They won two or three rounds of elections with mortgage policy.
This decade it is health care for all! Even an idiot can see that health care for everyone is a sound investment. Just look at these scary charts of runaway growth of medical costs. And the votes roll in.
In reality, most health care consists of vaccines, blood pressure pills, diabetes pills, and the occassional antibiotics. That gives most of the benefits and costs almost nothing.
Most of the costs come from ludicrous end-of-life procedures on old people, most of the rest comes from ludicrous $500k courses of treatments for this like multiple sclerosis and stage 29 recurrent cancer. These are lifestyle choices for well-off people who would rather pay a doctor than leave an inheritance.
Trying to extend this lifestyle to every waitress will destroy the economy. It's no different than last decade's plan to put every hairdresser in a $700k mansion.
[1] About 80% of Americans who died in 1997 were covered by Medicare at the time of death: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/
Then people have an incentive to save money but death panels aren't needed.
Of course this is assuming the heroics rarely work.
That's a lie. Try checking your facts next time:
http://fullfact.org/factchecks/nhs_malnutrition_death-28806
Oh, and by the way, the NHS costs us less than US public healthcare costs. Meanwhile, I can get zero deduction, all additions, money for any nights spent in an NHS hospital, private health insurance for $150 a month. How much does yours cost?
So instead of a trained nurse feeding helpless patients, a gormless food deliverer drops a tray off at the patient and leaves. On paper they are still being fed, but in reality patients were starving during the trickiest few hours of recovery. But look at the costs drop!
Similar cost cutting was done for the building caretakers and similar staff. On paper everything is the same just more efficient, but in reality the floors are not getting cleaned, nobody is bringing round tea for the surgeon in the middle of a 12 hour procedure. But look at the costs go down! Look at the readmission rate drop!
I know that they had some problems with some NHS trusts as they went more "efficient private sector", mainly with cleanliness, but this was not pervasive throughout the NHS and suggesting it was commonplace is a flat out lie.
And you never got around to answering my question: is your private insurance cost competitive with UK private insurance?
When looking at whole system costs and value delivery, it's really difficult to conclude that the American healthcare system is anywhere near as efficient as other national universal health care systems.
I have nothing against defense contractors, but I do hate ones that have hypocritical small government, conservative political views. Please feel free to put your money where your mouth is and go work in a free market industry. The taxpayers pay your company, and therefore your salary and health insurance.
I merely pointed out that nationwide programs tend to go horribly wrong. Obamacare in particular failed before it was introduced since American health care is already cheap, and any good ideas it might have incorporated were destroyed by its secret process of creation and lack of feedback.
Incidentally, defense workers are ideally positioned as experts on national health care schemes. We have seen exactly how large one-size-fits-all programs almost always destroy themselves.
http://www.economist.com/blogs/democracyinamerica/2013/07/hi...
Regarding "one-size fits all programs destroying themselves", please explain to me how Obamacare is a one size fits all scheme? It's a conservative policy, designed by the Heritage Foundation think-tank on K Street in DC. (I have a buddy who works at the Heritage Foundation. They all loved Obamacare when Romney was implementing it, and were disappointed that it was only for a single state at the time. Suddenly when President Blackenstein was implementing it, it became evil and socialist.
Frankly, Obamacare isn't the best solution. I would have much preferred a national, single payer system coupled with private providers, like the system in Canada. You know, the one that has vastly higher approval ratings among its patients than the one in the US. But no, the Republicans scared the old people into thinking they would lose their free, socialist medical care if people under 65 got in on the action, so we got stuck with insurance subsidies.
Yes, dirt cheap. As in we could abolish all payment plans and life expectancy would barely budge. Vaccines and generic antibiotics give you the lion's share of what is possible. Blood pressure and diabetes control gives you most of the rest. If you want to get extravagent, add trivial insurance for broken bones, treatable cancer, and the like.
Obamacare is one size fits all because it tries to give everyone the same treatments. There is simply no way to give $400/month anxiety pills and $100k preventative cardic caths to every dirt farmer in Mississippi. Either the poor will get a heavily rationed version of Medicaid or the budgets will explode.
I think the Massachusetts program is a pretty good idea. I have even considered moving there to get on the rolls. If it actually works in the long run, other states would naturally have adopted similar programs. The only reason to try a single national program is to pander to voters.
One of the big problems in American health care is price manipulation. Obama could have become the first black Republican president by proposing that no Medicare provider may render services to anyone else except according to a uniform fee schedule. (If you think a Latino single mother is pissed off about a $300 aspirin, try talking to a country club Republican.)
I like that idea. It would have never, ever made it past the medical provider lobby.
Did you see the Time magazine article "The Bitter Pill"? Fascinating, and the article actually provoked the CMS agency in the Federal Gov't to release their data on the "chargemaster" prices at various hospitals vs. the negotiated Medicare/Medicaid price (which is itself negotiated to ensure it covers a hospitals labor/materials for any given procedure).
I pay ~$430/mo (early 30s, single) for a high-deductible plan with low co-pays from a major carrier with no co-insurance. Do I wish my costs were less? Yes. Is it better than having to be someone's employee? Hells yes. Providing this to the entire country isn't the ideal solution for everyone, but it's a big step in the right direction.
That said, we're in an interesting part of the law's implementation. If you live in one of the 26-33(?) states who have currently declined to operate all or part of their own exchange (exchanges in these cases will be operated by the federal government) your state also lost some of the federal funding that was intended for use in spreading awareness and helping people to "navigate" the sign-up and purchasing process of the exchange. The worry thereafter is that if not enough people enroll through the exchanges they may not have enough leverage to keep costs down.
Add to this the idea that some state governments are actively dragging their feet with the implementation of anything exchange related (enrollment starts in October and my state has next to no information out there on the process yet) and we get the potential for messiness.
In my case, I still dream of single payer.
Disclaimer: Typing off the cuff, not a health insurance administrator, etc...
*For those interested in more about how the exchanges are progressing, I find the website of the Kaiser Family Foundation to be excellent:
http://kff.org/health-reform/issue-brief/establishing-health...
http://kff.org/health-reform/state-indicator/health-insuranc...