Health Care Reform, Tradeoffs, and the Need for Negotiation
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- Опубліковано 5 лют 2025
- We did an episode on the AHCA. Then we did an episode on the CBO report on the AHCA. Then… everything seemed to fall apart. What happened? It turns out, nobody is interested in negotiating about healthcare laws. Which makes it really hard to pass a new healthcare law.
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"unlike some presidents"!!! I died!!! and then I went and joined you on patreon!
Why does nobody ever mention the inflated prices when it comes to this? I'm an American living in Russia with my husband who is from here. You can go to a private clinic here which has the same machines (such as very modern GE MRI machine) that you find in the States. I went to get an MRI, a walk in service with same day results turn around, for $50 USD. Before Russia's crisis, that would've been around $100 USD. In the States, the average price of an MRI without insurance is somewhere in the $1,000-$6,000 range. WHY? Even if it cost out of pocket 300 bucks (probably what the negotiated price the insurance pays or less), that would at least be affordable to some people without insurance. But by charging such absurdly overinflated prices in the US, they can rip people off. The care at private hospitals here is top notch: I'm writing this from a private hospital right now where I just had a hysteroscopy surgery done and the care has been amazing. This whole "America has to pay more for better service" is an argument with limits: that is the case sometimes but most of the time, they just want to rip people off and they overinflate the prices so that insurance companies will pay hospitals more. The working class who can't pay high deductibles suffer via tax or high premiums and it's an absolute crime. Stop running the insurance business like the mafia and then we'll see some progress on prices.
Unfortunately there's too much money being pumped into our government by moneyed interests to maintain the status quo. There are a lot of countries with examples that could probably work in the states with some tweaking-- Japan, for example-- but the political will goes where the money is. :(
Tammy Silverwolf Yes, exactly. It's not even a pure Republican/Democrat issue. On both sides there are people who see the corruption, but the ones who are in with the lobbyists often have the loudest voices in Congress. It's just sad. It's sad that the US is such a great country in so many other ways but in this area the essentially usury of the sick or simply people who need basic help is so deep rooted. I think most Americans don't even know how healthcare works in other countries (really glad HCT is trying to enlighten people with their awesome videos about that!) so it just becomes this absurd political issue and the nuts and bolts of the reality fall to the wayside.
Thank you! Seriously, I don't get why we can't treat healthcare like the food market. Price transparency, and the ability to shop around.
Thanks for understanding that healthcare is a commodity just like any other.
Anastasia P Specific to MRIs, the US is way above the rest of the world in terms of quality and availability of these machines. That shouldn't cause the cost to go up anywhere near as much as it does now, but it can explain some of the cost. I've heard other people argue that a significant part of the cost comes from profits that are funneled into medical/pharmaceutical research, which the US conducts a lot more of compared to other countries. I have to agree that these components are going to influence the cost.
I do agree with your overall point though. The profit incentive has no place in an inflexible, urgent demand market. It is very much a mafia to allow greed to control people in such a debilitating state. In fact, most Americans will agree with you on that moral ground, but coming up with a plan to move from our current state to a more moral, cheaper state is what's keeping us logjammed. The ACA was one such plan but apparently it's not good enough to one of our two major parties.
+Rufei I went on medical tourism before, even in the third world country, the label on these machines said it was made in the U.S. Hell, even the doctors received education from the U.S. medical school.
It's actually ironic that privatization of healthcare cost more taxpayer's money than the public. Even in a well-regulated private-dominated sector in Switzerland still cost a lot in term of healthcare spending per capita.
Even Switzerland pays less of the GDP on healthcare than America so even their system is more affordable for their country and citizens.
One of the best channels on youtube... thanks!
Maybe we could cut cost if we negotiated price for drugs and medical devices instead of letting the private sector change whatever they feel they can legally get away with. What's that? No, because corporate interest is the only interest that matters outside bank interest? Gee thanks.
If we had price transparency in the market, people could shop for the best deal. That's why no grocery store gets away with charging $20 for a bagel. Because we go to another store. Treat healthcare the same way, and we'll be fine.
How about you just make the FDA approve drugs faster. So there will be more competition. Do you know how expensive it is to comply with the FDA? And how long it is? Many of those drug companies are HAVE to make prices astronomically expensive because they might lose money at the end.
Aleksandr Vasilenko This too has trade-offs. Making drug approval faster is great if the next "miracle" drug is being developed (a very effective drug with low side effects that treats an illness that isn't being adequately treated yet). But faster approval also means you're less likely to catch serious side effects before introducing the drug to the mass market, which means more patients can be harmed. Some people think the current process is indeed too slow, because there are very promising drugs that are getting held up in the pipeline. Other people think the process is not slow enough, because we've seen some drugs come out that ultimately proved to be pretty blatantly dangerous, and it might have been caught before widespread release if the approval process had been more thorough. Trade-offs.
The list of trade offs to all these proposals.
1. Negotiation of prices for drugs and medical devices is great. However, patent laws mean that only the company that discovered/invented the drug/device can reap its benefits for several years. Removing that would means nobody will want to innovate as there is little to no rewards. Trade-offs.
2. Same as previous point, price transparency does not matter much when only one company is legally allowed to produce the drug/machinery. Of course, drugs out of their original patent would allow prices to drop. At the same time, however, who is going to provide this transparency? Doctors are already getting kickbacks from medical companies to promote their particular drug so there is less perceived choice (most of the time doctors just give you the drug without telling you what choices you have). However, a common source accessible by the masses would mean many taking prescription drugs out of their own perceived "similarity", thus resulting in an uptake of consuming wrong drugs. Trade-offs.
3. Like the previous poster, faster approval means more harm due to missed side effects. Trade-offs.
area0404 Yeah this is a common line but the vast vast vast majority of drugs for actual treatment of common illness were made in the public sector with public tax dollars.
Aaron, a question: back in 2014, you mentioned in the American health care system that slightly over half of the R&D in the US is from private sector, and the US contributed the vast majority of medical R&D in the world. If we were to lower health care costs in the US (for example through a single-player system) would that lessen the incentive to research and innovate?
Would investments in public health education and prevenative medicine be a thesisable way to reduce overall health care expenditures?
yeah.. but this are long term results... most politician nowadays only care about short term results that they can claim in a reelection campaign...
It would take quite a long time for that to reduce overall health care costs, like 3-4 decades. The US has very high rates of many many health problems, heart problems, obesity, immune diseases, chronic pain, etc.
Is healthcare a public good, like police or fire departments, or public schools? Or is it a daily expense, like a car or Netflix? Is it something that betters society, or enhances an individual's day-to-day life? Every member of Congress should answer this question publicly before they debate any kind of policy.
Great video, but I think it ignores the more fundamental problem: a lot of liberals and conservatives understand the concept of trade-offs and they separately want mutually exclusive things. Most liberals demand increased access and are fine with increased spending, and most conservatives demand reductions in spending and are fine with reduced access. Trump may really believe that we can have it all, but most people don't. That isn't the problem.
Thank you Dr. Gachet.
Every U.S. Citizen should see this video. It should be required to graduate high school.
Start and concise as ever
There is a universal truth in life. You can have things done:
1. Well
2. Fast
3. Cheap
You only get to pick two of them. One will always be in opposition.
Incorrect
What about cars?
Well (they drive and don't kill us)
Fast (on a modern assembly line it takes just hours)
Cheap (it costs fractions less to buy a car that can move you thousands of miles in comfort than to buy a house which keeps you in comfort in the same place}
SilentS you're being disingenuous. These things are all relative and comparing houses and cars is meaningless.
Wait, things are relative and I can't compare things? Can I lend you a dictionary?
yeah.. but what about the process of planning and development?
But Aaron, Trump said that healthcare reform will be quick and that he expects bipartisanship. Our supreme leader can't be wrong or lying.
There wasn't even "Bipartisanship" within his own party.
Single payer isn't hard. It's logical.
hank made a point on the single payer... On short time.. it will peak unemployment (as a lot of non-necessary and/or business jobs on the healthcare disappear) and this led to probably a new recession...
but is not that the economy cannot recover, and the excess of money from people not spending on healthcare could stimulate the consumer market...
Does not encourage development and innovation. In fact, it's the opposite, government funded entities tend to develop ways to make sure everything stagnates. This is why the EU has a bigger GDP, and one single market, hence good to develop for that market, America still has the vast majority of drug and medical device development.
Switching to Single Payer threatens to choke off development of new drugs and better equipment.
We don't have a free market in Healthcare, we have some weird middleman controlled system. Imagine if food was purchased the same way as Healthcare. It will be awful. Walk into a store, nothing has prices, you just say you need food, show your "foodcare card," and a clerk fills up your basket and you pay some co-pay.
That store has zero incentives to lower prices, compete, or put less in the basket. They charge different foodcare companies different prices, based on negotiations. And they have dozens of full-time employees dedicated to working with foodcare companies.
well.. from 2004 to 2012 EU give 20 Billions on public R&D against 30 Billion of private EU investiment.
As U.S. give 38 Billions on public R&D against 48 Billions that came from the private sector....
and there is the fact that a lot of european countries give incentives to foster private R&D.(and to be fair...here in brazil I tend to hear much more about drugs and research that came from european companies than by americans)
www.janssen-emea.com/sites/default/files/Janssen-Infographic-health-RnD-2015-Web.pdf
***** My family lived in a country with government medicine. It sucked. Big time. We didn't come to the US just so it will become what we left.
If you want your Single Payer nonsense move to a place that has it!
Single payer is different. Just like every other option, it too has tradeoffs. Everyone gets healthcare, but you also increase unemployment and things aren't guaranteed to be cheaper for everything. Tradeoffs!
Can you do a video comparing single-payer systems to multi-payer systems?
Great summary!
What kind of reform would have to happen in the US just to begin moving in the direction of a system like those in Europe and Canada, where they spend less and get better outcomes?
A complete overhaul of the way a lot of people think. Most European countries and Canada have universal healthcare. Too many people threw a fit over the idea of the ACA, actual universal healthcare wouldn't fly with them; they feel it's too much government interference. The USA is the most backward first world country in so many ways (I say this as someone with serious health problems born and raised here).
Sure, but assuming the fantasy that we could agree to work toward universal healthcare, how would we proceed vis-a-vis these tradeoffs? Would the savings emerge when the system is robust enough?
It is mainly because so many americans only give a shit about themselves, and not our country as a whole, they lack empathy towards others. That is why you always see millions of people bitching about "having to pay for others care" and what not.
How about trading off the health insurance corporations? They add huge cost to the system and provide no health care at all. Go single payer, ignore the cries from the insurance executives, and enjoy lower costs.
The problem is when you try to impose tradeoffs upon others. Tradeoffs are for the people making the decision, and my decision to buy/sell something isn't subject to debate. It's my choice to make, period. Therefore, people advocating for forced participation into a single-payer system have no moral ground on which to stand.
Is there a UA-cam channel even mildly as awesome as this one but about education systems ? It seems to me to be another domain where we rely so, so little on research and comparaison with other countries and so much on ideology (I mean in France at least, where it is so hard to really reform in a satisfying way the deeply flawed elementary and secondary education systems)
I'd like to have more price controls and regulation to reduce all costs to consumers, personally.
But why the cost of Healthcare is soo high? Wouldn't solving that will be silver bullet?
Subsidies by the govt increase demand without increasing supply through market incentives.
Also, a lack of price transparency and the fact that we don't know how much anything costs until after we buy it makes stuff more expensive since hospitals charge whatever they want.
The healthcare industry has way too much of a lobby for the government to impose pricing restrictions
Price controls are seen as a very anti-capitalist method of governance. Many Americans are against that on ideological grounds.
I blame insurance companies. Well not really them, just the whole system being relied on them. Because insurance companies cover a lot, and the vast majority of funding to providers comes from insurance companies ( private, or Medicaid or Medicare), those providers don't have an incentive to show prices or even care about costs at all. They just need to make sure patients "have insurance." Does not matter if this test is not really needed, or that a cheaper one can be done, the patient does not see the bill directly anyways.
One reason why I don't like the ACA is that reinforces this insurance model. More people covered means more people not caring about what procedures cost. They just care about "premiums." An indirect cost.
Imagine if instead, Medicaid was a program that deposits money every quarter into the HSA of a poor person. And most people had HSA with insurance plans that only cover expensive emergencies (how it should be). Premiums would be super small, and the savings would go into HSA, that the individual owns. Now there are hundreds of millions of patients demanding to know how much this will cost, why it costs so much, and start shopping around.
Our Healthcare system will get changed radically. All without government involvement.
I'm not in favor of price controls. I'm arguing for letting us know how much things cost before we buy them.
what about the inflated prices? I've commented a lot on your channel about this. I remember seeing a Charlie Rose interview with Ezra Klein where he said the hard conversation we as a nation can't have is the one that tells providers and insurers that they won't be able to make us much profit next year and years after as they are now (with what feels like price gouging in practice).
They'll still make profits and the industry will still be relatively fat compared to other sectors of the economy but how can we talk about that as a tradeoff. The argument seems to be that they need to be fat to take risks on research to be innovating, but I think they could probably spend less on Viagra commercials during NFL games or that one Opiod Constipation pill that comes on during weekend morning news shows. Can we trade some of that weird spending and some of the billions CEOs are making it and send it to the doctors and some towards making care less expensive? I think that's the area where more "common good" can be traded in for some greed. Is this possible in the economic culture of today's US?
the only thing you don't see as a trade-off seems to be provider and insurance company profits. lower that and all those things need not be trade-offs. if we want real reform we need to mandate that employers who offer insurance offer employees the option to take the cost of employer-provided insurance as tax free cash after providing proof of coverage. that lets everyone participate in the exchanges, which will force insurance companies to participate too or loose business. that sort of competition will lower prices and raise the quality of care at the same time.
I think you're missing a critical point. We could have could have quality care and pay less for it if the healthcare market were just more efficient.
Currently doctors have to pay specialized staff to manage coding and billing or potentially not be paid by insurance companies. And when insurance does pay it is often a fraction of what is billed, so docs have to bill more and more to compensate for those losses (which really screws private payers). Then there is the inefficiency of the insurance companies themselves who employ large staffs of people to evaluate and pay claims.
Finally, there's the cost of malpractice insurance and legal fees to fight frivulous law suits.
None of these administrative costs actually affect the care that patients receive, but ultimately the patient is the one who pays.
We can have everything we want, and the only compromise is giving up a failed insurance system.
Insurance was never intended to be a wealth redistribution tool and it doesn't do a good job at it. Insurance should serve to do one thing only, pool and aggregate risk of critical illness and injury.
Beyond that, I could see care providers offering discounted health packages that include various routine services.
And there could be government or charitable subsidies to help pay for care of the poor and elderly.
It'd take a lot of work to make entirely reasonable, and would probably vary wildly by state but here is what I'd do: Ban medical insurance for non-emergencies. The government would provide a certain medical stipend, much like food-stamps, across the board. We could then use either single payer or our current system for emergency care. By doing it this way we eliminate the dramatic health care costs to being uninsured do to how insurers wrangle medical prices to force individuals into insurance. There might be other reasons, but given the difference in device costs(about 100 times more without insurance in some cases), collusion between these two groups seems to be a pretty big part of all this.
I know Healthcare reform is hard and it is something that needs intelligent people to work on it.....So it will never happen because we (Americans) seem to only elect the corrupt and/or ignorant.
"You can't have both" hello, France speaking, we spend less per capita, we have better service, and each individual pays less for their health care coverage AND in premiums AND in "deductibles" (we don't have deductibles..)
There is a system which reduces personal (tax) dollars while increasing coverage for all - including pre-conditions - available for much lower total individual outgoings. In UK we call it the National Health Service. Trouble is NHS is Socialist and therefore bad. Still, it's and idea worth considering!!!
no trade offs!!!! no premiums and no deductibles. how you ask? tax the shit out of the rich and cut and run from these 7 useless wars we are in.
I think you hit the right spot, it is all about tradeoffs. however, in my opinion, these same tradeoffs should be decided by each individual buying health insurance, not the government choosing for others things they don't want or need
you realize that that is in an off itself a choice of the government. you have cancer well we cant make health insurance help you because personal freedom. thats the part that people need to understand and accept. the choice by the government to do nothing is a still a choice the government is making for people. some people are ok with it ... till it affects them and then they wonder why its legal for insurance companies to refuse to cover an infant with cancer.
Tim David you dont have a choice to starve or not, then food is society's responsibility. under that argument everything is, we become the ussr in a second
Tim David first, you need to have respect and communicate like an adult. second, when the government gives something for "free" it is not, someone else is paying for it, immoral is to take money from someone, literally pointing a gun to someone's head to take its money. if we do it is robbery, if the government does, its income redistribution. additionally, obamacare requires to have "essential health benefits" there is a big difference between giving subisied alone and then putting minimum requirements. why does a sterile woman have to be covered with pregnancy and prenatal care? this increases the price she has to pay, and because government subsidies we all pay. this is not about beign heartless, there are many private charities, it is about being efficient. if the federal government combined all the programs for the poor currently in place (medicaid, obamacare, tanf, food stamps) and gave all that money to people under poverty, it would be enough to raise their incomes to 36k per year. do you know why they dont do it? becasue it is not about getting people out of poverty, it is about keeping them in dependency
Tim David so you think there is a fixed pool of things we have and the government should distribute them?
Tim David even further. if you are right then there is no private property, because if everything is "communal" then we have no individual right to property, in such case I urge you to move to North Korea,they will accept you with open arms ☺
could have just shouted TRADEOFFS for 4 min great episode
if you tax the rich you CAN give the working class lower premiums and deductibles at the same time.
We need to take the "profit" out of health care. No shareholders making cash off the illness of others for hospitals or insurance companies. Same goes for big pharma too. Medical research and development of drugs is classic big government stuff just like the space program and the military. I am not saying that smart people should not be paid for their knowledge, just that there is no reason for anyone to be making more than a half million dollars a year in the field of medicine or pharmaceutical research.
Theres a lot of college libertarians on here that seem to know how to solve such a complex system. Maybe we should let them reform our healthcare system since this comes so easily to them.
It would result in an even worse system, profit driven free markets belong noowhere near health care.
And so they cut NIH research.
both premiums and deductibles have gone through the roof. Not as in "oh look, a slight increase" but as in "the same plan as last year is literally two times as expensive this year as last".
If you're implying that the new normal is massive cost or massive deductibles, both of which jumped through the roof due to the ACA, then that's crap.
right because before the ACA healthcare and premiums were perfect....
You can't simply blame the ACA for increasing costs. They have been going up for decades and now we have a massive aging population that is partly to blame for those increasing costs. I agree that the ACA didn't do much to prevent costs from rising, but you blaming the program is ridiculous especially considering there are more people that actually have some insurance now. Lastly, you claim that your plan is 2x more expensive in one year, but I can't find a single state that had a healthcare plan reach anywhere near that amount. That is complete hyperbole.
I had 3 to 4% annual increases for a decade before the ACA was passed. the year it passed the premium doubled. It's entirely likely the insurance companies took the opportunity the massive increase in requirements the bill mandated to just jack the costs through the roof to get ahead of the curve, but double they did.
and no, before the ACA my premiums were not perfect. Insurance companies can buy a filing business, claim it's failure as it's own lost revenue and then say "SEE, we lost all this money last quarter, we HAVE to jack up our rates!" to justify raising our premiums. They can do this because of a bill congress passed allowing this...and they're the ONLY business than can do this.
Not to sound mean, but your prior plan probably was a sack of hot garbage. The ACA required everyone to have a certain amount of coverage. That's probably where your premium difference came from unless something fraudulent happened in your county.
I agree with you that insurance companies have odd protections from congressional provisions. I also believe that the hospital and pharma lobbies made off with bank from the ACA. There is much that needs to be done, but it's up to congress to alter the ACA to make it better for all of us. Repealing it will just put us back in the old situation with pre-existing conditions, garbage coverage, same increasing costs, etc etc.
Health care premium prices actually went up on average more under President Bush.
there isn't much to "negotiate". Single payer universal or the government can get out of the insurance business. Anything else will allow pharma to milk the taxpayers for more money than otherwise.
Public option anyone?
We need SINGLE PAYER!
American taxpayers already pay enough to fund national health insurance. We just don't get it.
In 2015, Americans paid $2.1 trillion in taxes to fund health care - $6,560 per person. That's more per capita than Canadians or people in any other nation pay. Indeed, our tax-financed health-care bill is higher than total health spending (private as well as public) in any other nation except Switzerland.
The U.S. system is fragmented and inefficient and more expensive.
We could be more economically competitive with other countries ---businesses would not have to manage and administer and pay health insurance for their employees. Doctors and hospitals would not have to spend enormous amounts trying to collect form insurance companies and patients. Patients would be freer to get preventative care which costs less
The healthcareindustrialpharmaceutical complex spends millions and millions on lobbying representatives in states and federal offices. Why? not for the public's best interest.
Follow the money.
ahhhhhhhhh fuck. it's just skyrim and deciding what items to give off once I reach the carry capacity of my inventory. do I keep my super cool magic shield. or do I throw away my extra damage dealing swords.
decisions decisions
*whistle* The frustration and annoyance from Aaron could be felt in Canada.
This is so obvious but sad that it must be mentioned.
Just copy Singapore its the best!!
This is why if we end the wars. or atleast stop spending 54% or more of the discretionary budget on the military. which is the bigger military in the world, by alot. so if we stop spending our tax dollars on killing civilians in other countries. we can help our own citizens.
The part left out of this video is the money provided to the healthcare industry eg www.fool.com.au/2016/08/30/ramsay-health-care-limited-reports-huge-profits-is-it-time-to-invest/
I liked the idea of Medicaid providing cover for 55 yo's.
But better still is Bernie'd idea of single payer. This is where we get rid of health insurance payments completely but pay 8% more tax. It means the healthcare profits go down considerably though (boo hoo).
The old graphics were better.
Huge flaw in this entire arguement: how about lowering costs? You totally failed to discuss the importance of innovation legislation to reduce the overall cost of healthcare thereby maintianing access and quality.
How about the sooner we stop treating the government like a parent or rich relative the sooner things will get better? Why should the government be tasked with doing things individuals should do for themselves? But then... I am supposing that you don't have an intrinsic right to the wealth of others and that you shouldn't use the government like robin hood to get what you want.
Yeah, why do we even need police? We have guns, and you can investigate your own crimes. Hire a private investigator if you want. Hire security guards if you don't feel safe. And no more getting wealth from your parents, you have to work hard if you want that money. If you want to protect your country then start a private militia to defend it. In fact, why should you be forced to defend the whole country? Just defend your own home instead.
The US constitution outlined the role of the government to protect us from foreign and domestic threats. Illness and death, as bad as it may be, are part of life. It sucks, but you gonna die. A person holding a gun to your head is not the same thing as cancer. Trying to get the "government" to pay for cancer protection is fighting a futile task. If you want to spend your own money on it, that's your choice. Placing up guards to keep the peace is an equal and universal benefit whereas health care is not.
Its annoying when more liberal minded folks talk about the government paying for something when its really tax dollars, your money, paying for it. I don't earn much and I don't agree with how the government frequently spends my hard earned money. I realize we must make certain concessions but welfare spending is the vast majority of our federal budget, its often wasted on bloated and ineffectual programs.
If we cut social security and medicaid and medicare spending (we'd cut nearly 50% of the budget out) and devoted just half that to R&D: fund research schools and NASA, we'd probably make so many medical and tech breakthroughs we wouldn't get sick nearly as much. Publicly held information benefits everybody (one of the many issues with current patent laws).
The government will be any role the majority of the public wants it to be, point blank.
The question is not what the government will be, it is what it should be.
It should be what the majority of the people want it to be as well.
You're spending a lot of effort to not talk about Universal Single Payer Health Care. Reducing spending can immediately be done by changing physician reimbursement from pay per value to pay per time in a single payer system. This eliminates most insurance industry micromanagement of physicians. That is how to lower the cost of health care.
Good faith negotiation with extremists results only in extremism.
I disagree. If both sides compromise, then the problems that everyone recognizes will still exist, and everyone will confirm their bias and blame the other. "Healthcare is still crap because we didn't fully repeal the ACA!" "Healthcare is still crap because they gutted the ACA!". We should just do one thing fully, to see if it was good or not. Then change if needed.
We've already done life before the ACA and that was total crap for people like me with serious health problems. Now we need to work toward fixing the flaws of the ACA, not tearing it down. Other first world countries have worked it out. We just need to grow up as a country, get past our bias against universal healthcare and stop flushing so much money down the drain on defense. Trump's budget increase for defense spending was laughable. The US already spends more than China (2), Saudia Arabia(3), Russia(4), the UK(5), India(6), France(7), AND Japan(8) COMBINED, with enough left over to cover the 11th on the list of countries that spend the most on defense, Brazil (en.wikipedia.org/wiki/List_of_countries_by_military_expenditures).
"Life before the ACA" isn't what Republicans are advocating. Some are "fixing" Obamacare in their own way, and others want it repealed and replaced. Also, what you're talking about regarding other first world countries is single payer, not "fixing" Obamacare. I would say "let's double down on that and see how it works" but right now, we have a Republican majority, so we should be doubling down on repeal and replace.
I happen to think that repeal and replace (Rand Paul's way), is the correct solution. You can't prove I'm wrong until it's been done. Same goes for me: I can't prove to you that single payer is the wrong solution until you see it happen. You might point to successful countries that have it as proof, but they benefit from America's innovation, which is one of the things someone like myself thinks we'll lose. Also, people come here to get surgeries instead of waiting for it in their own country. If America had the same system, then that option would be gone for non-Americans, stressing their countries' success too. I know you're not convinced of those arguments, but that's my point: you and I can't be convinced to change our minds without seeing one of these plans implemented fully.
You don't need to prove someone is wrong, what the republicans were planning to "replace" the ACA with was horrific. It was WORSE than what we had to begin with. In some cases, older americans health insurance costs would've jumped from 1700 dollars a year to like 17,000 dollars a year or something around that area. Plus upwards of 20+ million people losing health insurance in total, etc. Along with the fact that Rand Paul thought that the plan didn't go far enough (IE- more people losing coverage, and even higher prices for the sick and old).
In short, the majority of americans older than 35, or with medical issues, would've had skyrocketed insurance premiums in the ranges of 5-10 times the yearly cost. (With pathetically low tax credits, that were useless for most poor people, as they couldn't afford to pay it in the first place, let alone wait until the end of the year to recoup that money)
That's false. Don't believe me? Then you're stupid, because I don't have to prove anything, you just have to believe!!!... That's sounds dumb, doesn't it? That's why you have to prove things.
How about insurance be treated like insurance, and not as a middleman for temporarily storing money. Younger people SHOULD be able to pay less, and older people SHOULD have to pay more. That makes perfect sense. It does not sound nice, but it makes sense.
And the young people should be encouraged to use their savings by directing them at an HSA, so when they become older they have that money saved up. This also makes sense. It is not nice because that means young people must be more responsible with their health and money, but it must be done.
And Healthcare IS a market, and it SHOULD be treated as a business. Unlike what some Liberals say. Plus rare, extremely expensive, unavoidable diseases can be handled by a government program because the person could not have prevented them. This could also be said about disabilities. But the vast majority of Healthcare is about choice and responsibility.
I don't think it does make perfect sense. Yes, older people are likely to be more expensive. But younger people are more likely to be actively earning income. When you shift the burden of cost onto people who are less equipped to pay it, the system breaks down. There needs to be a balance.
***** because you view things in terms of premiums. That you pay some private or government insurance entity and they provide you with Healthcare access. That is the mindset problem.
Young people earn more, and are healthier. Therefore they should save their money...for when they get older and require more Healthcare.
Insurance should be only for catastrophic coverage. We don't make car insurance cover tire replacement, oil changes, and maintenance. Why does Health insurance?
Because if you don't change your oil, replace your tires, etc., you may be inconvenienced, but odds are good that you aren't actually going to die. Heck, some people don't even own a car. Meanwhile, nobody can survive if they just don't treat their health problems. A UTI is not "catastrophic," but it could still kill you if you don't go to the doctor and get a round of antibiotics, and even such a relatively cheap appointment and prescription is outside of some people's ability to pay on the fly. There are many medical problems you must treat in order to live and/or thrive. It's not just an inconvenience the way being unable to afford car maintenance is. Not everyone needs a car, but everyone needs a healthy body.
And yes, young people *should* save money for when they get old, and it is great when they do. But some young people simply *can't* whether they want to or not. They don't deserve to be left out to dry in old age simply because they lived in poverty in their youth. And what about people with chronic conditions that develop during childhood? They have to treat that all their life. They can't just wait until they're old to start paying into the system. Basically, your proposal works great in a world where people are generally healthy until old age and have a moderate income that allows them to afford to save what enough to provide for themselves after they are too old to work. But it doesn't work great in this world where there are people whose lives simply do not fit that mold.
***** look, a doctor visit, based on location, can be 100-250 dollars. I seen a location that is cash only and does check ups for $50. A yearly checkup can be afforded by anyone. Putting 400 a month to an HSA, 200 from you and 200 employer contribution. A cheap catastrophic plan with 50-200$ of contributions can be afforded by ANY employer, and I would support a mandate.
Now some people cannot save, they live paycheck to paycheck. And some have really expensive conditions they where born with. Those can be covered with a replacement of Medicaid, one that deposits money to an HSA on a regular basis based on need.
Aleksandr Vasilenko Old people use more healthcare and the healthcare they do use is more expensive than young people. So you are correct, it makes sense for old people to pay more on the fact that they consume more.
So it makes sense for young people to save for when theyre older. But since inflation exist, saving money alone isnt reliable enough. The average family income in 1960 was $6,500. Putting $50 a year into a HSA wouldnt of prepared someone back then for the healthcare cost of today because of inflation.
singlepayer or bust lel
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