You got it right, it's difficult to imagine for a European what it's like to deal with having no medical care if unemployed.
In addition, the fact that's part of every discussion gives a hint of how much of an issue this is.
In addition, the fact that's part of every discussion gives a hint of how much of an issue this is.
We're at 8% uninsured, which is nothing to brag about, but its far from a free for all post-apocalypse where people keel over in their desks or in the unemployment line. Its also important to note that those numbers include illegals who can't or won't get insurance due to citizen status and 1/3rd to 2/3rd of that number actually qualify for various insurance programs, but for some reason aren't seeking it (aside from citizen status).
We absolutely have a big problem with the rural poor and insurance, which is a hefty 14-20% of that demographic. I'm not sure what the fix here is especially considering rural states are heavily conservative and fight off ACA and Medicare/Medicaid expansion regularly.
I imagine ACA mandated insurance is a net boon here even if the monthlies are more.
Personally I'd offer the somewhat-feeble defense that it isn't as bad as people say it is, but I'd stop far short of calling it good... because I've got my own political axes to grind too, even if they are nearly diametrically opposed to the local consensus. But it isn't actually true that the American health system requires you to sign into indentured servitude the moment you walk in the emergency room door, and injects you with strychnine and tosses you out the door if you can't pay enough to satisfy the bureaucracy this week. Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape. Doctors do not actually giggle with glee and make "chaching!" noises when giving you bad diagnoses.
Why would they? The US produces a surplus of blood and tissue, to the point that many other countries (particularly in Europe) have to purchase to from the US to address their own shortages.
Watched this process with sick relatives in the 90s, and it was already fucked-up then. Gone through it with my wife's 3 pregnancies and a couple family illnesses in the last 5ish years. Same thing. It's a broken, evil system that ruthlessly exploits and crushes anyone without the time, wits, and wherewithal to fight it every step, and it has been for a long time. I think what changed is we have much better exposure to what it's like elsewhere, so more of us are aware that there is no reason whatsoever to keep hurting people this way.
Look up how much US spends on healthcare and how much rest of the world does.
Is your point, "we spend so much today that we couldn't possibly spend more under a different legislative regime."??
Do you have a reference?
It's possible some other reforms that differ radically from those systems would improve things, and maybe even be better than anything other OECD states do, but since we have a wealth of real-world data about how the existing systems work and only speculation about most others, it's a much safer move to base reforms on the ones that are observably better than ours in the real world.
Other than that, the patient-doctor match gets mostly allocated on the basis of location and narrow specialty, or with limited availability; e.g. if you want a particular popular doc, then (s)he might have a queue, so you either wait when they become available or pick someone else.
My view of the mainstream story is that things went from ok to chaos within the past, say, 3 years.
Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes.
Thought experiment: what if gas or milk prices had increased at the same rate? Education cost has increased a lot, but that's mostly inflated by student loans that I predict will implode like subprime mortgages.
Have voters done that, though? I mean look at the trouble Republicans are having repealing the ACA. Voters seem to not want to repeal it. It seems like only the Republican leadership actually wants it repealed. My understanding is that when you ask individual voters of all stripes, they agree that pre-existing conditions should not stop you from getting affordable healthcare, and that lifetime limits are unfair across the board. But those are the things the Republican leadership wants to axe first.
It's always harder to repeal a law, versus blocking it from passing. As soon as a law is passed, it's the new status quo. And recall how close the recent repeal vote was.
Why haven't we repealed the laws against weed and poker yet?
That's not really true; total expenditures have increased, but that's largely because the treatments and care that people are choosing are different (and more expensive) than previous ones.
Put another way: today you can still get the same type and quality of care that was available in the 1960s, and it'll be cheaper than it was in the 1960s (measured in 2017 dollars). You just probably don't want it, because it's nowhere near the current expectations and standards of quality of care.
No, in many cases you can't because the techniques and absence of procedural and other safeguards are no longer up to the standard of care in the profession, older drugs are no longer produced, etc.
It's been horrible for a long time (and there's been outrage for a long-time: while it got derailed and we got nothing out of it but HIPAA, the bad state of healthcare and plans to reform it were central to the Clinton campaign in 1992—and while Clinton tried for a complicated scheme involving insurance companies, polling showed majority support for single-payer even then; the ACA is often pointed out to be a copy of Romneycare in Massachusetts, but what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed, because even then it was widely perceived that something had to be done.)
> I'm not saying the status quo is best, but we didn't suddenly plunge into a crisis.
No, we've been in a crisis for more than a generation.
It's less-commonly pointed out because it's not really true.
It's true that there was one bill, in 1993, that was proposed by a Republican and which happened to somewhat resemble the Affordable Care Act at a very high level. However:
a) It was proposed by a Republican senator from a very blue state (Rhode Island)
b) That Republican senator lost his next re-election bid
c) The bill never received a vote
e) The bill was only one of many GOP-sponsored healthcare bills that year
f) Conservative and moderate Republicans strongly criticized the bill
g) While it bore some resemblance to the ACA at a very high level, it was a very different bill in details and implementation, so it's misleading to suggest that supporting one and not the other would be hypocritical. There were a lot of things Democrats like about the ACA that weren't in Chafee's bill, and there are a lot of things that Republicans might like in Chafee's bill (or the ANHRA in the House) that were not present in the ACA.
> so it's misleading to suggest that supporting one and not the other would be hypocritical
I wasn't suggesting that, I was illustrating that the perceived problem and many elements of the potential solution space have been part of the national dialogue for a long time.
Regulation in turn is driven by lobbying efforts of large professional groups (trial lawyers, AMA, large pharma etc).
In another word it is a corrupted system that manages stay afloat as people in power legally able to get their cut through lobbying.
you buy subsidized insurance. do Europeans really think the USA is just a free for all ?
EDIT: The less it costs for the same quality.
Your salary requirements factor into the price. Someone making only 17k a year is capped at $54 a month premium. There are caps at certain salary intervals.
> Whereas in the part of Europe where I live, the less you have the less healthcare costs you.
100% true for the US as well. Please don't listen to news or internet comments. Verify the facts!
I was buying plans from health care exchange for 2 years and my last plan for two (parent and child) cost me 500$ per month with 6500 deductible per person - 13000$ total.
So effectively I had only a catastrophic insurance but was forced to pay for some subsidized guys who had a platinum plan with no deductible for 54$ per month. Worst situation for people like me!
The system has warts. There are good reasons to criticize it. But saying we leave the poor dying in the streets because, well, fuck 'em they're poor, is both untrue and insulting.
Well, except that it's exactly true that that’s why the “warts” that you acknowledge which do, in fact, deny swaths of the poor access to care are tolerated.
And by the way, I do not buy subsidized insurance. I pay my taxes, and I have health insurance. My taxes pay for health insurance. There is nothing else to pay to get that, other than a small fee for the doctor out of pocket up to a certain amount. No doctor, no medicine = no payment. Other than taxes, assuming I'm working and paying taxes.
To the curious Europeans out there, if you lose your job you can stay on your job's health plan for 18 months while you look for new work. If you're unemployed that long then you'd qualify for Medicaid after that, the government insurance program for the poor. If for whatever reason you really didn't have insurance you will nevertheless never be turned away from any hospital emergency room. This "die in he street because you have no insurance" is a myth and total hogwash.
You've clearly never, ever been in a position where money was an issue for you. Especially not to the point where you felt your life was in danger because of it.
I have.
If you had been, you wouldn't be handwaving away legitimate concerns over the system of healthcare. Considering you didn't even address any of the points I mentioned, I have a feeling you have no response.
If you can pay the full premiums, including the part your employer paid while you were employed.
> If unemployed that long then you'd qualify for Medicaid after that, the government insurance program for the poor.
You don't qualify for Medicaid based on duration of unemployment; whether, and in what form, you would qualify for Medicaid depends on income, assets, and state you live in (Medicaid is a state-run program with some federal standards, though even the most basic broad-strokes qualifications differ between states, especially between those participating in the expansion under the ACA and those not.)
> If for whatever reason you really didn't have insurance you will nevertheless never be turned away from any hospital emergency room.
But will be booted into the street from the ER after stabilization without treatment of the underlying condition.
> This "die in he street because you have no insurance" is a myth and total hogwash.
Except that people do, in fact, die because of lack of health insurance in the US.
http://www.pnhp.org/excessdeaths/health-insurance-and-mortal...
No, and you don't want an emergency room treating you, because emergency physicians aren't trained to provide anything other than acute care.
That said, the point is moot, because once a patient is stabilized, if they need further care, they'll be admitted, and receive care from an internist.
Afterwards, they'll receive a bill for a rather large amount, which the hospital doesn't expect them to actually pay (but for legal reasons is required to present them with). If they know about this, the uninsured patient can almost always get away with paying less than 5-10% of the total (initial) bill, and the hospital writes off the remainder so the bill is paid in full (ie, it does not get sent to collections). Of course, most patients don't know any of that.
The billing situation is 100% fucked, and the reasons for that are way too long to explain here, but it's not true to say that an unemployed person without insurance can't receive anything but acute care from a hospital, or that they would necessarily have to end up in debt for doing so.
No, they often won't, because while ER stabilization without regard to ability to pay is mandatory, subsequent admission and treatment is not.
If the condition is not stabilized in the ER, they may be admitted for stabilization to fulfill the mandate, but there is no mandate for admission for treatment after stabilization.
That's not really true, and it's a common misconception that arises due to the way the ER mandate is specified in law (explicitly, and via a single bill), as opposed to the confluence of a few different regulations.
In short, because of the intersection of ways in which hospitals are and are not allowed to discriminate against patients by insurance status, what ends up happening in practice is that the decision to admit a patient is rarely made with the patient's insurance status as a determining factor.
That's especially true for public hospitals, but it's true of many private hospital situations as well. (Note that this doesn't apply to the decision of which hospital to admit a patient to - a single ER which has more than one associated hospital may decide to admit a patient to the public hospital instead of the private one based on their insurance status).