Question about Obamacare

[jaichind]

There is really no difference on which doctors you have access to between the bronze, silver, gold or platinum plans for a given health insurer.  The only difference is the cost sharing when using health care services.  But as pointed out before there is a cap on that cost as well even if one were to go with a bronze plan.

But lets be clear, the plans offered on Obamacare exchange will pay doctors differently from a Medicad, Medicare and company sponsored health insurance.  
On the whole, company sponsored health insurance plans will pay doctors the most so the access to doctors will be the best under these plans.  After that would be Medicare which starting with Obamacare will pay less to doctors so the number of doctors what will take Medicare will start to shrink.  Right behind that would be the Obamacare health exchange plans.  And the worst payment to doctors would be Medicad.  Doctors would often refuse patients on Medicad because they would be treating them for a loss.  The same would also take place but to lesser extent for the Obamacare exchange plans as well as.

For me the cost sharing is not enough and it is based on basic principles and assumptions which others might not take.  I take a stance that health insurance should be like car insurance.  If makes no sense that to use health care services and there is insurance that the usage should come at no cost.  That will just lead to overuse.  I could make the same argument about water.  Water is necessary to survive but it does not follow that it should be free.  Doing so will just lead to overuse and an overpriced market for water.  I think that health insurance should cover catatstropic health services just like a car being banged up badly in an accident.  But for checkups just like oil change the user should pay the cost of such health care services and not need insurance.  And defining up what is "necessary" health care keeps on rising to include things like in vitro fertilisation in some states, like MA, just pushes the cost up more for people that really does not want or need it.

[jaichind]

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

Correct.  This is why this Left wing dream idea of Medicare for all does not work.  Medicare "works" mostly because it keeps cost under control by underpaying doctors.  Medicare is the same thing but with a even bigger underpayment.  Obamacare is just making that underpayment even worse in Medicare.  The doctor makes up for it by charging corporate and individual health care plans more to make up for this loss who in turn will charge more for these plans.  If we put everyone who are uninsured on Medicare then this underpayment gap will grow bigger which in turn lead to either less doctors, or doctors charging the corporate heath plans more or both.  And of course in reality this is really the same thing as the people working in the private sector that gets wages from these companies subsidizing these people on Medicare since the company will merely pass that cost onto its employees.  On my W-2 form it says my health insurance plan costs my company around $30K.  That is $30K my company would have paid me if they did not have to pay for this.  And if this number becomes $40K or $50K because of the increased subsidies the insurance plan I am on has to take on for those Medicare  then my compensation will merely be reduced to make up the difference as my company will its profit margin come hell or high water as that is their job, to make a profit for their shareholders.  So Medicare for all is merely tax all working people to pay for subsidized healthcare for all that are not working.  Which in turn is just socialism.   

[jaichind]

Generally not, but in a smaller country like Austria it's much easier to find compromises and not drag out issues so that there is no action. The unions and the government usually always find a way that is acceptable for the doctors and the patients.

I think the difference is more profound that smaller country vs big country.  I spent a good deal of time in Europe starting in the 1980s and repeated trips until fairly recently.  What I noticed is that the economic crisis of the 1970s and early 1980s had a profound impact on Europe (excluding UK and Ireland.)  For me Europe has mostly given up on growth as a solution to problems.  Not to say there is no growth in Europe.  But in the USA there is a very strong belief that the growth of the economy will create an environment where people with ability can over economic circumstances as the economic pie gets bigger.  In Europe they mostly given up on that as a solution.  Ergo in Europe, given everything is seen as zero sum, it is mostly about how to divide up the economic pie to create a harmonious society (to borrow from the CCP of the PRC.) In the USA they focus on how to grow that pie.  This cultural difference can be even seen in what sort of sports people like.  In USA, it is mostly about American football or basketball where there are high scoring games focused on offensive skills and a battle to see who can score more.  In Europe it is mostly about soccer where the games are low scoring and it is mostly about a zero sum world and how to stop they other guy from getting points. 

This means that Europe and USA will view things like healthcare and a whole host of issues differently at the grass roots as well as the likelyhood of cooporation at the grassroots on these goals.