As flawed as it is, here is, in my view, the brighest spot of US Healthcare

[muon2]

There's no such thing as a person who will never use healthcare in any given year, except in retrospect.  A young healthy person is unlikely to need a lot of expensive medical care, sure.  But, it's not a guarantee at all.  Eating healthy and being young doesn't make you invincible. 

And, ultimately, that's what any insurance policy does, it protects you from risk.  Insurance, at least in theory, shouldn't be there to protect you from certainties.  If you were guaranteed to get more monetary value out of insurance than you paid, the insurance company would go bankrupt (See AIG in 2008). 

This comment is correct, but also points out one of the flaws in the current US system (both with and without the ACA). Insurance companies are set up to be risk managers, but a part of health care is wellness and health maintenance. For example plans cover regular check ups, but there's no risk in that, it's just a matter of budgeting the annual expense. When insurance companies are asked to cover that we create an overhead cost on the budgetable expense. Basically we asked insurance companies to both manage our health risk and our health budget.

I grew up in the 60's and 70's before the advent of HMO's and other comprehensive health plans. My dad's job gave us good coverage but it only covered the risk parts of health care - emergency rooms, surgery, and drugs for acute care. Doctor's visits and other health maintenance activities were strictly out of pocket. Medicare made sense then because the maintenance costs for the elderly had outstripped the typical pension or social security payments. Lengthy drug regimes were much less common then, which is why the Medicare drug benefit had become such an issue decades after its initial passage.

Insurance for other activities such as homes, cars, and life haven't conflated these two tasks. In these other areas you would generally buy a service contract separate from your insurance if you wanted budget smoothing for maintenance issues. As long as we perceive all of health care as a matter of insurance, rather than insurance plus service, we will continue to see price distortions due to mixing risk pooling with budget management.

[Sbane]

If you can't afford to pay for something, how do you consider that having access to it?  If you hit your coverage limit and the procedure or medicine you need costs $100k, you have as much access to it as you have access to a new $100k Mercedes. 

I suppose the "problem" with healthcare is that you are oftentimes sold a Mercedes without you knowing and assuming insurance will cover it. So they do have access to these devices, they might just get screwed over by the insurance company afterwards. Obamacare does tackle this situation by abolishing coverage limits.

No.  If you don't have insurance approval or a means to pay for expensive medicine or care, nobody is going to do it.  Do you think a hospital is going to do a $20k procedure and just hope that someday you pay your $100k bill?  They would if you came into the ER with a gunshot wound, sure.  They wouldn't if you have a chronic illness that's not an imminent emergency.  Or, in the case of medicine, you can't go to CVS and say, "can I pretty please have this medicine for free?" 

I was actually in this exact situation as a young invincible healthy person.  I developed a chronic inflammatory disease and my doctor prescribed an expensive drug.   I hit my prescription coverage limit the second time I filled the prescription and I couldn't afford $200k a year on medicine so I had to go without medicine I desperately needed.  But, it was OK because I theoretically had access to it, right?

Where did I defend coverage limits?

Also, even if an insurance company denies a certain procedure or medicine, it is not based on whether you have a good insurance plan or a crap one. All policies sold by that insurer would deny covering that, no matter how "Cadillac" your plan is. If an insurer denies covering something, it must medically justify that. With obamacare solving the coverage limit problem, it is true that the vast majority of people in America have access to the new innovations in medicine today.

[bedstuy]

If you can't afford to pay for something, how do you consider that having access to it?  If you hit your coverage limit and the procedure or medicine you need costs $100k, you have as much access to it as you have access to a new $100k Mercedes. 

I suppose the "problem" with healthcare is that you are oftentimes sold a Mercedes without you knowing and assuming insurance will cover it. So they do have access to these devices, they might just get screwed over by the insurance company afterwards. Obamacare does tackle this situation by abolishing coverage limits.

No.  If you don't have insurance approval or a means to pay for expensive medicine or care, nobody is going to do it.  Do you think a hospital is going to do a $20k procedure and just hope that someday you pay your $100k bill?  They would if you came into the ER with a gunshot wound, sure.  They wouldn't if you have a chronic illness that's not an imminent emergency.  Or, in the case of medicine, you can't go to CVS and say, "can I pretty please have this medicine for free?" 

I was actually in this exact situation as a young invincible healthy person.  I developed a chronic inflammatory disease and my doctor prescribed an expensive drug.   I hit my prescription coverage limit the second time I filled the prescription and I couldn't afford $200k a year on medicine so I had to go without medicine I desperately needed.  But, it was OK because I theoretically had access to it, right?

Where did I defend coverage limits?

Also, even if an insurance company denies a certain procedure or medicine, it is not based on whether you have a good insurance plan or a crap one. All policies sold by that insurer would deny covering that, no matter how "Cadillac" your plan is. If an insurer denies covering something, it must medically justify that. With obamacare solving the coverage limit problem, it is true that the vast majority of people in America have access to the new innovations in medicine today.

We're on the same page then.  Although there's a ton of other access issues that we still have.   Even if you have insurance, we have a divide between the have and the have-nots in the post-Obamacare world.  There are the doctors and hospitals that only cater to poor people.  There are doctors and hospitals that only cater to rich people.  I know here in NYC that if I had to go to the hospital, I would never go to my 3 closest hospitals because they're all horrendous.  I wouldn't call an ambulance, I would get a taxi to Manhattan to go to the white people hospital.

[Sbane]

Yeah, there are issues of access based on location, in poor urban areas as well as in rural areas. Still, I would argue those hospitals have better access to the newest innovations than hospitals in other OECD countries.

[Matty]

If you can't afford to pay for something, how do you consider that having access to it?  If you hit your coverage limit and the procedure or medicine you need costs $100k, you have as much access to it as you have access to a new $100k Mercedes. 

I suppose the "problem" with healthcare is that you are oftentimes sold a Mercedes without you knowing and assuming insurance will cover it. So they do have access to these devices, they might just get screwed over by the insurance company afterwards. Obamacare does tackle this situation by abolishing coverage limits.

No.  If you don't have insurance approval or a means to pay for expensive medicine or care, nobody is going to do it.  Do you think a hospital is going to do a $20k procedure and just hope that someday you pay your $100k bill?  They would if you came into the ER with a gunshot wound, sure.  They wouldn't if you have a chronic illness that's not an imminent emergency.  Or, in the case of medicine, you can't go to CVS and say, "can I pretty please have this medicine for free?" 

I was actually in this exact situation as a young invincible healthy person.  I developed a chronic inflammatory disease and my doctor prescribed an expensive drug.   I hit my prescription coverage limit the second time I filled the prescription and I couldn't afford $200k a year on medicine so I had to go without medicine I desperately needed.  But, it was OK because I theoretically had access to it, right?

Where did I defend coverage limits?

Also, even if an insurance company denies a certain procedure or medicine, it is not based on whether you have a good insurance plan or a crap one. All policies sold by that insurer would deny covering that, no matter how "Cadillac" your plan is. If an insurer denies covering something, it must medically justify that. With obamacare solving the coverage limit problem, it is true that the vast majority of people in America have access to the new innovations in medicine today.

We're on the same page then.  Although there's a ton of other access issues that we still have.   Even if you have insurance, we have a divide between the have and the have-nots in the post-Obamacare world.  There are the doctors and hospitals that only cater to poor people.  There are doctors and hospitals that only cater to rich people.  I know here in NYC that if I had to go to the hospital, I would never go to my 3 closest hospitals because they're all horrendous.  I wouldn't call an ambulance, I would get a taxi to Manhattan to go to the white people hospital.

This problem isn't confined to America. Poorer areas in other first world nations often have worse care than the richer areas, even though the systems are "public".

[Deus Naturae]

This is why the device tax is so important. Democrats trying to repeal it should be primaried.

Is this sarcasm?

[bedstuy]

Yeah, there are issues of access based on location, in poor urban areas as well as in rural areas. Still, I would argue those hospitals have better access to the newest innovations than hospitals in other OECD countries.

I agree. The biggest problem in our system is the cost/incentive structure.  Basically everything in our healthcare system is a market failure that makes no sense.  That's the overriding question without a doubt. 

But, I just go back to my original point.  A lot of our spending on so called top-notch care is wasteful spending on things like Nexium and needless procedures which don't make anyone healthier.  Just look at our list of top selling pharmaceuticals:  Many of those drugs just treating the symptoms of over-eating.  Our medical system hasn't figured out how to address the root causes of those conditions, but we spend billions and billions treating the symptoms.  It's not a good system for anyone, but the people profiting off our sickness.

[Sbane]

Yeah, there are issues of access based on location, in poor urban areas as well as in rural areas. Still, I would argue those hospitals have better access to the newest innovations than hospitals in other OECD countries.

I agree. The biggest problem in our system is the cost/incentive structure.  Basically everything in our healthcare system is a market failure that makes no sense.  That's the overriding question without a doubt. 

But, I just go back to my original point.  A lot of our spending on so called top-notch care is wasteful spending on things like Nexium and needless procedures which don't make anyone healthier.  Just look at our list of top selling pharmaceuticals:  Many of those drugs just treating the symptoms of over-eating.  Our medical system hasn't figured out how to address the root causes of those conditions, but we spend billions and billions treating the symptoms.  It's not a good system for anyone, but the people profiting off our sickness.

One of the reasons for that is the way we pay for healthcare. By having insurance pay for all of our healthcare needs, we do not realize what the real cost of our medications, doctors visits, labs etc are. Hell, we complain when the insurance companies try to pass on even 10% of the cost. If we were paying for non-acute care out of pocket (with a stop loss provision for those with expensive chronic conditions), we may make wiser choices and drive down the cost of healthcare. Obviously one can't choose what hospital one goes to if they get into an accident or have a stroke, but patients definitely have more choices in the outpatient setting.

[dmmidmi]

Yeah, there are issues of access based on location, in poor urban areas as well as in rural areas. Still, I would argue those hospitals have better access to the newest innovations than hospitals in other OECD countries.

I agree. The biggest problem in our system is the cost/incentive structure.  Basically everything in our healthcare system is a market failure that makes no sense.  That's the overriding question without a doubt. 

But, I just go back to my original point.  A lot of our spending on so called top-notch care is wasteful spending on things like Nexium and needless procedures which don't make anyone healthier.  Just look at our list of top selling pharmaceuticals:  Many of those drugs just treating the symptoms of over-eating.  Our medical system hasn't figured out how to address the root causes of those conditions, but we spend billions and billions treating the symptoms.  It's not a good system for anyone, but the people profiting off our sickness.

One of the reasons for that is the way we pay for healthcare. By having insurance pay for all of our healthcare needs, we do not realize what the real cost of our medications, doctors visits, labs etc are. Hell, we complain when the insurance companies try to pass on even 10% of the cost. If we were paying for non-acute care out of pocket (with a stop loss provision for those with expensive chronic conditions), we may make wiser choices and drive down the cost of healthcare. Obviously one can't choose what hospital one goes to if they get into an accident or have a stroke, but patients definitely have more choices in the outpatient setting.

That is definitely debatable. Depending on where you live and your access to reliable transportation, you may have just as many outpatient choices as inpatient choices.