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

[Sbane]

Obamacare is, and by far, the brightest spot of US healthcare.

Actually, no, he's right. Innovation is where the US is the world leader in health services.

Maybe that's just me, but I don't really prize the quality of healthcare if it's the privilege of an elite.

As with any technology, it is expensive when it first comes bit becomes cheap as it's use becomes more widespread. Many drugs and devices we use regularly today, and are fairly cheap today, were very expensive in the past. The innovations of today will become used more widely in the future. The goal should be to quicken that process, not stifle innovation. That would be a crime against the future of humanity.

[Sbane]

Obamacare is, and by far, the brightest spot of US healthcare.

Actually, no, he's right. Innovation is where the US is the world leader in health services.

Maybe that's just me, but I don't really prize the quality of healthcare if it's the privilege of an elite.

Ugh, in 2008, only 14% of Americans were uninsured. While this is a number that everyone would agree is too high in and of itself as the most vulnerable Americans were unprotected, healthcare was hardly the privilege of "teh elites" before Obamacare.

A good share of these 86% only had extremely limited and low-quality coverage. Certainly not what it takes to have access to the finest American health innovation. And yes, I know Obamacare has only partially changed that.

No, Antonio you are completely wrong about that. These people did have access to those innovative procedures/medicines. It is the payment mechanism that is the problem. These people might have had high copays try couldn't pay or coverage limits which they crossed and got screwed.

[Sbane]

Obamacare is, and by far, the brightest spot of US healthcare.

Actually, no, he's right. Innovation is where the US is the world leader in health services.

Maybe that's just me, but I don't really prize the quality of healthcare if it's the privilege of an elite.

Ugh, in 2008, only 14% of Americans were uninsured. While this is a number that everyone would agree is too high in and of itself as the most vulnerable Americans were unprotected, healthcare was hardly the privilege of "teh elites" before Obamacare.

A good share of these 86% only had extremely limited and low-quality coverage. Certainly not what it takes to have access to the finest American health innovation. And yes, I know Obamacare has only partially changed that.

No, Antonio you are completely wrong about that. These people did have access to those innovative procedures/medicines. It is the payment mechanism that is the problem. These people might have had high copays try couldn't pay or coverage limits which they crossed and got screwed.

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.

[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.

[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.

[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.