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

[bedstuy]

That's true, but sometimes the innovation is so directed at making money that it's a huge waste in terms of health outcomes.  The paradigmatic example is how AstraZeneca developed Nexium as an alternative to their older patent, Prilosec.  AstraZeneca's patent on Prilosec was going to run out so they developed and heavily marketed Nexium.  Nexium is virtually the same, except because it was newer and slightly different on a molecular level, they could get a new patent for Nexium.  So, long story short, millions of people have paid for Nexium when it's maybe 2% better than Prilosec.  That's not really what should count as R&D or innovation.

[bedstuy]

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. 

[bedstuy]

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.

Like me. I am an extremely healthy young man who eats healthy, and rarely goes to the doctor. I have (or had, after it was cancelled) a catastrophic plan in case something severe happens. I deal with sickness with OTC medicine and home remedies. If I truly need to go to the urgent care, I'll pay cash. Not all, but many of the people who had "bare-bone" plans were in the same boat as me. Now we have to pay a significant amount more a month for a plan we will never use.

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). 

[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?

[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.

[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.