Originally Posted by
KantoSooner
Midtowner,
Requiring X% go to 'healthcare' rather than 'admin costs' is not going to change much. One of those 'suits' simply slides the dollars over into a different column and off we go.
Improved quality and lower cost in a competitive market are produced by expanded competition between the suppliers, not between the consumers. Getting more people into the system might, arguably contribute to lowering costs by allowing for economies of scale, but something that consumes 17% or so of the largest economy on earth doesn't seem to be gasping for volume in order to cover overhead. I might be wrong; just sayin'.
'Restructuring the marketplace to lead to greater competition and more consumers within the system...' ...How? How restructured? What greater competition? What more consumers? Right now 100% of our population has a plan. It might be a crappy plan (ie, plan: "if sick, go to ER, get treated, go home stiffing hospital."), but it's a plan. The rest of us have some sort of insurance and carry the balance by ourselves. Does ACA fundamentally change this? I don't see it.
A Parable.
There once was a man, let's call him 'Dad'. He had knee replacement surgery. It didn't go so well. He got a staph infection in his femur. Knee had to be replaced several times. Upshot: 'Dad' doesn't walk anymore. He is wheelchair bound.
The wheelchair is interesting. Medicare bought it. (you're limited to 2 per lifetime. Glad to know 'Dad's' got one more coming in case he wears this one out.) Here's the deal. To buy a wheelchair costs about $400. If you pay yourself. To get Medicare to pay for it, you are billed $100 a month (with $100 up front) for 12 months. 100% of which is covered by Medicare. Then, if you want to keep the chair, you pay $100 more (also covered by Medicare) and it's yours. Notice what happened? A chair with some sort of market value of $400 becomes a thing that is billed to the government at $1400. 'Dad', being a bluff old traditionalist, suggested that perhaps he could just buy it for $400 and then submit the bill to Medicare. No go, said medstore guy, Medicare must be billed by the provider. Hmm, Okay, says 'Dad', how about I take it for 4 months, get Medicare to cover those months and then 'return' the chair, but actually keep it. Medistore gets $400, I get a chair and we don't rip off the public. Medistore guy: "We've thought of that but it would be Medicare 'fraud' and we'd go to jail."
Moral of the story? Our system is run by people who live in a parallel universe in which money grows in the little boxes in Monopoly sets. It has no meaning to them. To think that these people are somehow going to being able to keep up with insurance companies and hospitals who do, god help them, both understand and really, REALLY love money, and somehow use their purchaing power to reduce costs is to believe in, oh, the big rock candy mountain.
So far, no one has been able to explain to me why the ACA will work. Not why national health can't work. It does, in lots of countries around the world. But our system aborning. No idea why it will work at all. Kind of interested to see how BamBam deals with it now that it's his baby for four more.