Thought this was an interesting pic

[rufflesanddots]

The problem in a lot of states is that governors refused to expand Medicaid coverage. They were typically conservative states who were hell bent on seeing ACA fail. Like [MENTION=1049]poky[/MENTION], I am also uninsurable on my own. If I were self-employed I would be effed. When I was between school and and a job (pre-ACA) no one would cover me. It was terrible.

ACA has helped many get coverage, even if you don't know them personally. It is not perfect, but it is a step in the right direction.



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[PrincessFiona]

Thought this was an interesting pic

ACA has helped some people get coverage, and that is necessary. It should never have been an issue with a pre-existing condition. That being said, what has been the overall cost to everyone? There could have been a better way. I believe the ACA was not the right way to go about it, and no, I'm not a "republican hack". I simply believe based on my experience that the ACA has created more expensive and inconvenient care for a large number of people. I deal with people and insurance on a daily basis.

Our neighbor has a child with several disabilities. Their insurance has changed multiple times and the list of providers has changed as well. The child has a shunt problem that has required surgery twice. His new ACA plan didn't seem it medically necessary and refused to pay. The family appealed. They still refused. So now the family is in the process of deciding how to get medical care for their child.


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[Vanquisher]

It's really not the ACAs fault. Insurance was becoming more expensive and covering less for years. It wasn't an all of a sudden thing, but it is a convenient scapegoat. We have to have a national healthcare system. It's the only way.

[PrincessFiona]

Thought this was an interesting pic

A National Healthcare system will come. I've lived in two countries with this type of healthcare. I know a lot of the pitfalls. There will be much nashing of teeth by spoiled patients and overpaid physicians. But it will come. And legal reforms and free medical school will have to precede.

I want the option of purchasing my own private plan though just like in the NHS and Germany.

And things have gotten worse since the ACA.

Remember, I'm the commymommy.

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[Sheherezade]

I don't think you've been the commymommy for a long time! I'd love to dig up some of the healthcare debates you and Rapunzel had 10 years ago, but that was all lost when we switched to vBulletin.

What's happening with Insurance is odd and unpredictable. It does seem to vary by state and even circumstance. I work with two local government entities - small local government and a slightly larger school district (both under 150 employees) - and the school district is facing massive penalties this year due to the Cadillac plan tax, the other has seen double digit percentage decreases in insurance costs two years in a row. The insurance broker for the local government told me its a crap shoot, you can't predict what will be offered year to year. He keeps telling us to brace for an increase and we end up with a much better rate for the 50 employees each year. Saved over 100K for two years running now with almost identical coverage.

Meanwhile, the school is going to have to come up with 200k in tax/penalties due to the ACA regulations since they are apparently offering insurance that's too luxe. Of course, it's part of the teacher contract, so not negotiable to change this year. The teachers union here at least understands that it will have to be changed in the next round of negotiation. I guess this penalty/tax helps pay for the uninsured via ACA?

My point is it's very unpredictable. I think the insurance industry is still reacting and adjusting to the new system. I don't think rates will be stable for five years or so in that market, when they know better what's what.

Rob and I had drinks with friends here and their guest was involved in healthcare policy with the Obama administration. It was a very cool evening of discussion and the guy was absolutely interested in every complaint and issue anyone offered. He had all kinds of ideas and steps that need to happen next, etc. Since then we've seen him on a few news shows. We had no idea he was actually IMPORTANT. Hahaha. We should have sent more time connecting with him.

At least here, DHs hospital seems to be doing well with ACA. Many more paying patients that were previously uninsured making up for some of the required free preventative care. Now the quality measure, that's our current ACA whipping boy. They need work!


Angie

[PrincessFiona]

Actually, the commymommy didn't die. Im just not willing to pay more than what I currently do in taxes ... unless I personally benefit (like free college and healthcare for my kids).


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[Deebs]

Many, many, many in healthcare policy saw the ACA as a means to push an agenda for a national insurance system. It was designed to fail, and in many states (and it is different in each state, as it was designed to be), it is failing greatly. At the ED level, overcrowding increases, just as pretty much everyone in national leadership position at the American College of Emergency physicians said it would. Without getting rid of insurance companies or somehow only allowed those that are non-profit, insurance costs will continue to increase, execs for those companies will continue to make boatloads of money, and reimbursements will decrease. All the while, these execs will blame inefficiencies of the system and "rich" doctors for creating the problems. Unfortunately, there is no easy answer in a country our size with a low tax revenue.


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[PrincessFiona]

There is no easy answer, and a nationalized healthcare system isn't the easy answer either. I have lived it. I gave birth in two different national healthcare systems. I think that's where we're headed though. Prepare for physician salaries to be at and below 100k before higher taxes. Better push through torte reform and free med school first. And pay off your homes ASAP.


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[Deebs]

Even with free Med school, nationalized healthcare has been studied for decades in the US by brilliant scholars. In my experience (including spending several weeks in the UK and Canada to study those systems as part of my degree), none of those scholars can figure out how to make it work in the US. We now have people (mostly politicians) who "know better" than those who have dedicated their careers to finding better solutions. Maybe this is why healthcare and education are compared so frequently. I think they're the two fields most often dictated by those who know nothing about them.


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[SuzySunshine]

Why isn't this photo floating around fb?

I struggle with this argument because I don't truly understand how national healthcare would affect highly specialized specialists, like my DH. But I agree its an issue, my parents would like to retire, they can't afford to just because of the insurance. We also live in one of those great states who didn't expand because our crack-pot Republican governor won't take the money. Idiot!

[SoonerTexan]

While I have no doubt that many states, including my own, opted to not expand Medicaid partially as a hissy fit against the ACA, I really do wonder how states that are already struggling with their budgets are going to handle it when some of the bill starts to come to them in a few years. It wasn't "free" money forever.

[PrincessFiona]

Thought this was an interesting pic

Things have to change here Deb. What people don't understand is that under a national healthcare system there aren't private rooms and CT scans for every ache and pain. Nurses aren't high paid and nurses with lower-level qualifications run very busy units. They are often understaffed.

In Germany, I was literally in one large labor room laboring with other women and their husbands until I was moved to a bed. Rooms have 4 to 12 people in them. My hospital in Germany did not provide towels and told me they were not "a hotel". I was left alone laboring for more than 24 hours after a rupture of membranes. Busy midwives had no time and there were no doctors to be seen. After almost 48 hours of labor, dh actually went to a dr's lounge and demanded that someone see me. Andrew was in fetal distress and they had to perform an emergency c-section. How long was he in distress? Who knows. I was left alone and not monitored. That shit costs $.

Physicians are paid less. Substantially. Specialists too, Cheri, and there are less of them. (Obviously, because who does something like neurosurgery if you can't make bank, right?).

Hospitals are not redecorated every couple of years with marble floors, fireplaces, and comfy chairs. There is no money (and honestly, what a waste it really is). Most hospitals are old and don't get remodeled. Things get repaired, but the difference between the hospitals dh worked at in the uk and those here is staggering. That's not necessarily bad.

Recap:

1. Less nurses with lower qualifications who earn less money.
2. No more private rooms.
3. Lower physician salaries (but maybe you'll actually get that 6 weeks of vacation a year!)
4. Long waits for testing, services, and to see specialists unless you have additional private coverage. (My friend in N Ireland has a child with kidney damage because her GP refused to refer her child to s pediatrician to refer her to a nephrologist for 2 years. Same friend was told she had skin cancer and couldn't get an appt with a doctor for months. Also had a child with a severe speech problem and couldn't get him evaluated for a year. His preschool teachers and friends couldn't understand him. What did she do? She visited us and saw a dermatologist and speech therapist within the first week. Granted, we made the appointments for her, but her wait time was about 3 weeks).

Think about what Medicare and Medicaid currently pay out. Can you run a private practice/hospital on those low figures only? No. Quality, services, and salaries will have to decrease. There is no way around it. No neurosurgeon will make bank. No nurses will be self-supporting, and patients will wait for services. Is the US ready for that? Maybe we are. Just don't expect the same quality, service, and paycheck.




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[PrincessFiona]

Thought this was an interesting pic

That being said, I think access to basic healthcare is a human right.


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[Deebs]

I just don't think the US is ready. I don't know if it will ever happen, as our cultural expectations are very different. Look at US housing vs. UK. People here want everything large, shiny, new, and "the best." People Doctor shop, looking for the craziest things (definitely not the best care - much more pretty facilities).

Look at things like our use of helicopters in the US for medical transport, as an example. Places like Cleveland, where the helicopter crew has advanced capabilities from many community EDs are the exception, not the rule. In most places, we have helicopters that transport patients with no increased capabilities beyond an ambulance or outlying ED, yet they're used at a growing rate. Patient families love hearing "don't worry - we're flying him/her to another facility." The expense of this type of transport with no benefit to the patient is astounding, and yet, more are in the air every year.

In addition, hospitals that have long been safety nets are having huge problems with ACA. UT Southwestern in Texas no longer has any ACA plans accepted, unless something has recently changed. Those plans were reimbursing at rates lower than Medicaid and then were eventually cancelled.

http://healthcare.dmagazine.com/2015...wing-networks/

The same is happening nationwide.

All of this is why I won't go back into healthcare administration. It needs to be thinned out, go back to clinician led health systems, and be incredibly overhauled. With DH in medicine, it's enough of watching the sausage being made, I just can't go back. With everything I've said, I did tell DH last week that we're stupid. He should quit clinical medicine where he's shit on daily (often literally), take a high paying insurance company job, pay off his loans and retire. He's not going to, but sometimes the aggregations are just too much!


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[HouseofWool]

The corporatization of healthcare is a huge part of the issue, both from insurance companies and from hospital systems owned by monoliths.

I will say that being part of a physician owned system and working for the insurance subsidiary is interesting. Currently I handle a large number of the ACA claims.

I think it will take a good 5-10 years for the ACA to settle in. People are on it who put off healthcare for years and are extremely sick. I don't think you can look at the feasibility of the product until the overall health of the population has stabilized.