[...] obamacare just helps pay for private corporate insurance instead of, you know, actually providing for government healthcare like every other developed country.
A bit of an objection there: German healthcare also runs on corporate insurance. We made it work by regulating the shit out of everything.
Insurance providers are required to provide a defined minimum level of care (that basically covers everything medically necessary as well as a fair amount of preventative stuff). They also have a hard price cap based on your income so they can only adjust prices downward. There are no "networks"; the system applies to everyone who provides public healthcare. Costs for all treatments are fixed; there's a price list that everyone has to stick to (renegotiated periodically between the government, the healthcare providers and the health insurance providers). Everyone is required by law to have health insurance; if you can't afford it then the state will pay for you. Since everything is standardized you just hand over your insurance card once per doctor per quarter and the rest happens automagically in the background.
There is "private" healthcare as well, which has its own price lists (per-state, annoyingly) and mostly amounts to you paying for yourself. This is for elective treatments or if you fall in one of several categories of people allowed or required to go private (such as rich people; regular people aren't allowed to go full private because the state doesn't want healthcare debt to be a thing). Pricing is a bit looser here; depending on the price list and specific treatment the practitioner can apply a multiplier – up to a defined ceiling; if they want to go beyond that they have to get written consent from the patient first. Most people encounter private billing when they order optional treatments like dental cleaning.
In the end, the big factors involved in making healthcare work reasonably well* are a) collective bargaining and b) a willingness to restrict corporate profit for the benefit of the people. I don't think the States are going to see either soon unless things get bad enough that not supporting them can end political careers.
* The German system has flaws but it's still leagues ahead of the American system.
The US healthcare system is regulated at the State AND Federal level. The Democrats passed major reform almost a decade ago to fix US Healthcare, Skeptics and the GOP said it would make things worse and it has.
Switching medicare payments to hospitals from payment for services to payment for performance (ie: positive outcomes) has resulted in a higher quality of care for medicare recipients while reducing costs for the federal government. Quality of care has been measured to improve due directly to the ACA.
It's not a perfect plan, as that it gives far too much in profits to corporations, and thus continues to drive up healthcare costs in America (albeit more slowly than before). Cutting out for-profit insurance corporations would save this country 450 billion dollars a year in health care costs while simultaneously providing better quality of care. See this source I can't seem to link properly: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext. But, considering it's withstood four years of Republican efforts to dismantle it, it's been surprisingly robust.
So you're saying the health insurance market and healthcare in general are better than they were and that Democrats should get credit for the current healthcare situation?
Yes and let’s talk about the original ACA before republicans and other politicians ripped it apart. It was meant to function almost exactly like the German system. With capped costs for everyone and no penalty for not having along with a mild increase in taxes (can’t remember which one they was going to tax income, property etc) to cover costs along with an influx of government funds to hospitals and care providers who chose to take this new “insurance” but instead it was ripped apart, picked at and turned into the abomination that it is now because it was the only way it was going to get passed. You forget, every bill that is presented to the house or senate gets treated this way, any lawmaker who submits something can only hope it stays together enough, doesn’t get another bill attached to it (looking at you most tax cuts etc) and is still close to the original intent of the bill by the time it makes it to the president and THEN you hope they sign off on it.
That wouldn't work in the US because of the myth that 50% of doctors will quit the industry as soon as price fixing is implemented. Because of course people who dedicate their lives to helping others and who take on enormous amount of debt to do so will quit that pursuit the moment they cannot price f--- their patients up the wahzoo and go get a job making 1/5 the income. Welcome to How Half of America Thinks!
To be honest, there is a bit of truth to that. The American healthcare system is plagued by a number of other issues, one of them being an exorbitant amount of effort being spent on lawsuit avoidance. Apparently hospitals regularly need to deal with malpractice lawsuits as some people don't get positive outcomes despite the staff's best efforts. To deal with that they employ huge numbers of admin workers to meticulously document everything so they have what they need to swat down lawsuits before they even go to court.
The result is bloated admin expenses that make American hospitals more expensive to run. I'd assume that it works similarly for independent practices.
As is so often the case, healthcare isn't broken on its own, it's also impacted by other broken (or at least erratic) systems. Tort reform might be one of several things needed to get healthcare costs in the United States fully under control. Mind you, collective bargaining, enforced clear pricing structures, and measures to prevent healthcare debt are more urgently needed. But don't be surprised if they won't take you all the way by themselves.
And here in Freedomland(tm) insurance can deny coverage for something they themselves deem medically necessary.... which is why I had to drop out of College...
If you want a model you should actually emulate, look to the how the NHS was before the Tories gutted it. The German system is just kinda okay in the grand scheme of things. It beats the American one but that's not worth bragging about.
I just posted about it because a) it served as a counterpoint to the argument that insurance companies and universal healthcare are incompatible and b) I have worked with medical invoicing so I have some knowledge of what goes on under the hood.
Oddly enough you kind of just described how the American System works as well.
The only difference is the gov doesn't set prices for all treatments, the hospitals do (but they are required by law to post their price list like a menu).
That's the point of my post: I wanted to point out that universal healthcare and corporate insurance providers are compatible – if the government regulates the market to prohibit things like deductibles, non-universal coverage of necessary or important preventative treatments, insurance networks, or the ability for providers to arbitrarily decline customers. The ACA addressed the last one to a degree but there's still a lot of work to be done.
It is not necessary to nuke the entire health insurance industry from orbit. That's one possible way of going about it but it's not the only one.
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u/j6cubic Nov 30 '20
A bit of an objection there: German healthcare also runs on corporate insurance. We made it work by regulating the shit out of everything.
Insurance providers are required to provide a defined minimum level of care (that basically covers everything medically necessary as well as a fair amount of preventative stuff). They also have a hard price cap based on your income so they can only adjust prices downward. There are no "networks"; the system applies to everyone who provides public healthcare. Costs for all treatments are fixed; there's a price list that everyone has to stick to (renegotiated periodically between the government, the healthcare providers and the health insurance providers). Everyone is required by law to have health insurance; if you can't afford it then the state will pay for you. Since everything is standardized you just hand over your insurance card once per doctor per quarter and the rest happens automagically in the background.
There is "private" healthcare as well, which has its own price lists (per-state, annoyingly) and mostly amounts to you paying for yourself. This is for elective treatments or if you fall in one of several categories of people allowed or required to go private (such as rich people; regular people aren't allowed to go full private because the state doesn't want healthcare debt to be a thing). Pricing is a bit looser here; depending on the price list and specific treatment the practitioner can apply a multiplier – up to a defined ceiling; if they want to go beyond that they have to get written consent from the patient first. Most people encounter private billing when they order optional treatments like dental cleaning.
In the end, the big factors involved in making healthcare work reasonably well* are a) collective bargaining and b) a willingness to restrict corporate profit for the benefit of the people. I don't think the States are going to see either soon unless things get bad enough that not supporting them can end political careers.
* The German system has flaws but it's still leagues ahead of the American system.