(12-20-2017 03:22 PM)bullet Wrote: Its pretty ignorant of what happens in the real world. There are public health clinics in all the major metro areas. There are public hospitals in all the major metro areas. Obamacare made access worse in rural areas since not everyone takes medicare/Medicaid and its expansion caused problems for the people trying to get into those doctors and facilities.
Obamacare didn't even attack the right problem. Health insurance was not the problem. Access and affordability were the problems. It froze in place the items driving up costs and subsidized insurance companies.
Were you talking to me? I essentially said the same thing, talking about 'supply'. I work in rural healthcare.
(12-20-2017 03:44 PM)Fitbud Wrote: Quote:Just because they don't have insurance doesn't mean they won't get check-ups.
Sure some people will but most won't.
Your comment was about 'who would pay their costs'. Most of the people you're talking about would be having 'the taxpayer' pay the bulk of their premiums (since the IM is a tax on health, not wealth). You can't have it both ways.
Generally speaking, the people who earn too much to have the taxpayers subsidize their insurance would have the $300/yr to pay out of pocket for preventative primary care. If you want to make those check-ups mandatory, fine... so long as we have enough providers to deliver them.
Quote:Quote:Since 'preventable check-ups' cost around $300/yr and the individual mandate costs more like $2000/yr... Many people can afford $300/yr, but not $2,000. If you're talking about people with subsidized insurance, then the taxpayers are paying for that anyway. The overwhelming number of people (still) go to the ER for primary care because they can't get in to see their PCP because the ACA failed to start with 'supply'... so the taxpayers are on the hook for that anyway.
$2000 a year? I don't know about that. I have a friend who pays the penalty and it's only like $80. Yes, subsidized health insurance get paid by tax payers anyway but the value in having a health tax paying citizen is better than paying the bills on some cancer patient that ends up dying. How much do we as a country lose when a recent graduate of college dies because they couldn't afford health insurance? Hundreds? Thousands? Millions?
Subsidizing people's insurance is a good investment. Surely you can see that.
What I meant by the individual mandate was the cost of a policy that meets the requirements of the mandate.
The individual mandate penalty isn't remotely $80. For 2017, its $695 per adult and $347.50 per child under 18 with a family max of $2,085 OR 2.5% of household income up to the total premium of a bronze plan... WHICHEVER IS HIGHER.... meaning it's NEVER less than $695 per adult. Maybe you mean $80 per month? But again, that's not what I was speaking of. I was speaking of the cost of compliance (and thus the cost of getting the care we're talking about).
As to subsidizing people's healthcare being a good investment, that's far too broad a comment. No, I don't think that subsidizing the people I see every day in my ER who do drugs all day long or otherwise abuse their bodies... refuse treatment for the addiction or abuse and simply want us to treat the symptoms so that they can go back out and abuse their bodies some more is a good investment... In fact its a HORRIBLE one... as these people often engage in behaviors that endanger others, including but not limited to their children.....
which is specifically why I suggested this.....
Quote:Quote:I'd support paying for people who are victims of genetic lottery.... but I don't support paying for people who engage in risky behavior and then demand treatment.
But that's just it. You do anyway when they don't have insurance and they end up in the ER.
First, all the ER is required to do is treat the emergent event within their legal limits. That's all. You're not guaranteed specialty services.
Second, I never said I'd provide universal care 'without regard to ability to pay', did I? In fact, that's specifically what I'd change.
If the government is offering universal healthcare for everything except intentional acts (trying to shorten my preference into few words) then i expect hospitals to offer that emergency care as they do today. Lifelong smoker comes in with ARF, he gets O2 and is offered outpatient cessation treatment and sent home.
Obviously I'm being draconian there and there would have to be a period of transition where say we kept things 'as is' for the next 2 years with a focus on smoking cessation, in fact we'd probably have to do 2-3 major contributors every few years and it could take 10 years to get to where I'm talking about being.... but I think I'm being clear.
Otherwise, why would you ever quit smoking or over-eating? Quitting smoking and losing 100 pounds is hard. Sure, you'll die sooner, but everyone already knows that and they still smoke. We're making them MORE comfortable in the interim and I don't think we should do that. I'd love to make them LESS comfortable to force them to quit, but I'd be okay with just making them bear the costs of their unwillingness to quit.