ObamaCare ruined primary care medicine

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My union Healthcare is great.

My parents' Medicare is great.

You have poor health insurance because you have a cheap employer.

and this is exactly why health insurance should not be tied to employment.

I support comprehensive state backed health care coverage if the median American took care of themselves like the median Japanese, Singaporean, Italian, Spanish or Swiss person

Way too many Americans put themselves and their families in suboptimal health thru their own actions

? Have you ever been to Italy or Spain? They smoke and drink quite a bit.

i can speak about Italy - alcohol consumption in Italy per capita is lower than the us because hard liquor culture isn’t really there

Negronis, aperol spritz, grappa etc are not very strong.

Smoking is rife but food quality, walking, and chillaxing in the sun are way higher also

Americans consume about 20% more alcohol per capita than Italians

Italians have to walk way more because the country is small, roads are tiny, and their income isn't very high so they cannot afford to buy cars every few years. They chillax more but their GDP and economy is in the pits. Also, chillaxing in the sun can cause skin cancer.

ITA about food quality, though. Our government allows way too much hormones and pesticides in our food supply.

So, it's not so much as the Italians take care of themselves better, but that their culture and government doesn't allow them to have higher incomes and work a lot.

Oh, and they also have universal healthcare, and they don't ever have to worry about going bankrupt due to medical expenses. So, if they get sick, they can go see a doctor either free of charge or dirt cheap. We can't do that in the US. And we never will because the US is about greed and making money.

A young friend of mine is having specialized surgery. Her out of pocket medical costs, after insurance, is in excess of $25,000. The family is doing a GoFundMe. They have raised a bit over $6,000. Only developed country where one has to rely on the kindness of people to have life altering surgery.

[Anonymous]

I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

[Anonymous]

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

The ACA has succeeded on its cost savings promises. It didn't promise to bring down the cost. It promised to lower the rate at which costs were increasing, which it has.

Yes it was oversold but it has fulfiilled its promise
To be frank our entire system sucks because it is filled with middlemen taking a cut and the ACA didnt change that but rather ossified the system we already had. There are only two ways out: single payer or the elimination of employer based insurance. Eliminating the prohibition on medicare drug price negotiations and ending the state based regulatory system would help but isnt popular with the political donor class.

[Anonymous]

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

It is failing because the GOP undermines it at every turn and won't support the legislation that addresses the issues.

This is by design, so people like OP get angry and blame the left.

[Anonymous]

I had no idea people in DC were getting hustled into paying a $2k concierge fee for a primary care provider. That's pretty sad.

[Anonymous]

What is the argument for having employer-based insurance vs a transportable insurance system?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

The ACA has succeeded on its cost savings promises. It didn't promise to bring down the cost. It promised to lower the rate at which costs were increasing, which it has.

Yes it was oversold but it has fulfiilled its promise
To be frank our entire system sucks because it is filled with middlemen taking a cut and the ACA didnt change that but rather ossified the system we already had. There are only two ways out: single payer or the elimination of employer based insurance. Eliminating the prohibition on medicare drug price negotiations and ending the state based regulatory system would help but isnt popular with the political donor class.

This is revisionist BS. Obama and his champions in Congress clearly sold lower costs not just lower rate of growth.

https://www.nytimes.com/2008/07/23/us/23health.html

We were also promised better health outcomes and that hasn’t materialized, either.

The ACA, like every other progressive dream program was supposed to unleash real savings, better health outcomes and make our economy skyrocket (remember how entrepreneurs were now going to be freed from corporate slavery after the ACA passed?). As is always the case whether it is education, welfare, immigration or whatever other problem the left is convinced they can solve, rosy projections based on partisan studies led to badly flawed policies with shortcomings blamed on the GOP.

The harsh reality is that if you want lower health costs and better health outcomes, it has very little to do with the healthcare system. You simply need Americans to live healthier lifestyles. Diet and exercise would go a long way. I know, much easier said than done. Eventually progressives will get single payer and, right now, sight unseen, I’d be willing to bet everything I own that it will cost much more than predicted and fail to live up to its promises, with a decent chance of making things worse in the process. This is pretty much how it always goes.

As for OP, part of the problem is that the ACA incentivized consolidation of medical practices. The independent provider has all but been lost to history with a shockingly high percentage of primary care practices actually owned by private investment capital (PE firms). That is, without a doubt, the fault of the ACA.

Again, I love the optimism and failure to learn from history: the very employer based health insurance system we all loathe so much is a legacy of FDR and his intervention into wage markets. I’m sure government intervention this time will work as planned.

[Anonymous]

Anonymous wrote:What is the argument for having employer-based insurance vs a transportable insurance system?

Employers like having it as a perk. It makes labor mobility more difficult and allows extra non-taxed compensation for executives.

Politicians like it because it boosts the numbers of insured and both subsidizes and hides the costs.

Voters are afraid that what would replace it would be worse.

It would be a radical change and the free market solution however. It would also be easy to implement because all one would need to do is change its tax treatment from a business expense to indicidual income (with a corresponding individual tax deduction for health care).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

The ACA has succeeded on its cost savings promises. It didn't promise to bring down the cost. It promised to lower the rate at which costs were increasing, which it has.

Yes it was oversold but it has fulfiilled its promise
To be frank our entire system sucks because it is filled with middlemen taking a cut and the ACA didnt change that but rather ossified the system we already had. There are only two ways out: single payer or the elimination of employer based insurance. Eliminating the prohibition on medicare drug price negotiations and ending the state based regulatory system would help but isnt popular with the political donor class.

This is revisionist BS. Obama and his champions in Congress clearly sold lower costs not just lower rate of growth.

Republicans didn't let him do half of what he promised. Not his fault. He got compromise legislation. And the proof of the deal is that Republicans never once put up something better. As of this year they finally shut up and abandoned the repeal of Obamacare.

What he did mattered to many millions of Americans. It is more affordable for the poor and for working people who did not benefit from company health plans, such as independent contractors and small businesses.

Whether it is cheaper for you specifically, I don't know. But we all benefited from the elimination of the preexisting condition problem. I know people who were stuck in their jobs because of a sick kid or spouse, who suddenly became free to pursue better options.

You want a better plan? Get Republicans to put something down on paper that is actually an improvement.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:it was already going that way. the ACA simply provided a safety net particularly for people with pre-existing conditions who were rejected or exempted coverage in the prior version of health insurance

what we need is single payer/universal- our healthcare system has been horrible since the deregulation of the Reagan era

It doesn’t matter when people with pre-existing conditions have insurance, but now no doctors are out there who take insurance and want a $2000 per year membership club fee and cash payments for services. Right back to square 1 again, now access is impossible for all. Primary care in this region sucks so much a$$. Tons and tons of pcp are now concierge and charge ridiculous membership fees, or they’re impossible to access anyway even if you wanted to join because they take less patients.

ACA ruined primary care, so the solution is to double down with more govt medicine? Insane.

What you are complaining about was already happening. The ACA didn't create nor compound it.

The hell it didn’t. ACA made everything worse with onerous levels of paperwork, requirements/rules, and sh!tty reimbursement.

BS. It’s been that way for decades. I work in healthcare and I know firsthand.

ACA made it 10x worse. If you actually worked in healthcare you’d know this.

cry me a river. pcp w/ mds make $200k+ a year. i think we should force them to take aca patients.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

The ACA has succeeded on its cost savings promises. It didn't promise to bring down the cost. It promised to lower the rate at which costs were increasing, which it has.

Yes it was oversold but it has fulfiilled its promise
To be frank our entire system sucks because it is filled with middlemen taking a cut and the ACA didnt change that but rather ossified the system we already had. There are only two ways out: single payer or the elimination of employer based insurance. Eliminating the prohibition on medicare drug price negotiations and ending the state based regulatory system would help but isnt popular with the political donor class.

This is revisionist BS. Obama and his champions in Congress clearly sold lower costs not just lower rate of growth.

https://www.nytimes.com/2008/07/23/us/23health.html

We were also promised better health outcomes and that hasn’t materialized, either.

The ACA, like every other progressive dream program was supposed to unleash real savings, better health outcomes and make our economy skyrocket (remember how entrepreneurs were now going to be freed from corporate slavery after the ACA passed?). As is always the case whether it is education, welfare, immigration or whatever other problem the left is convinced they can solve, rosy projections based on partisan studies led to badly flawed policies with shortcomings blamed on the GOP.

The harsh reality is that if you want lower health costs and better health outcomes, it has very little to do with the healthcare system. You simply need Americans to live healthier lifestyles. Diet and exercise would go a long way. I know, much easier said than done. Eventually progressives will get single payer and, right now, sight unseen, I’d be willing to bet everything I own that it will cost much more than predicted and fail to live up to its promises, with a decent chance of making things worse in the process. This is pretty much how it always goes.

As for OP, part of the problem is that the ACA incentivized consolidation of medical practices. The independent provider has all but been lost to history with a shockingly high percentage of primary care practices actually owned by private investment capital (PE firms). That is, without a doubt, the fault of the ACA.

Again, I love the optimism and failure to learn from history: the very employer based health insurance system we all loathe so much is a legacy of FDR and his intervention into wage markets. I’m sure government intervention this time will work as planned.

Good! Get these greedy doctors under control. Dance monkeys, dance!

[Anonymous]

Anonymous wrote:

The harsh reality is that if you want lower health costs and better health outcomes, it has very little to do with the healthcare system. You simply need Americans to live healthier lifestyles. Diet and exercise would go a long way. I know, much easier said than done. Eventually progressives will get single payer and, right now, sight unseen, I’d be willing to bet everything I own that it will cost much more than predicted and fail to live up to its promises, with a decent chance of making things worse in the process. This is pretty much how it always goes.

The actual truth is that our for profit medical system is the primary reason we have such unhealthy people, and the “unrelated” reasons are all much of a muchness. Have a weird symptom you know should probably be checked out? Can’t; you know you can’t afford the doctor’s appointment and associated tests and, even if you could swing those, you couldn’t afford the treatment.

Yes our food supply is one of the world’s worst in terms of anything growers and manufacturers want to put in is allowed - profits over all! No, employers hardly ever have to allow sick days and our sick “grindset” culture has even contagiously sick people going into the office.

Your sick little post wants to put the blame where it doesn’t belong.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

The ACA has succeeded on its cost savings promises. It didn't promise to bring down the cost. It promised to lower the rate at which costs were increasing, which it has.

Yes it was oversold but it has fulfiilled its promise
To be frank our entire system sucks because it is filled with middlemen taking a cut and the ACA didnt change that but rather ossified the system we already had. There are only two ways out: single payer or the elimination of employer based insurance. Eliminating the prohibition on medicare drug price negotiations and ending the state based regulatory system would help but isnt popular with the political donor class.

This is revisionist BS. Obama and his champions in Congress clearly sold lower costs not just lower rate of growth.

Republicans didn't let him do half of what he promised. Not his fault. He got compromise legislation. And the proof of the deal is that Republicans never once put up something better. As of this year they finally shut up and abandoned the repeal of Obamacare.

What he did mattered to many millions of Americans. It is more affordable for the poor and for working people who did not benefit from company health plans, such as independent contractors and small businesses.

Whether it is cheaper for you specifically, I don't know. But we all benefited from the elimination of the preexisting condition problem. I know people who were stuck in their jobs because of a sick kid or spouse, who suddenly became free to pursue better options.

You want a better plan? Get Republicans to put something down on paper that is actually an improvement.

This is complete revisionist garbage. There was NOT A SINGLE GOP vote for the ACA in either chamber of Congress. It is political gaslighting to suggest the ACA’s flaws and failures are due to Obama compromising with or being limited by Republicans when Republicans didn’t even provide a single vote for its passage.

If I recall correctly, Obama’s real compromise on the ACA was with the Democrat senators from Louisiana and Nebraska. Democrats had the votes to pass whatever form of the ACA they wanted to, but they knew that (a) real reform would lead to a slaughter in the 2010 midterms, (b) real reform would imperil a second Obama term and (c) people like you would let them get away with blaming those darned Republicans who always ruin everything. So instead of passing real reform with the once-in-75-years political power they had, democrats took the easy way out and declared victory.

We were promised real savings, better health outcomes and a skyrocketing economy. None of that came true all while costs continued to march upward on a marginally less steep trajectory.

The preexisting conditions changes is a bright spot in the ACA.

The real lesson here is that—at least the third way generation Democrats—the leaders in Congress deep down knew that single payer or some variation of it will be a total mess and they don’t want to pass it. Single payer is to Democrat politicians what abortion is to Republicans. Great on the campaign trail but if you ever actually get what the party base wants the political blowback is going to be ferocious.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

The harsh reality is that if you want lower health costs and better health outcomes, it has very little to do with the healthcare system. You simply need Americans to live healthier lifestyles. Diet and exercise would go a long way. I know, much easier said than done. Eventually progressives will get single payer and, right now, sight unseen, I’d be willing to bet everything I own that it will cost much more than predicted and fail to live up to its promises, with a decent chance of making things worse in the process. This is pretty much how it always goes.

The actual truth is that our for profit medical system is the primary reason we have such unhealthy people, and the “unrelated” reasons are all much of a muchness. Have a weird symptom you know should probably be checked out? Can’t; you know you can’t afford the doctor’s appointment and associated tests and, even if you could swing those, you couldn’t afford the treatment.

Yes our food supply is one of the world’s worst in terms of anything growers and manufacturers want to put in is allowed - profits over all! No, employers hardly ever have to allow sick days and our sick “grindset” culture has even contagiously sick people going into the office.

Your sick little post wants to put the blame where it doesn’t belong.

No. You’re simply wrong. The outsized cost isn’t driven by weird symptoms and failure of preventative care. The stats really are insane. In the 1960s the obesity rate in this country was less than 5% and today it is 40%. We spend something like $1500 extra per year per American in healthcare due to obesity in this country.

True story: do you ever wonder why menus for chain restaurants (whether sit down or fast food) now include calories on the menu? Because “studies” suggested that the one weird trick of labeling calories on menus would lead to people making healthier choices. So, the ACA mandated that restaurant chains with more than a certain number of locations had to include calorie counts on their menus. The projected reduction in obesity due to these menu labels was supposed to lead to material healthcare savings that were included in the CBO scoring of the ACA. Have we seen any decrease in the obesity rate since 2018 when the FDA finally fully implanted the menu calorie count requirement of the ACA?

I don’t know whether to laugh or cry at the absurdity of all of this. Anybody that thinks government actually has the ability to solve this problem is delusional.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have to admire the optimism. ACA completely failed on its promises of cost savings and better outcomes. Instead of learning from that, people just want to double down and make believe that single payer will fix things.

Hint: the problem isn’t the payment system.

The ACA has succeeded on its cost savings promises. It didn't promise to bring down the cost. It promised to lower the rate at which costs were increasing, which it has.

Yes it was oversold but it has fulfiilled its promise
To be frank our entire system sucks because it is filled with middlemen taking a cut and the ACA didnt change that but rather ossified the system we already had. There are only two ways out: single payer or the elimination of employer based insurance. Eliminating the prohibition on medicare drug price negotiations and ending the state based regulatory system would help but isnt popular with the political donor class.

This is revisionist BS. Obama and his champions in Congress clearly sold lower costs not just lower rate of growth.

Republicans didn't let him do half of what he promised. Not his fault. He got compromise legislation. And the proof of the deal is that Republicans never once put up something better. As of this year they finally shut up and abandoned the repeal of Obamacare.

What he did mattered to many millions of Americans. It is more affordable for the poor and for working people who did not benefit from company health plans, such as independent contractors and small businesses.

Whether it is cheaper for you specifically, I don't know. But we all benefited from the elimination of the preexisting condition problem. I know people who were stuck in their jobs because of a sick kid or spouse, who suddenly became free to pursue better options.

You want a better plan? Get Republicans to put something down on paper that is actually an improvement.

This is complete revisionist garbage. There was NOT A SINGLE GOP vote for the ACA in either chamber of Congress. It is political gaslighting to suggest the ACA’s flaws and failures are due to Obama compromising with or being limited by Republicans when Republicans didn’t even provide a single vote for its passage.

If I recall correctly, Obama’s real compromise on the ACA was with the Democrat senators from Louisiana and Nebraska. Democrats had the votes to pass whatever form of the ACA they wanted to, but they knew that (a) real reform would lead to a slaughter in the 2010 midterms, (b) real reform would imperil a second Obama term and (c) people like you would let them get away with blaming those darned Republicans who always ruin everything. So instead of passing real reform with the once-in-75-years political power they had, democrats took the easy way out and declared victory.

We were promised real savings, better health outcomes and a skyrocketing economy. None of that came true all while costs continued to march upward on a marginally less steep trajectory.

The preexisting conditions changes is a bright spot in the ACA.

The real lesson here is that—at least the third way generation Democrats—the leaders in Congress deep down knew that single payer or some variation of it will be a total mess and they don’t want to pass it. Single payer is to Democrat politicians what abortion is to Republicans. Great on the campaign trail but if you ever actually get what the party base wants the political blowback is going to be ferocious.

We did indeed have a skyrocketing economy, alrhough I don't think that had anything to do with Obamacare.

The ACA itself was indeed a copy of the Heritage Foundation/Romneycare plan. They also did indeed precompromise with Republicans and Phrma. That is how we got pharmacy benefit managers instead of medicare negotiating drug prices.

They were also indeed talking about reducing the growth curve rather than net savings. It was very annoying at the time for those of us paying attention because as you imply it was mealymouth bs wordsmithing.