Our health care system is a mess IMO and also IMO obamacare makes it worse not better. Like I said it's just unfortunate we can't have an honest debate on this subject, on what we have now VS single payer. Man banded together in tribes for a lot of reasons but one of those reasons was so if you got sick or injured the tribe would take care of you and I don't think things should be that much different now. As usual the devil is in the details though.As someone who works in healthcare, I will say there is good and bad in the Affordable Healthcare Act. If you wanted to make the absolute minimum amount of changes to our healthcare system and get everyone access to insurance (note I did not say healthcare, I said insurance), then I suppose it is not the worst thing in the world. It does very, very little to address overall cost issues. It will likely make insurance for healthy people more expensive since it caps the cost of high risk patients' insurance. It caps profit/overhead margins for insurance companies which I think is a shortsighted idea. It sounds nice that they have to spend 80% on healthcare costs, but I think this'll be an incentive for them to spend more money so they can have larger nominal profits rather than keeping costs down. The healthcare exchanges are a good idea, but they should have just made a national system instead of allowing states to do their own thing. This'll create confusion. More confusion is a bad thing in an already confusing industry. Most of all, the main problems with our healthcare system are not addressed. That being we tie our health insurance to employment and that the administrative costs of our healthcare systems are far too high largely BECAUSE of the fact that we have 1000 insurance plans and companies whose rules we have to know and follow in addition to The Joint Commission, CMMC, DHEC, and the other regulatory bodies we have to contend with.
I think, if we are going to stay with the private insurance model, we should be incentivising companies to take what they are spending on healthcare costs and just give it back to their employees so they can get health insurance on their own. With more people in the health insurance market and companies competing to keep prices down, I think we would have better outcomes than people being tied to their employers plan which may or may not work for them. This also eliminates the need for people to worry about being left without health insurance or sudden expenses when they lose their job. They have a fixed expense they can anticipate and save for. Combine this with Medicaid for low income people, a progressively scaling subsidy for lowish income people, and the ubiquitous use of health care savings accounts that are tax advantaged and don't have to be spent in fiscal year, and I think we would have a decent system in place for insuring ACCESS adequately. Cost issues is another issue entirely.
A single payer healthcare system I think is ultimately likely outcome. If it was a perfect world, I would like to see a UHC system that had a progressively scaled deductible down to a very small or no deductible for low income patients. Co pays maybe too could scale progessively after the deductible is met and there would be a yearly maximum expenditure. Keep the tax advantaged HSAs around. This would help eliminate a lot of the unnecessary administrative costs of billing hundreds of different insurance plans, not being able to predict healthcare costs in advance to give patients accurate quotes, and unpredictability in income for the hospital itself. I think one of the reasons for cost increases in healthcare is a lack of transparency in billing due to it being completely unpredictable. How many times have you gone to a dentist or doctor and paid your copay only to receive another bill in 2 months for what the insurance didn't pay? A cost sharing component is necessary to curb abuse of healthcare resources and make people more inclined to look for competitive pricing. Cost sharing has increased dramatically over the last 4 years and it has directly lead to a slowdown in the growth of healthcare costs. Oh and the UHC would be completely paid for through a payroll tax and not run 30% budget deficits every year