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ACA, rising healthcare costs, and shortage of doctors

teamosil said:
Companies with more than 50 full time employees, that aren't eligible for exemptions, should have no problem at all offering health insurance.
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This answers none of my questions.

teamosil said:
but at least the ACA puts some upper limits on how fast it can raise.
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Can you cite or explain how it does this?
 
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Neomalthusian said:
Well if Morocco and Cuba can do it!!!

Underlying the feasibility of entitling the entire population to something is what the thing they're entitling actually costs there. Here a lot of it costs more than double what the next-most-expensive health care in the world costs. So obviously your comparison to these other countries ignores the differences in the cost of the medical.
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Well, Cuba is ranked just 2 slots below us for quality of care and Morocco is 8 slots ahead of us for quality. So any talk about somehow the American medical providers just aren't capable of doing it just doesn't cut it. They spend 1/3 to 1/2 as much as we do per person and get roughly the same quality. France spends 1/2 what we do and gets radically better quality care. I'm not prepared to just give up and let these corporations off with "waaa, but we make more profit by overcharging 80% of the people than we do by providing care at an honest price to 100% of the people".

Neomalthusian said:
Everyone getting 90% could very well be ten times as expensive as some getting 100% and some getting 10%. It's as though money is infinite in your book.
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No, you don't get what I am saying. Take however much you want to spend. I would rather it be divided equally and nobody is totally screwed.

Neomalthusian said:
Whether it's a need or luxury is irrelevant, because both cost money. And our collective need for our medical care costs more than we have. How do you reconcile that? You can't just go around looting people's bank accounts to pay for whatever "sounds better in your book." The astronomical costs of the underlying medical services have to be reined in somehow. PPACA makes this problem worse.
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No, it doesn't cost more than we have. Again, see Morocco and Cuba and pretty much every first world country for proof.

Look, capitalism is great. It really is. It is an amazing and easy to implement solution to many, maybe even most, of life's problems. But, it has an element of randomness. People win and lose partly based on what effort they put in, but partly based on luck as well. It is true that if we gamble in the capitalist game, on average, we win more than we lose, so it is worth doing. But we don't need to gamble every last thing we have. We don't need to be throwing people's health out on the table and hoping the ball stops on an even number. Everything in moderation.
 
teamosil said:
Well, Cuba is ranked just 2 slots below us for quality of care and Morocco is 8 slots ahead of us for quality. So any talk about somehow the American medical providers just aren't capable of doing it just doesn't cut it. They spend 1/3 to 1/2 as much as we do per person and get roughly the same quality. France spends 1/2 what we do and gets radically better quality care. I'm not prepared to just give up and let these corporations off with "waaa, but we make more profit by overcharging 80% of the people than we do by providing care at an honest price to 100% of the people".
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Quality comparisons have nothing to do with it. It's the cost. If our medical care is off the charts in cost, that needs to be addressed. You don't address cost by simply letting more people incur them.

No, it doesn't cost more than we have. Again, see Morocco and Cuba and pretty much every first world country for proof.
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What Cuba's or Morocco's health care entitlement costs them demonstrates nothing about whether we can afford to entitle our population to our care, because the cost of the actual care in those countries differs greatly, right?
 
Neomalthusian said:
Can you cite or explain how it does this?
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Any premium increase over 10% the insurance company needs to present their case for why it is justified and the states and HHS have the authority to reject their reason and then they can't raise it more than 10%. They've already rejected a bunch.
 
Neomalthusian said:
Quality comparisons have nothing to do with it. It's the cost. If our medical care is off the charts in cost, that needs to be addressed. You don't address cost by simply letting more people incur them.
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You aren't following what I am saying. The health industry in Morocco charges much less than they do in the US. That is the cost. They need to do a better job. Personally I wish very badly that the tea party didn't kill off the public option. That's the only thing that will put pressure on the health care industry to do a better job. But, the tea party managed to make that so politically toxic that we couldn't get enough votes to get it through, so we had to postpone that part. The way I see our situation right now is that the health care companies are on probation. If they don't get their act together ASAP, we're going to enact a public option and they will be forced to do better or lose their customers to the public option.

Neomalthusian said:
What Cuba's or Morocco's health care entitlement costs them demonstrates nothing about whether we can afford to entitle our population to our care, because the cost of the actual care in those countries differs greatly, right?
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Somehow we're just two ships passing in the night on this one... The cost is what I am talking about. The health care industry here is doing a terrible job of keeping costs reasonable. In Cuba and Morocco and the rest of the first world, they are doing much, much, much, better. I know we can do much better because all those other counties already have.
 
teamosil said:
You aren't following what I am saying. The health industry in Morocco charges much less than they do in the US. That is the cost. They need to do a better job. Personally I wish very badly that the tea party didn't kill off the public option. That's the only thing that will put pressure on the health care industry to do a better job. But, the tea party managed to make that so politically toxic that we couldn't get enough votes to get it through, so we had to postpone that part. The way I see our situation right now is that the health care companies are on probation. If they don't get their act together ASAP, we're going to enact a public option and they will be forced to do better or lose their customers to the public option.



Somehow we're just two ships passing in the night on this one... The cost is what I am talking about. The health care industry here is doing a terrible job of keeping costs reasonable. In Cuba and Morocco and the rest of the first world, they are doing much, much, much, better. I know we can do much better because all those other counties already have.
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You still have not shown ANY evidence to backup your claim that PPACA reduces the deficit as YOU CLAIMED, even the CBO has increased its estimated cost three times so far. I have posted several links showing PPACA has INCREASED costs for medical care insurance.
 
Neomalthusian said:
They exist, but I highly doubt in sufficient enough numbers to result in enough extra cash to entitle everyone to health insurance. That's the only money not in the game, right? The people who HAVE money but voluntarily CHOOSE not to use it to buy insurance. But I repeat, no one is suddenly "paying for" their health care due to PPACA, and no one can "afford their health care" due to PPACA. That is disingenuous. PPACA just entitles more people to an outcome and doesn't address the underlying problem, which has always been that the care itself is priced too high.
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We should have the numbers. Both of us. But, if you can afford, and having been paying, and now are, that is suddenly paying.

Not in the overall sense. Prices go up for all of us the more people have access but don't pay. How do I know? Because it's already been this way, and prices have continually gone up.
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You don't make much sense here. It goes up because they get access with NO PAYERS. They just show and get care. Since they don't have insurance and the government doesn't cover them, cost goes up to pay for it. Surely you can see a distonction here.



Using what standard of measurement? How can you not believe that's the case? It's no contest.

Medicare funding runs short by 2024, trustees say
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A couple fo different things here, but let's deal with your's first:

According to the Congressional Research Service, the Medicare trustees have predicted the program would become insolvent almost every year since they started issuing reports in 1970.

In one section of the report Richard Foster, who is the independent actuary for the Centers for Medicare and Medicaid Services, sounded a warning on the 2010 health reform law, his third such warning in three years.

“While the Affordable Care Act makes important changes to the Medicare program and substantially improves its financial outlook, there is a strong likelihood that certain of these changes will not be viable in the long range,” Foster wrote in the report. “Without unprecedented changes in health care delivery systems and payment mechanisms, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services.”

(snip)

The report notes that its primary analysis depends on some unrealistic expectations. It assumes that Congress will not override a physician payment formula that would mean dramatic pay cuts for doctors. It also assumes that the 2010 health care reform law's provisions will work as planned and without changes from Congress.

No Change in Medicare Solvency Date, Trustees Say - Meghan McCarthy and Margot Sanger-Katz - NationalJournal.com

So you're skipping a few cavots there.

Now to what I said:

The Medicare program continues to do better than private coverage for working-age adults when it comes to fulfilling the main purposes of health insurance—providing access to care and adequate financial protection from burdensome medical bills, according to Commonwealth Fund research published July 18 in the health policy journal Health Affairs. The study also found that elderly beneficiaries who opted for private Medicare Advantage coverage over traditional Medicare plans were significantly more likely to experience problems accessing care and to give their plan a fair or poor rating.

Medicare Works Continues to Outperform Private Insurance - The Commonwealth Fund
 
ttwtt78640 said:
You still have not shown ANY evidence to backup your claim that PPACA reduces the deficit as YOU CLAIMED, even the CBO has increased its estimated cost three times so far. I have posted several links showing PPACA has INCREASED costs for medical care insurance.
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I assumed you just knew that. It has been posted like 1,000 times here over the last 2 years and has been discussed on the news pretty much every day for 2 years. The CBO just did yet another update of their estimate and again found that it reduces the deficit- http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf

The confusion over whether or not it reduces the deficit was just a right wing hoax. A Republican Representative asked the CBO for an estimate of the impact of three different pieces of legislation combined on the deficit and they said that together they would raise the deficit, but the ACA lowered it and the other two would have raised it... Nonetheless, he released that and claimed that the CBO rescinded their claim that the ACA would reduce the deficit and Limbaughs and whatnot spread the hoax. The CBO has actually always said that it will lower the deficit.
 
teamosil said:
I assumed you just knew that. It has been posted like 1,000 times here over the last 2 years and has been discussed on the news pretty much every day for 2 years. The CBO just did yet another update of their estimate and again found that it reduces the deficit- http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf

The confusion over whether or not it reduces the deficit was just a right wing hoax. A Republican Representative asked the CBO for an estimate of the impact of three different pieces of legislation combined on the deficit and they said that together they would raise the deficit, but the ACA lowered it and the other two would have raised it... Nonetheless, he released that and claimed that the CBO rescinded their claim that the ACA would reduce the deficit and Limbaughs and whatnot spread the hoax. The CBO has actually always said that it will lower the deficit.
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There is NOTHING in your entire long winded attachment that indicates ANY savings. Quotes taken from YOUR link:

CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of $1,168 billion over the 2012–2022 period
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According to CBO and JCT’s updated estimates, the subsidies to be provided through the insurance exchanges over the 2012–2022 period are $210 billion higher than the previous estimates—$178 billion more in projected tax credits for health insurance premiums and $31 billion more in projected cost-sharing subsidies and related spending.21 As a result of the reduced availability of Medicaid, a significant number of people with income between 100 percent and 138 percent of the FPL are expected to be eligible for and to obtain insurance offered through the exchanges.
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ttwtt78640 said:
There is NOTHING in your entire long winded attachment that indicates ANY savings. Quotes taken from YOUR link:
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The sentence immediately after the first one you quoted is "Those figures do not include the budgetary impact of other provisions of the ACA, which in the aggregate reduce budget deficits." Like 2/3 of the document is detailing why and how it will reduce the deficit...

If the CBO's actual statement is too long and confusing, which admittedly, it is both, here is a nice summary of that finding- http://www.tnr.com/blog/plank/105327/cbo-obamacare-deficit-medicaid-expansion-cost-revenue-exchange
 
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teamosil said:
The sentence immediately after the first one you quoted is "Those figures do not include the budgetary impact of other provisions of the ACA, which in the aggregate reduce budget deficits." Like 2/3 of the document is detailing why and how it will reduce the deficit...

If the CBO's actual statement is too long and confusing, which admittedly, it is both, here is a nice summary of that finding- Updated CBO Estimate Of Affordable Care Act Still Says It Will Help Many Millions And Reduce The Deficit. But Fewer Will Get Coverage If States Opt Out Of Medicaid Expansion. | The New Republic
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OK, more smoke and mirrors, since that statement is then footnoted with this cryptic nonsense:

4 See the statement of Douglas W. Elmendorf, Director, Congressional Budget Office, before the Subcommittee on Health, House Committee on Energy and Commerce, CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010 (March 30, 2011). For the provisions of the ACA unrelated to insurance coverage, most of which involve ongoing programs or revenue streams, separating the portion of projected spending for those programs or revenue streams that is attributable to the ACA from the portion that would have existed under prior law is very difficult.
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The "statement" only says stuff about unspecified vodoo "projected" savings from Medicare, yet offers NO detail at all. Follow the embedded link and it is simply charts with NO explanation at all.
 
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ttwtt78640 said:
OK, more smoke and mirrors, since that statement is then footnoted with this cryptic nonsense:
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Yeah, it is very difficult to predict. But the CBO are the best there is at doing it, so, that's the best guess we have to go on- that it will reduce the deficit.
 
teamosil said:
Yeah, it is very difficult to predict. But the CBO are the best there is at doing it, so, that's the best guess we have to go on- that it will reduce the deficit.
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We will see, but I never understood all of that "doctor fix" and double counting nonsense that they pulled for Medicare. It was mostly way out in 2021 anyway - pure guesswork.
 
ttwtt78640 said:
We will see, but I never understood all of that "doctor fix" and double counting nonsense that they pulled for Medicare. It was mostly way out in 2021 anyway - pure guesswork.
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I actually think this is a reasonable response on your part. But I did want to mention the guess work goes both ways. And both sides are only as good as their information and ability to predict based on that information.
 
Boo Radley said:
They'll hire what they need. It's rarely if ever a mater of 49 or 50. As you notice from your article, they just skirt the rules, but they hire what they need.
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Which is why they have 10.1% unemployment right?
 
ReformCollege said:
Which is why they have 10.1% unemployment right?
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Can you show a causal link? There is likely other elements at play. But the article said they hired, just under a new company name.
 
teamosil said:
Somehow we're just two ships passing in the night on this one... The cost is what I am talking about. The health care industry here is doing a terrible job of keeping costs reasonable. In Cuba and Morocco and the rest of the first world, they are doing much, much, much, better. I know we can do much better because all those other counties already have.
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Then the discussion needs to stop being about expanding access and start talking about HOW prices of care are going to be suppressed. Your previous contention was that we can afford all the health care we need just because some other country has a health care entitlement.

Boo Radley said:
You don't make much sense here. It goes up because they get access with NO PAYERS. They just show and get care. Since they don't have insurance and the government doesn't cover them, cost goes up to pay for it. Surely you can see a distonction here.
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Giving someone insurance doesn't address the fact that, if they don't have much (or any) money, and they get treated, someone else pays. It does not matter what the mechanism of cost transfer. Take a bunch of relatively poor folks (because the uninsured, let's agree, are disproportionately the poor ones), and find a way for them to get all the health care they'll ever need. Whatever your solution, it's always going to involve someone other than them covering the cost. The dilemma isn't solved by creating a government plan, plopping on it, calling them "insured!" and letting them rack up health care expenditures that way. Makes no difference. Because no matter how you go about entitling moneyless folks to an expensive benefit, the cost is transferred elsewhere. And it is THAT mechanism (cost transfer) which has been what has allowed the cost of medical care to rise and rise. Why on Earth would eye surgery and plastic surgery be improving in quality while costs drop? Why would that happen? Is it pure coincidence that the things no insurance will cover have a very suppressed cost? No. When you transfer health care costs to others (the collective), no one has a cost containment incentive.

Boo said:
“While the Affordable Care Act makes important changes to the Medicare program and substantially improves its financial outlook, there is a strong likelihood that certain of these changes will not be viable in the long range,” Foster wrote in the report. “Without unprecedented changes in health care delivery systems and payment mechanisms, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services.”

(snip)

The report notes that its primary analysis depends on some unrealistic expectations. It assumes that Congress will not override a physician payment formula that would mean dramatic pay cuts for doctors. It also assumes that the 2010 health care reform law's provisions will work as planned and without changes from Congress.

No Change in Medicare Solvency Date, Trustees Say - Meghan McCarthy and Margot Sanger-Katz - NationalJournal.com

So you're skipping a few cavots there.

Now to what I said:

The Medicare program continues to do better than private coverage for working-age adults when it comes to fulfilling the main purposes of health insurance—providing access to care and adequate financial protection from burdensome medical bills, according to Commonwealth Fund research published July 18 in the health policy journal Health Affairs. The study also found that elderly beneficiaries who opted for private Medicare Advantage coverage over traditional Medicare plans were significantly more likely to experience problems accessing care and to give their plan a fair or poor rating.
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Thank you for answering my question "based on what measurement?" is Medicare outperforming anything. Your answer is "access." Yes, I agree, Medicare does great on access. But I've been talking about financial sustainability. Caring what our quality and access look like while we ignore the financial storm ahead is like caring how orderly your house is as you're defaulting on the payments.
 
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Neomalthusian said:
Then the discussion needs to stop being about expanding access and start talking about HOW prices of care are going to be suppressed. Your previous contention was that we can afford all the health care we need just because some other country has a health care entitlement.
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Again, how we control costs is the public option. Unless the health care providers suddenly get their acts together in the next few years, we just need to enact a public option to force them to get their acts together.

My contention is, and was, that of course we can afford to provide health care for everybody. Much poorer countries do it all the time for much less than we spend currently and still provide the same or better quality care. So it is clearly a solvable problem. The commonality of all the countries that have succeeded at that is that they all have either a public option or are single payer, so it seems to me that that is the solution.
 
teamosil said:
Again, how we control costs is the public option. Unless the health care providers suddenly get their acts together in the next few years, we just need to enact a public option to force them to get their acts together.

My contention is, and was, that of course we can afford to provide health care for everybody. Much poorer countries do it all the time for much less than we spend currently and still provide the same or better quality care. So it is clearly a solvable problem. The commonality of all the countries that have succeeded at that is that they all have either a public option or are single payer, so it seems to me that that is the solution.
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Last try here. "The public option" does not explain how costs will be suppressed. What's getting capped? What is the mechanism of control over prices with a public option?

All we're seeing here is "We need a public option, other countries do it. We need a public option, other countries do it." What's to say we won't implement a public option and just continue entitling all people to all sorts of the world's most expensive health care? We can't fund entitlements like that. The mere existence of a public option by itself does nothing to restrain cost growth. Things have to be cut, capped or rationed. For it to work, it would have to oppressively control who gets what services or what providers get to charge or... SOMEthing. Within a US government-run health insurance program, what cost-supressing action will be taken?
 
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Neomalthusian said:
Last try here. "The public option" does not explain how costs will be suppressed. What's getting capped? What is the mechanism of control over prices with a public option?
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Oh, I get where you're not following my position. Sorry, I assumed that was a given.

The public option lowers costs by inserting some honest competition for price into a system that has stopped really bothering trying to keep prices down. The public option has no profit margin, so in order to compete with it the private companies would need to lower prices and be more efficient than the public option in order to make a profit. A public option also has a stronger bargaining position with the providers because it is bigger. A pharmaceutical company can afford to walk away from negotiations rather than take a reasonable price, say with one of the five insurance companies in Indiana, but it could not afford to walk away from the public option like that, so it would need to bargain.

For capitalism to work, what you ideally want is a perfectly informed consumer making rational purchasing decisions based on price and quality. Our health care market doesn't work like that at all. A person has some control over who they work for, but that choice has virtually nothing to do with which health insurance company that employer works with. The employer picks the insurance policy pretty much just based on price and doesn't care about quality. The doctor is who actually decides what products to buy for the patient and he only cares about quality, not price at all. The insurance company only cares about price relative to other insurance companies. If it is paying $1,000 and so is everybody else, it can just jack up rates. All of this is clouded in a thick haze of incomplete information. Nobody actually knows what conditions, of the tens of thousands possible ones, they are going to get some day, or if their insurance will cover what treatments and whatnot. People have no choice other than to go off of this vague "well, I think blue cross is probably good since I've heard of them before" sort of decision model... So, the capitalist mechanism that runs off of informed consumers making rational decisions just doesn't really apply to the health care market. It's too bumfuggled up. The public option fixes that. The government does have the capability to absorb and analyze all that information. Because it is driven by votes, it has an incentive to make rational decisions about both price and quality, and it negotiates directly with the providers. It breaks through the flaws in the market, and by doing so it would force insurance companies to do a better job in order to compete with it.

In an ideal world, we would launch a public option and nobody would sign up for it. It would release rate information and insurance companies would get their act together to beat those rates. It is more important as a way to prod the companies into behaving themselves than as an actual provider. But, if the companies fail, it would be there to catch us.

Also, you talk about it as though it is an entitlement. That is not the case. The public option would be a paid insurance plan just like private insurance plans are. Just like with private insurance plans, low income people can get subsidies, but that is true now as well. The public option would not change that.
 
teamosil said:
Oh, I get where you're not following my position. Sorry, I assumed that was a given.

The public option lowers costs by inserting some honest competition for price into a system that has stopped really bothering trying to keep prices down. The public option has no profit margin, so in order to compete with it the private companies would need to lower prices and be more efficient than the public option in order to make a profit. A public option also has a stronger bargaining position with the providers because it is bigger. A pharmaceutical company can afford to walk away from negotiations rather than take a reasonable price, say with one of the five insurance companies in Indiana, but it could not afford to walk away from the public option like that, so it would need to bargain.

For capitalism to work, what you ideally want is a perfectly informed consumer making rational purchasing decisions based on price and quality. Our health care market doesn't work like that at all. A person has some control over who they work for, but that choice has virtually nothing to do with which health insurance company that employer works with. The employer picks the insurance policy pretty much just based on price and doesn't care about quality. The doctor is who actually decides what products to buy for the patient and he only cares about quality, not price at all. The insurance company only cares about price relative to other insurance companies. If it is paying $1,000 and so is everybody else, it can just jack up rates. All of this is clouded in a thick haze of incomplete information. Nobody actually knows what conditions, of the tens of thousands possible ones, they are going to get some day, or if their insurance will cover what treatments and whatnot. People have no choice other than to go off of this vague "well, I think blue cross is probably good since I've heard of them before" sort of decision model... So, the capitalist mechanism that runs off of informed consumers making rational decisions just doesn't really apply to the health care market. It's too bumfuggled up. The public option fixes that. The government does have the capability to absorb and analyze all that information. Because it is driven by votes, it has an incentive to make rational decisions about both price and quality, and it negotiates directly with the providers. It breaks through the flaws in the market, and by doing so it would force insurance companies to do a better job in order to compete with it.

In an ideal world, we would launch a public option and nobody would sign up for it. It would release rate information and insurance companies would get their act together to beat those rates. It is more important as a way to prod the companies into behaving themselves than as an actual provider. But, if the companies fail, it would be there to catch us.

Also, you talk about it as though it is an entitlement. That is not the case.
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Yes it is. It ALREADY is an entitlement, because at the moment of need, a person is entitled to care. By virtue of providers' requirement to provide care on the basis of need, we are very literally entitled to life-saving and life-prolonging medical care.

Your entire post is already too complex, because it's trying to foresee how private insurance companies would interact with a public insurance program that is not subject to the same market forces. The possibilities about how this plays out are endless. Step back from that rat maze for a moment and just think about the cost of medical care, and the amount we spend on it per capita.

You briefly touched on it when you spoke about pharmaceuticals. If a private company or private provider wanted access to public option patients, they would be subject to bargaining with the bureaucracy over what the reimbursement rate will be. In theory, the bureaucracy could be a hardass about reimbursement for all sorts of medicines, procedures, tests, etc. If, on the other hand, the bureaucracy decides (for one corrupt reason or another) that it will reward pharmaceutical companies with a generous deal (see also: Medicare Part D), then that will cause overall health care expenditures to rise.

The ability of government to control cost growth depends on how trustworthy they are to 1) give both patients and providers some unpopular answers, denying them the care they arguably need, or denying providers the reimbursement of the amount they need to charge, and 2) not be corrupted by big business who will be looking to infiltrate the departments making regulatory decisions.

And this is really the main problem with government health "insurance." Government is averse to giving unpopular answers (political self-sacrifice) and has shown that it frequently welcomes industry insiders into the regulatory agencies that oversee those industries.
 
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Neomalthusian said:
Giving someone insurance doesn't address the fact that, if they don't have much (or any) money, and they get treated, someone else pays. It does not matter what the mechanism of cost transfer. Take a bunch of relatively poor folks (because the uninsured, let's agree, are disproportionately the poor ones), and find a way for them to get all the health care they'll ever need. Whatever your solution, it's always going to involve someone other than them covering the cost. The dilemma isn't solved by creating a government plan, plopping on it, calling them "insured!" and letting them rack up health care expenditures that way. Makes no difference. Because no matter how you go about entitling moneyless folks to an expensive benefit, the cost is transferred elsewhere. And it is THAT mechanism (cost transfer) which has been what has allowed the cost of medical care to rise and rise. Why on Earth would eye surgery and plastic surgery be improving in quality while costs drop? Why would that happen? Is it pure coincidence that the things no insurance will cover have a very suppressed cost? No. When you transfer health care costs to others (the collective), no one has a cost containment incentive.
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Actually, it matters a lot. Insurance companies because they have money in hand can and do negotiate lower prices. And there is some watching of the prices and where the money is. When no one pays, the hospital raises prices, and has not this for that formula that assures they are hitting the right amount. No control. Not watch dog.

Add to it those who will simply pay their own way, and it is clear this is better than the nothing we were doing.

Thank you for answering my question "based on what measurement?" is Medicare outperforming anything. Your answer is "access." Yes, I agree, Medicare does great on access. But I've been talking about financial sustainability. Caring what our quality and access look like while we ignore the financial storm ahead is like caring how orderly your house is as you're defaulting on the payments.
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I think I addressed financial sustainability as well. Note, the the sky is falling has been pushed for some time. And that much of the cry is based on limited information and assumptions that may be wrong. Certainly if we could enroll more healthy people, the metrics change. With UHC, we can remove insurance from the work place, assure pay for services, address the public health need of access, and design it two tiered so those who can afford more can buy more. Any way you add it up, nations with UHC pay less. Mechanism matters.

What we have now is not perfect, but a journey of a thousand miles begins with a single step. On this, let's say it is a half step. I wish our leaders would go back to work and move us at least to a full step if not more. Say, the public option?
 
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