I agree that we need a tax funded NHS system. That is what the public option would have been, and the insurance companies persuaded (if that's the right word) Obama to give it up, since they didn't want the competition. So the ACA essentially delivered the entire population into the hands of a private industry- some of it nonprofit, to be sure, but still greedy as hell- and made the population into a captive group.
As to the premiums going down, part of the sales job on this law was that some peoples' premiums would go down. As I said before, I have not met a SINGLE individual whose premiums have gone down. Not one. If you know someone in that small group, great. I don't. And I think the idea that anyone's premiums would go down was part of the group of lies that we were told about this law.
I've been a physician for over thirty years and since I work in emergency departments, we treat everyone, regardless of whether they pay us or not- and where I work, very few pay us anything. If this law results in more rational use of the medical care system, then fine, but I remain unconvinced.
I too have been a physician for some time. As a hand/upper extremity surgeon I see the trauma for followup once Jim's patched them up in the ER.
The irony of the ACA is the use of the word "Affordable". There is little in the law that reigns in costs. The runaway costs is the primary reason why medicare and medicaid are failing. This is in spite of steady decreases in physician reimbursements over the last 3 decades. Instead of properly addressing costs, the ACA took the easy way out and expanded coverage. Expanding coverage without successfully addressing runaway costs merely accelerates the debt problem in the US. It's no wonder Jim knows of no one who has seen there premiums decrease. I too know of no one who's seen premiums decrease.
To answer Keith's question: the primary problem we face in controlling costs and having a functional health system is the lack of personal accountability and personal restraint. Patients want expensive care and overutilize resources because they feel they're not personally paying for it (my insurance company covers it, my employer pays for it, I have medicaid). This is why December is my busiest month for surgery and I routinely work to midnight many days in the month: "I need to get all my elective tests, surgery etc done now doc before my new deductible kicks in". Expand that attitude to 317 million and you get the picture. Americans won't be satisfied with the waiting lists and rationing in Europe. They want free reign with no restrictions.
The answer? Well, no one really knows, but accelerating the problem certainly doesn't solve much.
My philosophy?
1)Keep a private system but only allow insurance companies to play if they offer a very basic plan at cost (no profit). This keeps costs down.
2)Let individuals get they're own plan and pay for it with pretax $. The most conscientious consumers of healthcare I encounter are small business owners who choose their own plans, deal with the consequences and compromises, and also deal with providing plans for their employees. Get rid of employer sponsered plans but allow the employer to provide a stipend (tax free) as a benefit to employees, who in turn pick a plan that's right for them. My practice employs 165 people. We have one plan. There's no way that plan works for everyone. We have single mothers, older single people with chronic disease, married people with large families. Let the individual pick their plan for themselves/their family. Personal responsibility with personal consequences (something our population seems all too wiling to abdicate to the govt who in turn botches it)
3)If you don't get a plan, no one has to treat you unless you pay cash. Does anyone really think the ACA penalty is going to make young people buy into the system? What a joke. The consequences of going "naked" aren't significant enough.
4)No matter where you move, you can take your plan with you. It's portable and can't be cancelled.
5)Insurance companies can make their profit on the ala carte additions onto a basic plan. Patients can choose the ala carte features that are important to them. The states decide via a commission of appointees (from the state medical societies, hospitals and insurance industry) what constitutes a basic plan and what "cost" is on a basic plan. All plans have some basic deductible/copay that is alway due at the time of service. People need a deterrent to overutilization. My biggest overutilizers are medicaid patients: it's essentially free healthcare so they come in frequently with every little ache and pain and want head-to-toe MRI's (wasteful abuse of resources).
6)Govt (either state or federal or a combo) can subsidize plans for indigent patients on a sliding scale based on income/wealth.
OK, pretty pie in the sky and full of holes (more details would put you to sleep, if you're not by now) but at least it's not 2000 pages of total BS like the ACA.
Interesting factoids:
1) Did you know that with the ACA it is illegal for doctors to own hospitals. This in spite of the fact that the CBO found that MD owned specialty hospitals offer higher quality care at lower costs with higher patient satisfaction rates and they don't cherry pick the best payors.
2) Did you know that a health insurance company can own hospitals, and doctors! Ever meet a health plan that took a hippocratic oath?
3) Did you know that employed physicians whose compensation is based on patient satisfaction surveys prescribe a dramatically higher rate of narcotics?
4) Did you know that outpatient surgery centers are paid 40-60% as much as hospitals for the same procedure? In spite of this they have to meet more stringent federal (CMS) and state regulations, have higher patient satisfaction rates and comparable or better outcomes on average? Still they are often legislated out of business in some states. Ever wonder why?
