…to the alligators…
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I really wish that at some point there could start being some public discussion of the way that the Republicans have been killing the very parts of the ACA that are supposed to keep prices down and competition up.
So much for “we’ll let Obamacare implode, and we won’t own that”. M****rf*****r, if you’re actively taking steps to bring it down without any attempt to make something that’s actually better, you damn well better own it.
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…there even female Republicans?
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And now there’s this.
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?
Typo?
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TLDR: the TrumpGOP healthcare bill failed not because it threatened the Obamacare exchanges (which are a mess, and unpopular), but because it threatened Medicaid (which works fairly well, and is very popular).
It’s related to what I’ve argued before: to succeed with a strategy of “the people will love socialised medicine so much that the opposition won’t dare take it away”, you need to actually give people socialised medicine.
The Nevada strategy of using Medicaid buy-in to provide de facto single-payer and a floor in the markets seems promising.
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Yeah, they use the new infant as a way to get around individual out-of-pockets. When I had both of mine, we were close to the out-of-pocket cap. But with both, we’d get nickeled and dimed for months. With my first, I was living in a different state and got a bill for like $175 bucks on Christmas Eve. She was born in June.
My second was born in what is basically a birth factory, so they calculated my total responsibility, asked for half up front (no problem if I couldn’t pay it) and then billed the remainder a week later. But I still got bills from third-party servicers (most anestheticians are out of network at most hospitals, for example) for months.
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I really wish that whole concept would just die in a fire. I pay my insurance, they pay my health care providers. If they have a disagreement with each other, that’s between them. I don’t handle their networking and shouldn’t be held responsible for it.
I know on a technicality I have to agree to be responsible for what the insurance doesn’t cover and I have to agree that they can play the network game. But given that it’s unethical practice in the first place and I have no choice but to agree or forgo healthcare entirely (forced to agree under duress), I don’t really feel that it’s unethical on my part to refuse payment. Especially when the facility is listed as being or claims to be in-network.
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It’s also a concept which doesn’t exist in countries with socialised medicine. Either you’re a qualified doctor or you’re not practising. The only exceptions are doctors who run private clinics, but they’re not going to be assigned to someone in labour in a hospital. You’re going to know what you’re paying extra for well before the procedure.
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Healthcare has been allowed to exempt itself in most major ways from the whole concept of a marketplace. In many places, unless otherwise regulated, you have no idea how much a service will cost before you get it.
And to some extent that makes sense: shit goes wrong or information changes while the doc has their hands in your chest cavity. They can’t wake you up, inform you of cost, and move on. But the idea of the rational consumer who will choose the best price for things doesn’t exist in that scenario. Healthcare isn’t a good like a normal consumer good, and trying to hold people to the regulatory framework we’ve used for most other goods doesn’t make sense.
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That assumes a time and materials pricing, though.
They could do fixed price and still make a tidy profit. But they don’t. The endless itemizing on American health bills is always notable to me. When I was a student I used to work in the business office of a hospital during the summer, and although we love our standard billing codes, it wasn’t nearly as detailed.
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Frankly, I don’t know why anyone has to make a profit off healthcare. Working people, everyone from providers to janitors, should absolutely be paid (well) but shareholders add no value, and I don’t think it’s actually moral for them to take a cut. Capitalism depends on the moral character of everyone involved, and our system rewards dubious moral character above all else.
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Shareholders are supposed to add capital, but as you pointed out, they don’t anymore. They’re basically a useless cost centre.
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And now stock is the only product companies care about, and stockholders are their customers. It’s perverse—but inevitable, I guess.
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That is a direct result of making serious stock options part of management compensation packages, and of shareholder revolts. Both reward immediate, substantial profits (to accrue to the shareholders) over any other criterion, even the health of the company.
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. . . the people, the environment, the country, the world, etc.
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Yeah, but the health of the company, their cash cow, is the lower limit of what they should concern themselves with.
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