Originally posted by Cowpoker
You have to clear a few things up for me.
1) Pre-existings. It doesn't really do anything to save costs. ACA does nothing to cut the cost of care, it just changes how that care is paid for in some cases. Instead of it being paid by federal/state/county through normal taxes, it is just absorbed in to insurance rates. In other words, instead of my $20 in property tax hikes to the county, $20 state income, $20 federal income tax the idea is that I pay an additional $60 in insurance premiums assuming that I won't use the product and that $60 along with thousands of others like me, will pay for the pre-existing care. Problem being that I don't get the original $60 reduced from the other forms of tax.
2) How does it cut medical costs. I agree that preventative care is cheaper but nothing controls the actual medical cost.
You are hedging your bets well by saying that insurance is the wrong way to go which is pretty much what I am questioning and repeating but I don't see the long term cost reduction unless you are able to negotiate price which is probably another benefit to going full out universal government care and then still maintaining your high end health care/insurance.
Also, it isn't a mystery that with the DFL in office, insurance was "politically acceptable" since insurance/finance are probably the top industries in many of your key blue states. It obviously wasn't widely acceptable (see mid term election results)
1) for the most part, agreed, unfortunately. Some providers and economists would argue that by covering pre-existing conditions, early costs will be higher but the net will be lower medical costs down the road, less unpaid medical bills the rest of us have to make up for, higher productivity for the patient with the pre-existing condition, higher productivity for the spouse/family of the patient (less time/energy lost to caregiving), higher productivity and profits for the employers of the patient and spouse/family care giver. 60% of all bankruptcies in America are due to medical conditions, and covering pre-existing conditions will have a positive effect on reducing that number, which will ripple through the economy. Does that make up for the additional costs? Heck if I know...that's way above my pay grade.
2) The only direct cost savings in the ACA that I'm aware of medicare inflationary caps & insurers must reimburse customers if their medical reimbursement rates are under 80% of total revenues, iirc. Insurers had to return something like $1B to customers in the first year of the ACA because of this.
Medicare inflationary caps work like this: let's say that rising medicare reimbursement rates are currently capped at 1.9% annually by law (pulled that number out of arse, but prolly not too far off). The ACA caps those reimbursement rate increases at 1.8% instead, forcing insurers and providers to work together to cut costs or lose profits. That small difference may not seem like much at first, but over the next decade, with nearly every baby-boomer on some form of medicare (private or public), that small difference is going to save the taxpayers several billion dollars in direct savings. That's basically how Obama and the DFL can lol-claim the whole thing is going to save money.
Indirect cost savings:
A) preventative care
B) insurance incentivizes patients to use their primary care providers and/or clinics instead of ERs - copay = $30 vs $100 (your mileage may vary)
C) exchanges force insurers to be more competitive in pricing
Ironic cost savings:
X) Because 15 Republican states opted out of the ACA, overall ACA costs have come in under budget so far - ironically making Obama and the ACA look better.
3) Your point about negotiating from a point of strength, basically treating universal care/single payer as a tool to leverage volume discounts is exactly the reason I've been harping against the MMA since its incarnate inception. If you recall, the MMA is the law that legalized private medicare as well as made it illegal for the U.S. govt (the largest purchaser of pharmas in North America) to negotiate for discounts with the pharma industry. I'm still perplexed at the lack of opposition and the lack of demand for a recall by large portions of the public/media for that law relative to the ACA. As far as universal care/single payer goes, I'm 100% in agreement that, barring political monkey business, it saves money.
4) Pelosi and the DFL in Congress passed a version of the ACA with optional medicare for all included. That got nixed because the Repubs and some DFL in the Senate would not accept 'dat socialism'. Recall Pelosi's famous words, 'we have to wait to see what passes before we know what's in the bill'. That's what she was talking about.
Iraq notwithstanding, the vast majority of defense spending isn't about intervention anywhere. It's about expensive projects that usually go nowhere along with ridiculous administrative waste. It's insane that cuts usually hit personnel when that's the only area that doesn't need to be cut drastically.
