ACA stuff

You mean like it is in every other developed country?

Or, if not solved, at least much closer to being.

1 Like

How much do businesses and individuals collectively pay each year for premiums?

I donā€™t think there are that many people not receiving care they need in the US if they want it.

Many undocumented immigrants canā€™t find a way to get covered care. :frowning:

But thatā€™s more a problem of the messed-up immigration laws than ACA, Medicaid,ā€¦

Iā€™m not so sure about that. Anecdotal skew though.

I think itā€™s relevant to ask how much money weā€™re willing to spend to save a given life. Particularly in the era of zjillion dollar medicine.

Then we should be transparent about that reality.

Between the ACA and Medicaid, I think ā€˜mostā€™ people get ā€˜mostā€™ of the care they need. Iā€™m being a bit vague because I donā€™t want to get too bogged down.

There is still a lot of financial toxicity, medical debt is cited in about 60% of bankruptcies. Still lots of room to improve disparities in clinical outcomes. Plus all of the other things mentioned here and the other thread.

I donā€™t think of it as a right, but I think improving public health is the right thing to do.

Itā€™s a really important question. One that society should probably have, since healthcare is largely paid for by society, or at least large groups. And a discussion we need to have in good faith, without going right to ā€˜death panels.ā€™

The other question we need to ask is: how do we save the most lives in healthcare? Would love opinions, I think controlling blood pressure might be it. Lots of opportunities and fairly low cost. Black people have much higher rates of uncontrolled blood pressure than white people, and itā€™s fixable.

I agree. Itā€™d be nice if there was good-faith open discussion about all of this. It seems like people want to jump to taxes and death panels. A lot of people donā€™t know the cost of medical services, and the cost to receive service isnā€™t necessarily the cost of delivering it. There is definitely waste within the system, like doctors being tied up on the phone trying to reverse denials, or patients that could be released from the hospital but canā€™t be until their meds they need to continue as an outpatient are approved. Or doctors who give in to patientsā€™ demands for low yield tests out of fear of litigation or being reprimanded for low Press Gainey scores for not giving the patient what they want.

Anecdote time. I was having a discussion with a medical oncologist once about drug cost. This was the early, early days of thinking about value based care in oncology. And I asked him why he preferred drug A over drug B given that Iā€™d heard safety and efficacy were comparable but drug A cost 5x as much. And he said ā€˜I went to medical school, not business school, I have no idea what drugs cost.ā€™

And this guy wasnā€™t an outlier. He was genuinely a good physician. If a family member had cancer, Iā€™d want this guy treating them.

Not an anecdote. There isnā€™t a mandate related to cost effectiveness for FDA approval of drugs. As long as they pass the bar for safety and efficacy they get approved. And then CMS pays whatever the manufacturer asks for, and private payers pretty much follow suit. I could do a whole podcast on drug pricing.

I donā€™t disagree with any of that. Unless they seek out the info or they receive medical bills themselves, doctors donā€™t necessarily know pricing either.

Back to anecdote time, I was fortunate to know to ask how to get some subsequent treatment after my ER visit without having to return to the ER to do so. It took some work on my part to arrange it, but I wasnā€™t keen on 3 more ER visits within 2 weeks with charges over at least 4x the cost of what I arranged.

Drug pricing is problematic. Continuing my anecdote, the pharmacy charge on my ER bill was $15k.

Itā€™s a good question, but most people arenā€™t willing/able to contemplate the monetary value of health, or the way it runs hard into income disparity, or for that matter large sums.

eg. Iā€™m not sure the average median income person would willfully spend $100k to extend their own life 10 years, assuming they were handed the money before they were old. Nevermind millions and millions and millions.