SCOTUS Upholds Affordable Care Act!

"We can only hope that it will not result in the same sort of tragic situations for breast cancer patients that I have seen on these boards in the UK and Canada. "

HUH???  I've seen many more "tragic situations" among American women who've been struggling to figure out how to pay for their BC treatment or pay their insurance, or who've decided to not go ahead with a particular treatment because of cost. People fall through the cracks in every system, and there are those who are unhappy with and find fault with every system, but overall the percent who suffer and struggle under the current U.S. system is much greater than those who have to do without proper care in the UK and Canada. 

I'm a big supporter of a single payer not-for-profit system. I am not a big supporter of the ACA.  The ACA is nothing like the healthcare system in Canada or other countries that have government sponsored single payer systems.

One difference and problem with the ACA is that the system is profit-based and centered around insurance companies. Everyone is being forced to buy insurance which in aggregrate is supposed to cover the cost of treatment and deliver profit to the insurance companies, drug companies, health service providers, etc.. That's one reason why U.S. healthcare costs are so much higher than the healthcare costs in any other country. All that profit sure increases the cost!  But before anyone blames the insurance companies, let's remember that most are publicly traded companies, who must deliver profit to their shareholders (which includes many people who own 401Ks). It's a catch-22.  

Another problem is that it appears that the tax for not having insurance in many cases - possibly most cases - will be less than the cost of insurance.  So will this actually encourage many who don't have insurance to get it?  And is it possible that some who today have insurance and are struggling to pay will decide that it's cheaper and therefore better to just pay the tax?

A third problem is although the theory is that by adding all these additional insurance and/or tax payments into the pool, the cost for everyone will come down, what this doesn't consider is the fact that right now many people are paying for health care out of their own pockets. So it's not true that the costs for those who are uninsured or under-insured are all being covered today by everyone else and in the future all these uninsured individuals will be chipping into the pool enough to cover their own costs and therefore will lower the cost for everyone. No, a portion of what is being spent on healthcare today comes from individuals (you know, all those people who are going bankrupt paying for their care). With no limits on insurance payments in the future and with full coverage of pre-existing conditions, insurance companies will soon have to cover all these costs.  Although the money into the pool may be increasing, I suspect that the costs incurred by insurance companies will be increasing by more and that will result in insurance cost hikes for everyone.  And that will lead to more people who choose to opt out of insurance and simply pay the tax.

I think that healthcare is basic human right. I think that covering pre-existing conditions is humane and necessary and shouldn't even be up for debate.  I support all that.  But I don't see how the math works for individuals under the ACA, not when you consider all the profit that is in the system, increasing the overall cost, and not when you consider all the extra costs which until now were paid by individuals but which in the future will be going into the system.

I hope I'm wrong.  

I think a lot of the costs will be contained when people without insurance stop using the ER for medical care.

Good point.  I wish our health insurance industry was streamlined. A Washington Post reporter wrote a book comparing health care systems around the world. In one country (France? Japan? I can't remember) there is a list on the back of the exam room door showing the price for any procedure. Yes, everyone pays the same amount. Right now in the US there are soooo many different plans (even within the same insurance company) and the overhead cost (time, money) of managing and processing all this paperwork is outrageous.  There are so many people whose job is simply to process all this paperwork. If it were streamlined it seems like we'd save a big chunk right there.

Rebates? Now that is awesome.  This isn't the plan I would have written had they asked me, but it's a huge step in the right direction.  I had insurance, decent insurance and it was still a stretch to come up with deduct ables and co-pays, and of course "going out of network simply" wasn't an option, but I got good care and won't lose my home because I can't pay my bills. But my best friends sister Mary? Now she's another story.  She didn't do the routine mammograms and stuff because they lost their insurance when her husband lost his job.  Ditto with routine visits to the pcp.  When she found a lump she was scarred to death, but didn't seek help because they couldn't afford it.  Both she and her husband were working, but at dead end jobs with no benefits. Anyway by the time a family member convinced her to seek treatment she was already stage iv.  They ended up losing their home to the medical bills and then she died.  She wasn't quite 51.  I can only believe that this new plan is better than the current one.

Beesie - I think your right.

I am curious...in Massachusetts, what happens to someone who opted to pay the penalty and then ends up in the ER?  I assume they incur debt, which might never get paid...not much different than our current scenario.  I think the ACA's real strength is in the fact that many more will get assistance with paying for insurance.   I think we can fairly assume that many more people will actually be insured.  This will drive down premiums.  We cannot assume everyone will opt in, though.

I am Canadian and had no problems getting access to health care for my breast cancer.  I know that not all Canadians are as fortunate as I have been.  It makes a big difference, I think, who your primary care doctor is.  Mine is very prompt at seeing problems and referring his patients to a good specialist as soon as possible.  As soon as he got the biopsy report, he called me into his office and referred me to a good surgeon.

I have often been upset reading on these boards about the terrible fears of Americans who are afraid that they will have a recurrence or need treatments that their insurance companies won't pay for.  I hope that this new health care plan will solve some of your problems.  With all the fears and anxieties that I had to go through, I never once had to worry about money.  Here all citizens have the right to health care, but, as in any health care system, things can go wrong.  Practice never quite lives up to what theory says should happen.  I can only report on my own experiences, which were excellent.

If you don't have insurance in Massachusetts and choose to pay the penalty and need medical treatment, you go to the emergency room. They cannot turn you away. Just like before Mass healthcare, you will get a bill and likely won't pay it. So no difference.

I'm with the single payer crowd, but this might be as much as we can get at this time.  Vermont is planning on going single payer.  I'm thinking of moving....

Cindyl - meant to say 51% of votes in the house. Republicans already have a majority in the senate. So sway a few democrats in the house and senate AND Romney gets elected and ACA could be eliminated. No denying that a lot of things would need to fall into place for this to happen, but it is possible. plus, if you believe all the pollsters less than 50% of Americans agree with ACA in its current form. So, assuming elected officials vote the way the citizens in their district want (never happens) its probable.

Democrats currently hold a slight majority in the senate. Repubs hold the house.

I thought that less than two percent of MA residents opt out health care. That seems to me like a good start.

I too would like to see not-for-profit health care.

Cindyl, I could have been Mary. Rest her soul and bless her husband/family.

We had insurance and an Alfac type plan. I even had a cancer plan. When the economy tanked we had to choose between a home to live in or keep paying the insurance. After the lump; I truely thought of sinking down in the tub and not coming back up...

Don't get me wrong.  I'd love to see a single payer system.  But I think we have the framework here of something that can help a whole lot of people and I hope that enough of the voting public realizes that...

To me, what's being missed in the dialogue is that since this is a tax, if you are not working and/or are unemployed, you don't pay taxes and therefore will not be paying into the system.

The tax is not enforcable by the IRS. Given this, I don't see  where the large increase in funds to pay for the ACA will come from.  I'm also concerned as employers who now offer health care, may stop; it will be cheaper for them to pay the penalty on a corporation who is required to provide health care and doesn't.  This will place more stress on the system. It wil be an interesting 2 years as this all shakes out.

In Massachusetts, if your an employer with 50 employees or more you must provide insurance. If you don't, you pay a penalty of $2,000 per employee. But many who hover around the 50 employee count simply hire a few part timers to keep their full time count under 50 then they don't have to offer insurance. If your a mid size or larger employer your cost per employee is far less than $2,000 so it makes sense to keep the plan you have in place. So be prepared for small employers to try to find crafty ways around the rules.

I can only speak for what goes on in Massachusetts....the group rate is not cheap. Quite unaffordable for many. I have a friend who is unemployed and single. She pays $500/month for coverage that isn't that great. I can only imagine the cost for a family.