You are unbelievable. You really live inside the bubble and see the world in a rightwing way. 1st off I’m not a leftist, that is something from your own imagination that you use to try and degrade me. I’ don’t know where you live but I see obese people everyday, some so heavy that they can’t walk around and have a motorized cart, and I live in a thinner state. The south is the heaviest and some states like Misissippi and Tennese rank amoung the fattest. The south leads in the rate of diabetes and you can look that up anytime.
I don’;t know where you get your information except you write like a Fox news watcher.

As I wrote I was on the board of a hospital and know where health care costs come from and it’s not government regulation, that is a right wing myth. The only health care system that the government runs is th VA. Everything else is private or non profit. The only process the government regulates is patient care to prevent disease spread,and that is the state not the feds, since the state issues a license.The rules and regulations mostly refer to facilites. Ex. You need a operating room to do surgery
There is no national standard of care for any disease. Lawyers are the biggest regulatory system since they sue when there is wrongful death or dismemberment. There won’t be any tort reform(another right wing slogan) untill there is a national standard that all doctors adhere to and are held accountable to, instead of the free for all that exists. No government agency challenges the decisions of a doctor,(bubble myth)only lawyers do.
Doctors are licensed by the state and not the feds.

Prior to the ACA Insurance companies ran the health care system, and will exert a lot of authority under the refomed system. They alone determined length of stay, and what procedure would be done or not on any patient, whether a patient qualified for surgery or not, and what treatments they would get. They are profit making organizations and made their money 2 ways. 1 deny care for pre existing conditions.ex So if you had scarlet fever as a youngster and developed heart disease later they could say that you had the condition all along, or drop you from coverage if you had marginal health status. Sometimes ins co’s would wait till after you had the surgery to tell you that they were not going to cover it. This was the primary cause of personal bankruptcies. They are the ones between you and your doctor, not the government. The feds audit medicare/medicaid after the fact to see if there is too much over teating or un need surgeries. It is estimated that there is 700 billion of waste, fraud, un needed surgery and over tesating in the currrent system

Obamacare didn’t regulate the health care system(myth) it put regulations on the insurance companies. How much of your premium should go directly to your care and how much to profit, they can’t drop you for pre existing conditions or drop you from coverage, and your kids could stay on your policy till 26. In order for the insurance companies to not keep dropping people, the congress said ok then everyone has to buy it both sick and well, young and old. That way the ins co can keep their profit margins the same and wall st was happy since the ins industry is publically traded. I don’t see how this is socialistic and is actually an idea dreamed up by the heratige foundation a republican think tank. It revolves around personal responsibilty for you own health Once again only states have the authority to regulate the hospitals through their licensure.

Insurance rates are determined through a risk profile, so if you are in a large group plan the companies determine what is the risk profile of the plan participants. That determines the price and it and is ajusted to area as well. So if you live in a state with a high rate of diabetes, cancer, heart disease, you will pay more for your private insurance. See how this all ties together? The socialistic system you on the right always yip about is the public option which we don’t have, but people on medicare do somewhat, so to say that Obamcare is socialistic or a tyrannical take over of health care is a bald face lie. Get that bucko! So go back to watching Fox and listening to Beck, Palin, Coulter, Hannity, O’Reiley, and of course that picture of health Limbaugh feed you a line of untrue crap. Stay away from thinking people because you will look silly.
See how I wrote all that without call you names

I don’t dislike you and at times you provide a good reasonable discourse. I agree with some of your points about the government forcing healthy people to purchace health insurance is not great, but you can’t have it both ways. Conservatives want prople to have responsibility for their own health care , and getting them to buy insurance is a republican thing to do not a democratic one. This idea was formulated by the heritage foundation(republican think tank), and 1st presented on the floor of the senate by Bob Dole, who is by no means considered a leftist, as the republican answer to Hilliarycare. Romney a republican governor, adopted this plan for Massachuttses, and went on CNN to say this should be a national model for heath care reform.
You can’t look at the ACA in a vacum and you have to see what it was trying to correct, so let’s set the stage. During the Bush years there were approximately 32 million that lacked insurance and access to the illness intervention system. A Harvard study concluded that out of that number 50K died every year, men, women and children. The other issue is that every health care portal is this system is a profit making entity.

The insurance companies didn’t want the uninsured since they are owned by Wall st investors and were expected to return a 20% profit on investment, and wanted only paying customers. One might ask here, is this an efficient way to run this system? A good example of this is Aetna Ins co. One yr they came through with an 18.5% profit. Wall st downgraded their stock and Aetna responded by cancelling the coverage for 8.5 million margially healthy Americans. This is what happens when private enterprise runs your system. In that system the first .20 of every dollar of premiums paid went to Wall st, and not to your care.

Every doctor’s office is an LLc and is there to maintain a profit at years end. They work hand and hand with Big pharma in the dispensing of drugs. Big Pharma realized a long time ago that since they have to return a profit to investors, they really can’t make drugs that actually cure you, but rather they maintain your illness. So you can take insullin for diabetes for 20 yrs and won’t ever be cured of the disease. The problem with all these drugs though is that they have side effects, sometimes toxic ones like cancer drugs, so you always have to go back to the doctor either for testing or a modification to a different drug. Every time you walk into that office there is a charge since it’s a fee for service system. Unlike your analogy of a car, where you can always go back to the garage and demand a refund if they don’t fix it, you can’t demand a refund for a drug that dosen’t work, or causes you harm. Statins don’t really work as well as diet and exercise, but have toxic effects on your liver, which requires more tests and more money paid.
Hospitals take a cut of every service preformed by a staff doctor or visiting specialist. They work off a payer mix of medicare/medicaid, private pay and insurance. They are also the last resort for the uninsured who stream into the emergency rooms for care, since doctors won’t see them in private practice, hurts their bottom line. They cost shift from low paying plans to higher paying ones so that’s where you get the $40. asprin. This is a very expensive form of care and it’s like you takikng an old care to an Accura dealer for repair. Your state taxes reimburse hospitals for treating the uninsured.
In the end we pay about 2.6 trillion for illiness intervention. Of that number around 700 billion is based on un needed testing, fraud, un needed surgery, prolonged hospital stays on vents, and could be cut out. We spend far more than every country in the world on illness because it’s all about profits. How do we rank? 34th in the world in terms of health of our population, just behind Costa Rica.
France is # 1 and they have a public option.
All the ACA said to the ins companies is spend .80 out of every premieum dollar on paitent care, so wall st is really pissed off, don’t drop anyone, and there are a few pilot programs to see how we lower costs and improve outcomes.
It is not great but better than nothing

How would you design a system that achieved the goals of a healthier America with lower costs?. Tell me what would you change? Don’t just complain about it. How would you cover everyone?
Have a good day

Something I have to point out to you that may shock and stun. What you described is what is in the ACA with minor variations.

As part of the ACA states are required to set up insurance exchanges where companies will compete to offer the best price on insurance coverage. Those that don’t make enough will be subsidized to be able to afford to purchace insurance. People will be able to pick from a menu of coverage options so for example if you have no kids you don’t have to buy a pediatric plan.
Pt 2 if hospitals took Hill-Burton(construction) money from the feds then as part of the funding they have to accept the uninsured. Private practice doctors already don’t except uninsured patients so that is not an issue. If you are really poor or on welfare you get a clinic card and are seen at a hospital based clinic. What you are talking about are people who are working but make too much for welfare and too little to afford insurance, and where the work place doesn’t provide it. If we want to keep people out of the hospital emergency rooms we need to set up primany care alternatives with a sliding scale payment schedule.These are usually staffed by hospital interns.
Pt 3. I think I covered that above
Pt 4
If they tell you, that it’s a myth about lowering primeiums. Isurance rates use the CPI of an area to set rates along with risk profile data of the policy holders. So if there are a lot of people with poor health status in you state or region then the coverage price will adjust to keep the profit margin intact. The insurance companies don’t want state regulations to interfere with business. Example. In NJ Ins cos were kicking post partum women out of the hospital in 24 hrs after delivery. The state stepped in and passed a law giving women a 48 hrs stay. Let’s take your example with car insurance. All the companies are nationwide but all still use accident data to determine rates in a given area. So if you live in a urban area you will be paying a higher rate than a person who lives rurally. You get no break because the company sells across lines.

In answer to your conclusion. We had a free market uncontrolled system up to the end of the Bush presidency, and it didn’t cure problems it created them. That is how we ended up with 32 million uninsured and 50k deaths a year. That is how the Aetna situation that I described to you happened. It was all unregulated. The problem with free markets and especially in health care is there is way too much concern with profit and less with patient care. Doctors to make a profit order un need tests, prefom un needed surgery all to get money. Drug companies make drugs that don’t work, all for increased profits. that is an unregulated market approach. Do you want your family to have to deal with that?Would you like your wife or children to get un need ed surgery so the doctor can make a profit? How do you like being treated with drugs that don’t cure you?this is the free market you want. Wild west in medicine. It dosen’t work. We’ve been there and done that as they say. You can’t say free market and control of health care costs in the same sentence and have it meaningful. Hospitals already compete and it hasn’t lowered costs. We need to take the profit out of the system, but let everyone eran a good living if you want to ever control costs.
I will leave you with this. When CIGNA was dropping people off their coverage and denying care for pre existing conditions, people who needed operations, who had cancer and heart disease, children who had birth defects the CEO made 24 million that year because he made a profit for the company.

This is why the ACA was passed
Have a great day good chatting with you

You remain dellusional about how a hospital really works. Most emergency rooms are unbundled private corporations that charge $500. to walk in the door. Does your doctors office charge that? They are not part of the hospital and are usually owned by a doctors group, as are some of the high tech testing like CAT scans and PET scans, which are also off campus.. This is why having them be the portal of entry for the uninsured makes no economic sense if you are serious about controlling costs as Mitt Romney suggested their use. He knows better and his healthcare reform plan moves people away from that, and into primary care. Health care cost control basically is moving people to the lowest cost center for their non emergent care. Do you at least agree with that?
The institute of medicine did an extensive study and determined the HC system is riddled with waste and fraud, around 700 billion so I didn’t make that up. Unneeded testing that is not just defensive medicine but unnecessary, unjustified surgery, and pharmacuticals that weren’t appropriate for the disease. Most of the intensive health care costs(80%) are spent in the last year of a patients life. Think of someone with an advanced stage of cancer, that patient will spend the last month in a hospital bed. Think of some elderly patient on a vent which costs $5000./day. An ICU/CCU bed is over $5000/day. This all adds up.The hospital on was on the board of usually made a net profit of 2 million/year
The HC system is divided into two parts. One being illness intervention and the other being managed care(insurance).
Managed care came out of california and worked well there because the insurance company(Kaiser) owned all the primary care and the hospital so it was in their best economic intrest to keep people healthy. All the kids got their immunization on schedule and a lot of counseling was done to reduce risky behaviors like smoking. It dosen’t work well when it is overlayed on a fragmented fee for service system, and this is the place where we differ.
The managed care companies first lowered the patient days in a hospital, which netted them millions. They were the darlings of Wall st and shares of US health were skyrocketing. Then the inital managed care companies sold to the tradional companies like Aetna and travelers, CIGNA and the like. Now they had no more patient days to grab and the original Managed care companies squeezed the profit out of the system. The only way to make a profit then was to deny care, drop marginally healthy people, seriously shorten stays, create gate keepers to try and diswade you form expensise care since now you need their approval, and not pay the hospital for care they already gave, and the battle for money began.
The hospitals responded by unbundling their services into different corporations, and creating seperate bills. The doctors realized right away that the companies and also medicare/caid would pay for testing, so this was not all done as a protection from lawyers.
The problem in all of this is that the people were not getting better care it was worse, with hospitals and ins co fighting over the level of care that patient would get. Sometimes lawyers were brought in to fight ins co’s for care. Ins cos began dropping people at a faster rate and denying more and more care. Why? to keep wall st happy and stock prices high.This is how we eneded up wiht 32 million uninsured. None of this improved the health status of the poulation, in fact it got worse. This is the dirty side of profits in health care. You can call me any name you want but you can’t change what went on. the difference between me and you is I care about people and their health, and you care about the free market no matter what the human cost .
Have a great week end
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