Bob Fleming
Hi Janalu. (I have ben in Canada for the last 3 monts; got back last night and have been catching up on The Forum). I was interested in your post on the American health care system.
You asked what you Missed." Not much really, but I thought I would give you my understanding.
1. You're right; the largest part of the Anmerican health care system is through employers and the private insurance markets. The first reform under Obama care was an attempt to help Aneircans without private health insurance because thier employers did not provide heatlh insurance and their lower incomes did not allow them to enter the privatemarket. The reform provided premium subsidies to people so that they could enter the private market. It was not just for Americans with catastrophic expenses.
I'm not sure what you meant by the "the rest of us are forced to pay." If you mean that somehow a portion of your paid premiums and/or your paid bills are used to subsidize others, I think that's not correct. If you mean that our tax payments fund the Obama program, Medicaid, and Medicare, you are, of course, right.
2. I do think your comment on health insurance for the very lowest inocme Americans is not complete.
Medicaid is the government health program for lowest income Americans and actually consists of 50 different state programs funded by both federal monies and state monies. The Supreme Court ruled that Obamacare Medicaid expansion could not be made mandatory with the result that all blue states expanded the program in terms of services provided and total numbers served. So did a few red states, though the large majority did not.
I really liked that you picked up on the public or charitable hospital system. In Houston (Harris Health) and in Dallas (Parkland System I think) these systems treat the lowest income residents using federal programs like Medicaid or CHIP but also a portion of local property tax revenue.
However, please know that people are turned away from these systems. In Houston, the system served 25% of those eligible. The money only goes so far. By the way, these public charitable systems are widely acknowledged as getting the best bang for the buck in the country.
At any rate, the Big Beautiful Bill has dialed back significantly the number of dollars appropriated to Obama care refroms - both the premium subsidy for private markets and Medicaid expansion and eligibility.- and the number of people who will participate in them. With obvious results.
As you said, In the end the American system remains the same as always - a mixed system of care
a. largely a private system of employers , employee contributions and insurance companies uisng private hospitals and private doctors to provide services combined with
b. a mixed system of care - a combination of private dollars and signficant public subsidy (Medicare, Medicaid, and Obama care premium subsidy) using private doctors and private hospitals and
c. a socialized system using public money and public hospitals and public doctors to provide services (Veternas Administration, Military health care system, and the Indian health care system.) (Also, Public charitable systems are largely socialized to uisng public hospitals and government employed doctors and federal government and local government taxes)
Two things are true at the same time One, the system is wildy expensive, inefficient and inequitable and its measureable health care outcomes are not as good as in other countries. Two, The system is very, very successful for those that can pay and participate fully in it and its health care marvels are legion (including the fact that most of us on the Forum - who can largely afford it somehow - ARE STILL ALIVE. Praise God.)
|