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I have trouble coming up with a decent analogy that describes the situation with the ACA and the U.S. healthcare system. The system is so bad and yet the fix, though not simple, is obvious. U.S. health care and the ACA fix is kind of like the patient walks into the E.R. with a life threatening bullet wound, the bullet is lodged close to the patient’s heart but, for some reason, the doctors only put a bandage, the ACA, over the entry hole and send the shooting victim home without surgery. What was really needed was heart surgery to remove the bullet however some of the doctors think that even the bandage is more treatment than the patient needs; so the compromise was nothing more than a bandaid and the patient, the U.S. healthcare system is now dying.There are a lot of people lying about what is going on with U.S. healthcare. We are told that the ACA is some kind of socialist program designed to ruin a perfectly good free market based system of healthcare. On the other hand, others are saying that the ACA band aid is somehow going to fix one of the worst health care systems in the developed world. (U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries - Forbes).The U.S. healthcare system is a uniquely twisted American approach to providing a service via middlemen and the politician’s response to those who say it needs improvement is a microcosm of the problem of the poor political leadership of the U.S. The ACA is trying to fix something that cannot be fixed. The ACA never had a chance of success.There is No Profit Motive to Provide Good Service to the PatientLet’s put to rest the B.S. that the U.S. healthcare system is some kind of capitalist free market system serving patients. Under the existing system of U.S. healthcare, regardless of ACA or no ACA, a patient that walks into a doctor’s office is most likely not the paying customer. The paying customer for healthcare is most likely either an insurance company or the government but almost never the person receiving the service. In other words, the paying customer for healthcare in almost every case is a middleman, whether it is Humana, or Aetna, or Medicare or whatever. The middlemen customer’s demand determine costs and services provided. The patient is nothing more than a transaction. No wonder U.S. healthcare is so bad.A patient walks into the doctor’s office or a hospital and the very first piece of information that the patient provides, sometimes even before what is wrong with them or what hurts, is health insurance information. Why is that? Why does the doctor want to know what health insurance you have before they treat you? The doctor needs to know who the paying customer is so he or she will know what treatments will be paid for. The patient is not the customer; the tail is wagging the dog.For example, personally for a long time I needed a drug called to fix my genetic high cholesterol problem, but my doctor didn’t bother to prescribe it or even tell me about it because he knew my insurance would not pay for it and no way could I afford it. Instead he prescribed which is the generic and drug that only marginally addressed my condition. Finally after 3 years of additional damage to my pulmonary system, , a generic for came out, but it would be another year before the generic was cheap enough so that I got what I needed and only after Pfizer made $130 billion over charging for the drug.Why the ACA is Nothing More than a Bandaid over a Bullet HoleBefore the advent of the ACA, a very high number of Americans did not have healthcare insurance. Either the insurance was too expensive, there was no employer to provide it, or the patient had a preexisting condition that the insurance companies would not cover. One symptom of this problem is the scandalously high infant mortality rate in the U.S. Basically, impoverished women are having babies without the services of a obstetrician because they cannot pay for it. The ACA set about trying to fix the access to healthcare through the current private and government insurance system. By making healthcare insurance mandatory, the ACA attempts to change the statistics of healthcare allowing insurance companies to accept higher insurance risks and insure pre-existing conditions without losing money. Thus, theoretically, more people are insured. In cases where patients simply cannot afford health insurance, the ACA has the government step in to subsidize insurance. The ACA does not attempt to improve the quality of the U.S. healthcare system. If you had a choice of where to break your leg and receive care for it then you are better off breaking it in Cuba and going to the hospital there, than the U.S. ACA or no ACA; you will almost alway be more likely to have a better outcome for the most common injuries and illnesses in another country. Also the ACA does not lower the incredibly high cost per patient in the U.S. which is double the amount spent by countries known to have the best healthcare in the world.The Health Insurance Companies Make Everything WorseAll insurance companies, doesn’t matter what kind, make their profits through something called float. Everything else, the administrative overhead and claim payments are a wash verses premium payments from clients. Float is simply the interest earned on the money while it sits in the insurance company’s bank account before it is paid out to claims.For an insurance company, managing float, i.e., lengthening the amount of time that money spends in the company’s bank account, is everything. Even lengthening the float a few hours can make a huge difference in the profitability of an insurance company. While this business model may be OK for car or life insurance, having the management of float determine what treatments a patient will get is just nutty, but that is basically what is going on.The middleman is a U.S. phenomenon. We buy our cars from a dealer and it is illegal in many states to sell cars without the dealer middleman. We buy our cell phones from a network instead of directly from Apple or Samsung because the AT&T or Verizon middlemen have manipulated the politicians and FCC to create a system that forces us to into a technology that is more primitive than in countries like South Korea. So it is no surprise here in the U.S. that actuaries instead decide what health care is available and at what cost.Remember the float is what counts. The more money floating in the bank account the better. The insurance companies are not motivated to reduce the cost of healthcare. Quite the opposite actually. The more money things cost the better it is for them. As long as the actuarial tables predict the costs accurately, insurance companies will gladly pay.The Political System Does Not Serve the PeopleYou think these idiots in Congress do not understand the problem? Think again, insurance companies, mostly health insurance companies have donated $15 million to politicians during the current election cycle. That is only the part that we know about and does not include PAC money. Any solution that Congress comes up with is going to have insurance companies involved, guaranteed by our corrupt political system. We either going to have the extremely poor pre-ACA health care system or something with a bandaid like the ACA.A Modest ProposalSpain and Italy do not have the best healthcare systems in Europe. Yet, they are miles, miles better than the U.S. system and at 1/3 the cost per patient, with better service, more and better doctors, nurses, and hospital beds per capita and there has been less than 1% inflation of per-patient costs for a decade in those countries (What Makes Spain's Health Care System The Best?). We should emulate them. Imagine your health insurance premium at 1/3 what it is now and not inflating. Walk into any doctor, no fees; maybe they ask you your name and lookup your healthcare history; that is all. The only difference is that you write that check to the government not an insurance company.The barriers to this solution are getting past the political marketing financed by the insurance companies. The people must for an end to political corruption and forcing the U.S. political system back to serving the people instead of serving the corporations. Basically, we have one group of politicians working together to make the U.S. government fail where other governments succeed brilliantly, while the other group of politicians sit idly by like so many sheep as wolves tear apart one of their number and watch it happen. The American people are SOL as long as that is going on.

What is the best way to fill out an advance health care directive for a peaceful death ) ie stop fluids, stop food etc)?In New Zealand these are called living wills. Although living wills have no legal status they will be an indication of the person’s wishes.Two suggestions: that apply in NZliving will - get your lawyer to draft a living will. Tell your family, your doctor and any other medical people; andtattoo - some older people are having - DNR ie do not resuscitate tattooed on their chest.Best wishes

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Original Question: Can we 'Quorans' come up with solutions to the U.S. Healthcare crisis and hopefully provide inexpensive medical care solutions?How many times have I answered this, discussed this, explained this? Here are some of my posts and answers from recently. First, a recent (this week) comment I made is key to everything that follows.[I]nsurance is not medicine. Insurance is access. If the costs are too high and those cost drivers aren't addressed we are doomed. (Your humble Quoran)Universal Health Care…coming soon? by Tom Byron on Byron's BlogHere are a few of the key points recently which will solve this “matter”Agree to all revisions in a bipartisan manner. Include congress on the plan, no special exemption for the few, the partisan, the privileged.Congressional exemption from some Republican health plan cuts again in place With hours to go before the latest vote on repealing and replacing the Affordable Care Act, it appears members of Congress and their staff would be exempt from losing some popular provisions of the health coverage available under Obamacare, as it is popularly known.2. Allow policy holders to keep their insurance when they move from state to state. Allow insurers to compete for their business.3. Allow ony for catastrophic and wellness coverage for the poor. Prevention is a great idea and should help keep the few 5% from incurring 50% of health care costs.5% of Americans Made Up 50% of U.S. Health Care Spending When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending.Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.The figures are from a new study by the Department of Health and Human Services, which examined how different U.S. demographics contributed to medical costs. It looked at the $1.26 trillion spent by civilian, non-institutionalized Americans each year on health care.The top 5% of spenders paid an annual average of $35,829 in doctors' bills. By comparison, the bottom half paid an average $232 and made up about 3% of total costs.House members on Thursday will vote on the latest iteration of the Republican-backed bill, the American Health Care Act, in another attempt to overhaul the U.S. health care system. As of Wednesday night, an amendment included in the bill would allow states to waive certain Obamacare requirements, including coverage for pre-existing conditions, maternity care and mental health care. However, members of Congress and their staff, who are currently required to buy insurance through the marketplace just like every other Obamacare enrollee, would not be affected by these changes, Vox reported.4. Stop the practice of practicing defensive medicine to keep from being sued. Excessive tests to “CYA” if the doctor doesn't immediately figure out the exact problem, and has an “ambulence-chaser” calling him. The English System, loser pays would help reduce this situation.5. Allow plans that fit the policy holder’s needs, not “one size fits all”. This is why the mandate was created. Force people who don’t need/want certain coverage based on age, sex, etc—everyone doesn't need the same coverage.Original Question: As of 2016, should the Affordable Care Act be judged a success or a failure and why?Preface: I've written 59 answers here on Obamacare (Patient Protection and Affordable Care Act) and you may link there for more of my many discussions. I will reference a few of these in my answer here.First let’s examine (a) what we were promised. Then let's see (b) what the impact on delivery of the Affordable Care Act (ACA) has been. Finally let’s examine (c) where is ACA today in August 2016 and (d) How ACA is projected to be in the future.As we examine this, I will give you a question to ponder in the back of your mind as I make my case. Have you, or do you know someone who has heard, “I'm sorry, we don't take that insurance (card) anymore.” My doctor is going to retire earlier than she wants to because of all the unnecessary paperwork she is mandated to fill out. She specifically says, “It's that Obama Care!” It cuts into her and her staff’s time interacting with patients and the churn of her patients.Finally, before I outline my thesis: Why are we still debating this brave new world of health care delivery? It has a large group who hate it and another group who love it. It was signed into law six years ago, back in Mar. 2010. Isn't insurance meant to spread risk?(a) What we were promised?We were promised (37 times) specifically, that we could keep our Doctor. We could also keep our plan we had. This was based on a lie and repeated as a lie to move forward. We would see a bending of the cost curve; you will save $2500 per year on premiums. That has not happened yet either.Tom Byron's answer to What are the biggest misconceptions about Obamacare? (1) That you can keep your insurance if it meets Essential Health Benefits (EHB) level and you had it before the law was passed and it has not changed at all). My take on the reasons (behind the reasons) for Obama Care. by Tom Byron on Byron's Blog(2) It will cover millions of uninsured, but we all thought that our insurance we were paying for we could keep. It was sold to provide the 40 million who did not have insurance, to have insurance. We were not told about (1) above.From the Huffington Post (not FoxNews) this Sept. 23, 2013 article is scary as hell. Does anyone believe that 80% of the insured will have nothing to worry about?If you're one of the roughly 80 percent of Americans who already has health insurance through an employer or is enrolled in a government program like Medicare, the answer is: probably nothing.For nearly everyone else -- the 170.9 million people covered by employers and the 101.5 million enrolled in government health programs -- the ballyhooed launch of the Obamacare exchanges will mean little, according to health care, consumer and business experts."If you have employer coverage now, do not worry," said Lynn Quincy, a senior policy analyst at Consumers Union in Washington who specializes in health care issues. "If you're on Medicare now, please don't worry," she said.http://m.huffpost.com/us/entry/3...(3) It would be as easy as going to Expedia and booking a flight. We did not know that they didn't know how difficult designing a complex system of verifications, and subsidies from other agencies would be.(4) We did not realize how many people would be routed in to Medicaid. How will this bend the cost curve down and "won't add a dime" to costs according to President Obama?Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only "a trickle of sign-ups for private insurance." Health & Science - philly.com...(5) We did not know that the insurance companies would be compensated if they lost money. Risk corridors. PPACA the next shoe to drop. by Tom Byron on Byron's Blog(6) We were not told (originally) that millions would be dropped, or policies cancelled, due to EHBs, though we were warned. These people regularly get cancellation notices, except (a) they didn't see this coming, (b) they are now under mandate to switch and use a mostly inefficient web site.(7) Most people did not know that special interests would get waivers and delays in the implementation of the ACA. http://m.nationalreview.com/arti...(8) Most people thought they were immune from all this churn and mess with insurance, "I have a good policy with Delta Airlines, company provided. I am exempt." Not so fast, Delta sees a $100 million additional in expenses and may dump their employees into the exchanges. August 2013 - RedState...(9) Most people did not realize that a normal work week would change to 29 1/2 hours, due to ACA. 77% of the Obama jobs created are full or part time. Read here for the shocking answer. Breaking news from around the globe: U.S. news, politics, world, health, finance, video, science, technology, live news stream...This week, in August, 2016, we see that the insurance giant Aetna is pulling out of many insurance markets. They have a fiduciary responsibility to shareholders to maximize their profits. They project worse losses in the future after recent signNow loses. Less competition drives up costs. This is the death spiral that has been predicted. Now it has become even more real. As insurers exit the market and competition disappears, costs will only rise.(b) What is the impact on delivery of the Affordable Care Act (ACA)?There was no Republican support in passing this law. Those in the heat of this partisan battle saw what was happening. In spite of harsh criticism and much ballyhooing by Democrats they said the system being created would implode like a Stellar Supernova. So far, we are on schedule for that prediction.The bailout mechanism was placed in the law to prevent this collapse. It was labeled “risk corridor”, also known in the military as an ejection seat. Catastrophe coming up—bail out! The insurers were to be reimbursed for losses. This section was later deleted, the losses arose, they are bailing out.How many enrollees were predicted and how many are now covered. That's an interesting way to show great results. But is it an accurate result, as I mentioned earlier, insurance is about spreading risk. Under ACA the result is pseudo-wealth redistribution in the form of “free” health care.Today, after more than 6 years, you have too many elderly, sick and previously uninsured people. The young and healthy would rather pay the penalty for not being insured. Odd this is so great that for the first time you are penalized for not buying something. Odd?!How Many People Has Obamacare Really Insured? (2015) far, even if you accept the most optimistic math, Obamacare is hardly the unmitigated success that its many apostles proclaim. Whatever minimal gains in the level of commercial coverage that’s been achieved has come at a huge fiscal expense. This is not to mention the massive growth in costly and restrictive regulation.This why Aetna and others facing the difficulty of writing policies with 30% or higher premiums; the risks aren't being spread by sound Actuarial Analysis. For some graphs and charts to explain profits and losses in different markets, with and without competition.(c) Where is ACA today in August 2016?ACA is first and foremost a powerful campaign topic. Democrats want to make health care like VA care. Republicans want to repeal and replace—after several dozen attempts. Why repeal a failed program instead of expanding it? Some labor statistics show why.We have the lowest worker participation rate in many decades. 300.000 INDICATORS FROM 196 COUNTRIESCombined with an increase in part time work, this is not a benefit for the working class. Part time work is directly tied to ACA regulations forcing employers to provide health care or reduce employees hours. That is a no brainier, just like paying $15.00 minimum wage and reducing staff and automating staff.This is a new Applebee employee, a tablet!(d) How ACA is projected to be in the future?There are two schools of thought:(Mar. 2016) The Obama Health Care Legacy: More Coverage and Less Spending(Feb 2016) CBO: Obamacare Costs to Increase in 2016 As Millions More Get Subsidized InsuranceWhat is certain that ACA depends on which party is elected. This will be driven by the reporting of the November 2016 ACA premiums, state by state.Here is what may drive the election, in part, these new rates which have yet to be made public widely.Obamacare's November surprise Indeed, Republicans are already pouncing on UnitedHealth's decision as proof the law is unworkable. “You’re seeing the beginning of the so-called insurance death spiral," Sen. John Barrasso (R-Wyo.) said last week.Democrats say they will mount a vigorous defense of a law that has provided 20 million people with coverage — and point to Republicans' failure to propose any coherent alternative to Obamacare.Conclusion: I would judge it a failed but noble attempt. Universal health care may be the solution, but there are easier and less expensive ways. The government is never the least expensive not the easiest. They pick winners and losers, whereas a free market system allows the better ideas to compete and win. The discussion on how to accomplish this goal has been laid out. More details will follow depending on who is elected President in November, 2016.Obamacare's November surprise The last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare.But that looks increasingly likely as health plans socked by Obamacare losses look to regain their financial footing by raising rates.Read more: Obamacare's November surpriseUniversal Health Care…coming soon? by Tom Byron on Byron's Blog

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