[vertex-four]

But if you're rich you have low wait times, so it's all good.

Frankly, Obamacare is a bit of a failure for some - I have friends who have "insurance plans" that don't actually cover anything without a deductible that they can't afford. Care for ongoing conditions is essentially not covered as a result.

The thing is... they'd have no healthcare at all under the previous system either, so going back to that isn't a solution for them.

The only real solution is single-payer healthcare paid out of taxes - unless you believe that somebody's right to live depends on how much money they make.

[FussyZeus]

The ACA is far from perfect, though it doesn't help that the more aggressive components were kneecapped by Republicans so Republicans could bitch about the weak points for the next 7 years or so.

I'm a big believer in Single Payer, I mean come on, we have huge rolls of the public already on Medicare for a variety of reasons. Why not just put everyone on it and be done already?

[chimeracoder]

> I mean come on, we have huge rolls of the public already on Medicare for a variety of reasons. Why not just put everyone on it and be done already?

1) Medicare isn't single-payer; it's a multipayer system

2) The government-run portion of Medicare underperforms the private payers in cost, medical outcomes, and patient satisfaction (the three primary axes on which success is measured).

If you want to point to data that suggests that a single-payer system would be successful in the US, Medicare is the last example you want to pick, because it suggests the exact opposite.

[FussyZeus]

> The government-run portion of Medicare underperforms the private payers in cost, medical outcomes, and patient satisfaction (the three primary axes on which success is measured).

Would you be willing to cede that this is likely because their patient base grows constantly and yet their funding is cut at every turn? I'm not saying it's their only issue, but constantly being drained of resources while getting additional work to do makes it somewhat incredible that they operate as well as they do.

[chimeracoder]

> Would you be willing to cede that this is likely because their patient base grows constantly and yet their funding is cut at every turn?

Medicare Advantage is growing faster than Medicare and operates on the same budget, so no, that's not an explanation for Original Medicare's shortcomings.

[maxerickson]

You can dictate prices and have a private service model.

See Medicare Advantage for a US based example of this that is fairly popular with consumers.

[vertex-four]

> You can dictate prices and have a private service model.

Perhaps, but at that point, you usually have a system where providers see their only way of making a profit as cutting costs - except those cuts are never passed onto the taxpayer. It's the worst of both worlds. NHS England has been forced into selling off parts of its operation in a similar manner to what you're suggesting for ideological reasons, and it's only cost us more money for worse service.

Perhaps it works where there's actually competition - e.g. where there's a choice of half a dozen providers owned by entirely separate entities that you could reasonably go to, which might be the case in some cities - but it doesn't work where there's few options for service users.

[chimeracoder]

> You can dictate prices and have a private service model. See Medicare Advantage for a US based example of this that is fairly popular with consumers.

Medicare Advantage doesn't dictate prices. And indirectly, this is the entire reason that it it's popular (the service is substantially better).

[maxerickson]

For additional services, but what about Part A and Part B? Seems that Advantage plans get similar pricing to traditional:

http://content.healthaffairs.org/content/34/8/1289.abstract

[chimeracoder]

> For additional services, but what about Part A and Part B? Seems that Advantage plans get similar pricing to traditional:

Parts A and B are Original Medicare. If you're on Medicare Advantage, it replaces Part A/B coverage.

(It's also a bit more complicated than that, because Medicare Advantage plans are provided by the same private insurers who cover non-Medicare patients, and they'll structure their agreements in such a way that the extra payments are hidden. For example, "for every Medicare Advantage patient of ours you see, we'll reimburse an additional X% for non-Medicare patient" - it's not literally like that or that explicit, but that's the shape of how it shakes out).