Repealing ACA

Editorial Team / Admin · Jun 29, 2017

What are your thoughts? Please begin the discussion.

Orca, ADN, ASN, RN · Jun 29, 2017

We need to get away from a system that ties health insurance to employment. This isn't done in any other industrialized country, and employers have learned how to manipulate the system by keeping full-time employees' hours just below the threshold where they have to provide benefits. It seems to me that a single-payer system would be the best option. That way, companies with a profit motive wouldn't decide what care that we would or would not get.

Canada's system seems to work pretty well. I never had to worry about whether my grandfather had to choose between food and medicine, whether he would have the money to get the care that he needed, or whether he would lose his home due to medical bills. All of those would be concerns here. Reports of Canadians pouring over the US border to get care here are completely overblown. It just doesn't happen very often. We pay more for health care than any country on earth, and our results are middle of the pack.

TriciaJ, RN · Jul 1, 2017

I think a combination of catastrophic care plus health savings account would be the way to go. A catastrophic policy is usually pretty inexpensive but takes away the financial worry if something major happens. A health savings account would pay for the routine stuff and you would be using the money you otherwise would for high premiums.

I have noticed that people absolutely hate the idea of using their own money for health care. I don't know why that is. We use our own money for everything else.

heron, ASN, RN · Jul 1, 2017

I think a combination of catastrophic care plus health savings account would be the way to go. A catastrophic policy is usually pretty inexpensive but takes away the financial worry if something major happens. A health savings account would pay for the routine stuff and you would be using the money you otherwise would for high premiums.
I have noticed that people absolutely hate the idea of using their own money for health care. I don't know why that is. We use our own money for everything else.

How large would an hsa have to be in order to pay for routine care for an insulin-dependent diabetic? Hint: lantus now retails for around $300 per 10ml vial (a 28 day supply). Then there's test strips (about a dollar apiece), labs, work-ups and meds to manage related health issues and pcp visits to direct it all.

Hsa's sound good on paper, but with the cost of living nowadays, they make sense only if you're young and completely healthy.

MunoRN, RN · Jul 1, 2017

I think a combination of catastrophic care plus health savings account would be the way to go. A catastrophic policy is usually pretty inexpensive but takes away the financial worry if something major happens. A health savings account would pay for the routine stuff and you would be using the money you otherwise would for high premiums.
I have noticed that people absolutely hate the idea of using their own money for health care. I don't know why that is. We use our own money for everything else.

That's the system we currently have and people don't seem to like it. One of the common complaints is that deductibles are too high, so I don't really see people embracing plans that are more catastrophic coverage oriented (higher deductible) plans.

HSA's currently exist and are more common than ever, but it's not really feasible to replace insurance with HSA's, since potential costs per patient can exceed $1 million, so for our system to be largely HSA dependent we would have to put massive amounts of money into everyone's HSA, which is cost many times what we pay now for healthcare.

TriciaJ, RN · Jul 1, 2017

How large would an hsa have to be in order to pay for routine care for an insulin-dependent diabetic? Hint: language now retails for around $300 per 10ml vial (a 28 day supply). Then there's test strips (about a dollar apiece), labs, work-ups and meds to manage related health issues and pcp visits to direct it all.
Hsa's sound good on paper, but with the cost of living nowadays, they make sense only if you're young and completely healthy.

Another part of the equation is why stuff has to be so expensive. Yes, R & D costs money, but there is a certain amount of gouging that happens. Other countries negotiate with big pharma.

TriciaJ, RN · Jul 1, 2017

That's the system we currently have and people don't seem to like it. One of the common complaints is that deductibles are too high, so I don't really see people embracing plans that are more catastrophic coverage oriented (higher deductible) plans.
HSA's currently exist and are more common than ever, but it's not really feasible to replace insurance with HSA's, since potential costs per patient can exceed $1 million, so for our system to be largely HSA dependent we would have to put massive amounts of money into everyone's HSA, which is cost many times what we pay now for healthcare.

But wouldn't costs over a certain dollar amount qualify as catastrophic?

allnurses Guide · Jul 2, 2017

I think single payer is the way to go. Everyone gets healthcare regardless of socio-economic status.

TriciaJ, RN · Jul 2, 2017

I think single payer is the way to go. Everyone gets healthcare regardless of socio-economic status.

It works well in Canada, but we only have 1/10th of the US population. We also went from self-pay to single payer; we didn't have the challenge of upending a whole lucrative industry. I can see many challenges to US going single-payer.

But we do need to do something. The "Affordable" Care Act is anything but for the middle class.

TheFrenchGirl · Jul 6, 2017

Hi, sorry wrong post

RobbiRN, RN · Jul 7, 2017

I agree with either single payer or combo of catastrophic and HSA. ACA did nothing to fix waste, inefficiency, inequity, and a hoard of middlemen (insurance and legal people) siphoning billions out of the the system. Healthcare cost increases have continued to grossly outpace other inflation factors during the ACA experiment. ACA is not sustainable, and the current proposals do nothing to fix the real problems.

Single payer has worked well in other countries because they have less legal and regulatory clutter. Our government is already the largest payer and the largest creator of clutter. Can we make them the only payer without an exponential increase in clutter? And how could we just shut down the massive--and very lucrative for the 1%--insurance industry? The legal people need the system to stay messy so they can get paid to sort through all the ambiguity when they aren't busy suing.