• Au sujet de l’accès aux soins de santé aux USA, par David Broussard :

    In light of the SCOTUS decision, let me (re)state a few things here. Insurance does not equal healthcare. Most if not all of the people who have insurance under the ACA are not getting substantive healthcare because their deductibles are so high. You could make all the current plans FREE for every single person in the United States and you’d still have millions who would not be able to afford access to healthcare. This is why the ACA was flawed from the start. It does nothing to provide access to healthcare. It provides access to INSURANCE. This has lined the pockets of insurance companies (both through individual payments and through subsidies) while actually INCREASING the amount of money it would take to access healthcare for the individual consumer. This is a GREAT deal for the insurance companies because most of the people who have insurance are NOT filing claims since they haven’t met their deductible - they are just getting routine preventative care that they could have gotten WITHOUT insurance pre-ACA and for a better price. The LIE that ACA is built on is that people need insurance companies to access healthcare. It is, in fact, the biggest insurance industry reform dodge in the history of our nation. Rather than addressing the cost of healthcare, this has been another bait and switch by the insurance company lobby.

    #santé #assurances

    • OK, so for solutions. First, I do think that people who dedicate their lives to medicine and those that develop drugs and equipment deserve to be paid for the work that they do. I will even include ALL forms of medicine and healthcare (naturopathic, etc.). I will call these “healthcare providers” because from those who develop and sell the tools for MDs to the RNs and LCNs and techs, everyone else, it’s all designed to provide care to the patient. So, the question has always been around how much and how the provider should be paid. This is tricky because you’ve got market influences at work, however, one thing that I DO know is that anytime someone “touches” money, they get a cut. So, if my $100 has to go from me to the government, to an insurance company, to a billing processor, to the practice, and finally to the MD, THOSE people have all got to be paid... So, the beginning of a solution is to first remove as many of those people as possible from the equation. This will increase the purchasing power of the patient to pay the provider. Incidentally, this is one of the reasons why self-pay rates are always lower than the billed rate - because there is a big advantage for the provider in not having to go through coding, billing, etc. I’m not against third parties, because some are really needed.. but, only when they are beneficial.. So, insurance companies ARE needed because if I have an accident, I’m not going to be able to pay $1M or something for my care. Even $20,000 would break me. So, clearly, insurance is needed. However, in my view, insurance is a big problem NOW because it’s overstepped it’s “help people pay for accidents or big medical bills that they would not be able to otherwise afford” genesis and moved into “you will now be dependent on us for all your preventative, routine, and major medical care.” Side note: I’m not addressing those who can’t even afford that preventative care right now because there is definitely a good solution for that but I feel like I need to get the basics down first. So, first step, reform the entire billing process. This is always the most difficult because it’s how people get paid. And, when you start messing with that (look at campaign finance reform!), you start to get strong opposition. But, IMO, if you don’t fight that hardest battle first, all other battles will be influenced by the $$ and the entrenched interests and you will not arrive at a real solution. Simple and transparent is better. Complexity hides corruption and breeds waste.