[ijusluvit]

Originally Posted by Quixote

I respectfully disagree, at least to a great extent. The "beginning" was a good quarter century ago or even a couple years more than that. There was a climate in our country that threw consumers and working Americans under the bus in behalf of whatever you want to call it: "big business," "multinational corporations," "the bottom line," "extraordinary CEO salaries and benefits packages," and so forth. At the risk of being off-topic for one statement, that was the time when corporations were able to begin shipping decent-paying American jobs to third-world countries, along with the death knell of American manufacturing industries.

As far as medical care was concerned, "big business" in the form of the insurance and pharmaceutical industries were given more control, taking it from the relationship between doctors and their patients. Soon an insurance clerk could tell a doctor what services he or she could--or could not--provide for patients. The focus became "the bottom line," less for the doctor and more for "big business." (I realize this is an ovesimplification.) As the well-paying jobs disappeared overseas (the jobs that invariably included health insurance coverage), the service businesses, which by their nature were nowhere near as profitable, did not offer health insurance coverage and created huge numbers of low-income workers, often at minimum wage or barely above, who now use hospital ERs for their medical care. One need only to refer to another thread about the long waits in ERs to understand this better.

When Medicare Part D was created in the first decade of this century, I looked at it and saw it as a travesty for senior consumers and a boon to the insurance and pharmaceutical industries. The government at that time went so far as to pass a law prohibiting Americans from buying their prescription drugs far cheaper in Canada (or from Canadian sources). And why were they cheaper in Canada, especially that they were the identical drugs? Because Canada required the pharmaceutical companies to negotiate prices based on bulk purchase, while in the U.S. the full costs had to be borne by seniors, in order to maximize profits for the companies, and who had also to contend with deductibles and "doughnut holes" even as drug prices rose!

Way back when, living in New York State, I had to have a radical surgery that was so serious that I had to be flown to another state for it to be done. My insurance company, Empire Blue Cross Blue Shield of New York State, covered about 20 percent of the cost, saying that that was their "reasonable and customary" payment for this surgery. Thankfully, NYS had a government that was supportive of its citizenry; I asked the NYS Insurance Department to demand of Empire how it had arrived at this "reasonable and customary" figure, since the surgery had never been performed in NYS! Thanks to this governmental agency's support, Empire was required to cover considerably more of its cost!

And it has continued to worsen. I'm in the care of a doctor since he began practice, and he's ready to retire, so I know him well. First, I asked him why out of the clear blue he had "sold his soul" to some major medical holding corporation. His answer? "The way things are going, we have no power anymore at all; we can no longer decide what's best for our patients. The corporation, much as we dislike it, is what medical care has become." Second, he confided to me that he had dissuaded his daughter from going to medical school, which had been a lifelong dream of hers. However, she understood, seeing what her Dad was going through, and instead is now in her second year of veterinary school and is happy with this second choice. But this means the loss of someone who would likely have become an excellent physician. Sad.

OK, I'm getting off my soap box....

You have identified some of the fundamental inequalities which have been part and parcel of health care in the most prosperous nation on earth.

My glass is half full - but I do get frustrated when I read posts from folks who are certain the Affordable Care Act is not an improvement.

Give it a chance. There will be tweaking. Just today the deadline for the small business insurance mandate was extended to 2015. I want to change insurance because my health situation has changed. I'm guaranteed I can do that. I'd woud have been turned down flat by every company in the past. Coverage will be extended to millions who otherwise end up in emergency rooms we pay for. The fraud investigation rules have changed and hundreds of millions have already been saved by catching crooks before they can raid the cookie jar. Etc, etc. etc.

Give it a chance.