Obamacare is flawed because it did not change any of the underlying causes that are driving costs higher.  

Agreed, and the one thing it did hope to change - more healthy people signing up thus lowering the average costs, hasn't worked out as hoped. Endless bashing of it hasn't helped either, for instance I've read articles with families complaining about the cost of Obamacare and the reporter said he plugged their details into the system in 5 minutes and found it costing like half as much as they say, because they were so biased against it they had already made up their mind about it without even looking.

Still, the point is Obamacare and privately insured will see their costs rise, and businesses will likely continue to pass on more costs to employees, when people are already feeling the squeeze.

Obamacare was indeed sold to the public with the promise of containing costs, but I think it was naive to expect it to fully deliver on that promise, if the players (i.e. doctors, hospitals, Drug companies and Insurers) were not really forced to change their ways.  It is still a fee based system and it is overused/abused.  

I can understand why Americans do not want to go to a single payer system, they hear the limits that will be imposed on them and immediately state their opposition to it.  As more and more cost is passed onto employees this attitude may begin to change.

Jester and lt cap,

Don't get me started! Lol. 

Almost everything about healthcare is a double-edged sword these days. Except for the *really* bad guys (Big Pharma - increasing prices 500% when a drug is in demand - shame!)

On the one hand, people without healthcare are the ones most screwed:

Each hospital, pharmacy, and all the way down to doctors have their 'shelf price' - an ungodly high and unfair top tier price. Most all of these places and people are contracted with various insurance companies, and that 'shelf price' has been negotiated down (or more often, really, imposed by an insurance company (insurance company guys are near the top of the 'deserved most hated' list) from that 'shelf price'. So, for instance, if you break a leg, let's say. If you've got insurance, most likely the majority of your expenses will have a 'negotiated price' if the hospital has insurance contracts with negotiated prices.  *Some* of the cost is going to come down to you, because the anesthesiologist and/or whomever is not contracted with your insurance. They are allowed (but should not be, imho) to do what is called 'balance billing' - they collect the 'negotiate fee' from your insurance co. PLUS they send you a bill for the difference between that and the negotiated rate. You are *never* informed of this in advance, even if you ask, you'll just get a generic answer. (Or, perhaps more fiendishly, perhaps the anesthesiologist will whisper his rate in your ear just before he *really* turns the anesthetic up to full blast, sending you into oblivion, and unable to object.) 

But you are still on the hook for 'balance billing' and if you don't pay up, eventually you get sent to collections and from there, your credit is pretty much ruined. Medical bills are, by a huge margin, the largest cause of bankruptcy in the country, in part I believe because either people don't have insurance, or they simply don't have the money to pay what insurance didn't cover. Remember that anesthesiologist? (Well, chances are you don't because he was far along the way in sending you to la-la land when it occurred to you whether he was part of your network and what his bill might be.) But he's still got his hand in your pocket. 

And even if you can handle those costs, other entities are probably going to get you anyway: A 'shelf rate' for a Tylenol might be $50/pill. Or, if the hospital is contracted, 50 cents a pill. Or, if your insurance 'formulary' (constantly changing) doesn't include Tylenol, only aspirin, *how* many pills at $50 a pop did you take while you were there, lol? Heroin is cheaper. And when you get the 57 page computer generated bill when you get home (assuming that, you weren't turfed out of the hospital early to make room for the next sucker, um, I mean patient, and you can walk on that recently broken leg, you'll probalby want to get into some real good smack so you don't flip out trying to simply decipher it. 

And yeah, everyone abuses the system to some degree. From my point of view, I have Obamacare, and I'm darn glad I do, even not forgetting about its huge flaws in implementation. I don't worry anymore if I have a medical issue, that if I send it to insurance, rather than pay out of pocket myself (which I had done for years), they'll kick me off and/or raise my rates. I was at the pharmacy the other day, and I was waiting in line to get an Rx filled. The guy at the counter had an Rx for the same thing I did - really. They told him his price (no insurance, I guess) was $70 - and he went away because he couldn't afford it. My cost w/insurance - $8. (No, it's not missing any zeros). 

One other thing - I have a fair amount of friends who are doctors. And they're good doctors, and really spend time and take good care of their patients. But Obamacare is just killing them unmercifully with paperwork. They spent a lot more time on that than with patients. And that's a real shame. Or criminal. And some of that isn't at all Obamacare's fault: Your insurance company (or Medicare for instance) is *constantly* changing their formulary - if you're on a medication that's working, and they take it off their formulary (and this freaking thing sometimes happens *weekly*), your doctor has to write an 'appeal' to keep you on the same med, rather than switching to an equivalent, or more often, a generic. And they have to go through explaining why the old med is medically necessary and the patient does not respond well to the new med, blah, blah, and in the end, most of the docs just give up filling out these criminal forms and prescribe what's on special this week - and a lot of them feel badly about it. But there's nothing they can do. 

If only a single-payer system would work here: Fair compensation for fair work. The Europeans have this down, so it's not impossible - well, it is to us. How come? Someting in the water? (Yes, I realize rationing or triage comes into the European system. But like Sweden I think it is - 50% taxes for 100% assurance that your health care needs (and other needs) are covered for as long as you live - I'd take that up if it were available, probably)

Jamok,

Good post, I think you have captured a good deal of the issues with the system, perhaps only missing a few.  There is no question that because the system is made up with human beings it is subject to so many abuses, including the Medicare fraud (rampant here in South Florida), and as you mention, big Pharma being out of control.  Then there is the impulse for a Doctor to do more tests than necessary (which may be performed at labs they own).  In short, it only takes a small percentage of players in any system to skew things negatively and drive up costs.

BTW, I am glad you mention that even though there is a negotiated price, Doctors and Hospitals still pass on some of the unpaid bills to the patient, it always ends up hitting the patient's pocket book, this, even as we are paying increasingly more for our coverage every single year.  In my case, my coverage went up by 7% this year, or about three times the rate of inflation. Now, I understand that things cost more every year, but I consider this intolerable, it is contributing to this country's troubles in an insane way.

I believe that given the fact that Medical care continues to far outstrip inflation (for decades if IRRC), resulting in an ever increasing cost for healthcare and forcing employers and Obamacare to pass on these costs, that it will eventually (who knows when, but it will) change people’s mindset and accept a single payer system.  Obamacare is but the first step towards that.

I would propose a system where employers are not off the hook, they would still pay a special tax which would be targetted for this purpose (I know, I knwo politicians would loot it) and of course there would be higher federal taxes for tax payers.  One way or the other we are still paying for this massive system (the saying: there is no free lunch comes to mind), so why not face up to it and fix it once and for all?

If we did, maybe its costs would be on par with European countries where they pay quite a bit less than we do on a per capita basis.