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Pipe dream? Obamacare
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pueno



Joined: 03 Mar 2007
Posts: 2703

PostPosted: Thu Mar 27, 2014 12:45 pm    Post subject: Reply with quote

mac wrote:
...is it 40 now, idle exercises to repeal the Act.

They've wasted taxpayer dollars to the tune of 51 or 52 attempts so far.
.
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Thu Mar 27, 2014 6:27 pm    Post subject: Reply with quote

The problems with the implementation of the ACA go much deeper than the obstructionism of the GOP. Of course, a reform of this magnitude should involve constructive participation from all levels. So, I am not forgiving the GOP for being that party of no on this.

BUT, I am totally unimpressed, but not surprised, by how poorly the HHS has been able to implement this plan.

An example. The ACA is providing incentives in the way of cash and disincentives in the way of reduced reimbursement for provider implementation of Electronic Medical Records (EMR's). My wife, and my best friend, both physicians, have been implementing EMR in their offices. Problem is...the HHS forgot (?) to require that EMR's are compatible from one system to another. The local lab here is on an EMR contract (with a third party) that forbids (seriously!) any other system from accessing theirs. So, these Docs cannot get lab reports unless they, completely, redo their EMR and buy the one the lab uses. So what now? My wife walks to the hospital to get lab results in her mailbox and ends up with a partial paper record.

Sorry to be long winded. I have more examples I will not boar you with. No one likes to be board.
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nw30



Joined: 21 Dec 2008
Posts: 1799
Location: The eye of the universe, Cen. Cal. coast

PostPosted: Thu Mar 27, 2014 7:24 pm    Post subject: Reply with quote

coboardhead wrote:
The problems with the implementation of the ACA go much deeper than the obstructionism of the GOP. Of course, a reform of this magnitude should involve constructive participation from all levels. So, I am not forgiving the GOP for being that party of no on this.



I can, when you get not 1 GOP vote on this, NOT ONE, doesn't that tell anybody anything? And many dems voted against it as well, not enough to kill it, but it was in no way a slam dunk at passage.
It's a classic example of passing something that was against the will of a % of people, that was far too large to be taken seriously.
It never had enough support from us subjects to begin with, it was rammed through, and nothing more.

_________________
I don't drink the 'cool' aid, I drink tequila, it's more honest.
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Thu Mar 27, 2014 7:42 pm    Post subject: Reply with quote

NW

I continue to argue that the basic structure of the ACA is the only type of reform to the health care system that is viable...either politically, or practically. I have way too much experience with dealing with Medicare to trust that a single payer could be implemented. Unless, it were done under a completely different bureaucracy. The problems in that system are so ingrained I do not think it could change.

So, enter the ACA. Basically, a pretty good outline for medical care and delivery. Not unlike successful systems in France and the Neth...as far as financing...a cooperative effort between private pay, insurance and government. The reimbursement system that will place a burden on results of treatment, rather than, strictly reimbursement for a treatment, is a step ahead of any other system in the world.

Problem is...too many self interests feeding at the trough. The ACA has created a system of middlemen (electronic records, quality of care specialists...yada yada) The definitions and processes should, and need to be, better defined. Rather than toss it out, why not fix it? Oh yeah...wouldn't want it to be a success would we?
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mrgybe



Joined: 01 Jul 2008
Posts: 2712

PostPosted: Thu Mar 27, 2014 11:08 pm    Post subject: Reply with quote

Regardless of the utter ineptitude displayed in the formulation, the enactment and the implementation of this law, and the staggering cost, there remains a fundamental question for which I have seen no satisfactory answer. We were told that about 15% of the legal population had no health insurance..........so about 45 million. This is a disgrace we were told and unthinkable for any civilized country. After four years of front page coverage, and six months of availability of insurance subsidized by the taxpayer, only 6 million have signed up. It is well known that a significant percentage of that number were not previously uninsured. Where are all the rest? Why aren't they rushing to take advantage of this opportunity for which they have been waiting for so long?
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keycocker



Joined: 10 Jul 2005
Posts: 3453

PostPosted: Fri Mar 28, 2014 4:23 am    Post subject: Reply with quote

That group of people so eager to sign up is an invention of the fake press.
They get free care now and many would like to continue on our tax dollars.
The fine was to give them a chance to put some money in the pot.
The planning for this was done by the conservative heritage foundation.
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swchandler



Joined: 08 Nov 1993
Posts: 5888

PostPosted: Fri Mar 28, 2014 4:32 am    Post subject: Reply with quote

The financial penalty for not buying insurance is far too light. Things will be much clearer once we learn how many folks elected to pay the penalty instead of choosing being responsible. Needless to say, as time moves on and penalties become more notable, things will slowly change to reflect greater participation.
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techno900



Joined: 28 Mar 2001
Posts: 1493

PostPosted: Fri Mar 28, 2014 7:54 am    Post subject: Reply with quote

Coboardhead said:
Quote:
The reimbursement system that will place a burden on results of treatment, rather than, strictly reimbursement for a treatment, is a step ahead of any other system in the world.


Conceptually, good thinking. But practical - I seriously doubt it. Very little in the way of medical treatments is cut and dry. A guy has a mild heart attack, has a few scans and tests, and has a stint inserted in a partially blocked artery.

How do you measure "results"? Fixed for the moment? Stints have proven to be only a temporary fix, so if the guy goes back for another or replacement stint, the doctor doesn't get paid?

The guy goes back in and gets a replacement stint and comes down with an infection. Does the hospital treat the infection for free because of bad results? They also find more blocked arteries and a bypass is needed - bad results (not enough testing) on the first visit and no reimbursement for the bypass?

The subjectivity is enormous, so who is going to be determining "results"? If the government can't get the basics right, how will they manage this element?

Pessimist? You bet!
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Fri Mar 28, 2014 9:00 am    Post subject: Reply with quote

All true Techno.

This cuts to an issue close to my heart (no pun intended). This process needs to be driven by the health care providers with "guidance" from the government. However, many do not trust those providers to do this. We have seen this on this forum, regarding tort reform. So, the government takes over the whole thing, with minimal input from the providers. And, clearly, they are not, currently, up to the task.

Back in the nineties, Clinton's attempts at health care reform
almost completely shut out input from the providers. Bean counters and lawyers were writing that legislation. It is why I opposed those attempts and started supporting the basics of the ACA back then.

This time, there was more involvement in the process by providers. However, they are now losing this day by day. There is just way too much industry (special interests) that muddy the waters surrounding legislation such as this.

It should be noted that the US is not alone. While our health care costs are a lot higher than other countries, the growth of these costs is not unique. France's system is incurring debt by the day. Canada is grappling with the costs of a aging population and a capitated funding system.

It is also worth noting that these cost containment strategies have been on the books for years in the Medicare program. With or without the ACA.
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Fri Mar 28, 2014 9:21 am    Post subject: Reply with quote

mrgybe wrote:
Regardless of the utter ineptitude displayed in the formulation, the enactment and the implementation of this law, and the staggering cost, there remains a fundamental question for which I have seen no satisfactory answer. We were told that about 15% of the legal population had no health insurance..........so about 45 million. This is a disgrace we were told and unthinkable for any civilized country. After four years of front page coverage, and six months of availability of insurance subsidized by the taxpayer, only 6 million have signed up. It is well known that a significant percentage of that number were not previously uninsured. Where are all the rest? Why aren't they rushing to take advantage of this opportunity for which they have been waiting for so long?


I have been questioning this also. My theory is that there is an element of the population that just does not care to be responsible about paying for their health care. (Based on doing my wife's books for 5 years). These folks are planning on continuing to game the system as they have for years.

The ACA should have forced this issue by allowing any provider to refuse to treat someone who is not going to pay for it or does not have insurance.
Now, depending on the State, ER's must take any patient. Private practices , here, are not subject to those rules. These folks may have a lot of difficulty in the future getting treated for non-emergent conditions.
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