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Pipe dream? Obamacare
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swchandler



Joined: 08 Nov 1993
Posts: 6034

PostPosted: Thu Apr 04, 2013 2:41 am    Post subject: Reply with quote

Well, NW30, I have to give you credit for finding a more credible source that appears to support your point of view. It would have a much better strategy for you to have posted it first instead of the Fox News article.

That said, I think that Klein was unfairly taking a lighter weight view of the fact that the Republican governors and the GOP have been fighting tooth and nail to defeat both President Obama and the ACA through the election and through the Supreme Court. Ironically, as we have learned right up to the election, the Republicans thought they had it all in the bag only to lose everything. Still though, the real risk was rooted in how the Supreme Court would rule. Nobody, and that includes the Obama Administration, was going to seriously invest in what was needed until that was determined. Klein's admonition that Obama should have been running an impeccable operation is a bit out of tune in my view. However, he is right about the need to ensure that federal programs are run efficiently, and I would add, effectively too.

Lastly, I'm with coboardhead concerning the ACA. The Republicans have accomplished nothing. To show that they have their act together, they need to be smart enough to change the ACA to a more perfect program, and in addition, work to cut health care costs. You know, I don't think the Republicans have the stuff to pull it off. It will be like their bold promises for more jobs if they were elected to Congress in 2010. They won the majority in the House of Representatives, but have they done? Absolutely nothing.
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isobars



Joined: 12 Dec 1999
Posts: 14634

PostPosted: Thu Apr 04, 2013 8:04 am    Post subject: Reply with quote

nw30 wrote:

Obamacare Incompetence By Joe Klein

Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.
<snip>
Sooner or later, the Democrats may come to understand that making it run efficiently is the prerequisite for maintaining power.

• This ACA is starting to sound, look, smell, feel, walk, and quack like Bush's wars: Big fanfare, great opening act, then ... Bupkus.
• The administration (euphemism for "the president") doesn't want to set up exchanges. That would delay his stated goal of a single-payer centralized health care system (euphemism for socialized medicine, straight from the dictionary), and would take time from his obsession with celebrities.
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coboardhead



Joined: 26 Oct 2009
Posts: 2036

PostPosted: Thu Apr 04, 2013 9:00 am    Post subject: Reply with quote

Interesting article NW. I have read Klein before, and he makes good points. There is no question that they are behind on implementation efforts and are playing catchup.

I will not go into details on problems that small practices are having (not going there again) meeting the hastily assembled new Medicare regulations, coding and record keeping. Suffice to say...organization is lacking! I have long had issues with an electronic medical record system program that relies on a number of vendors integrating their programs. As I have indicated many times, the federal government should have supplied this years ago in house.

I also agree with SWC, this administration has had to spend way to much time defending the law and not enough time working on it. This law requires (and it is a good thing) that the states come to the table. Many have been dragging their feet. The Feds can only force the states to do so much (another good thing).
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mrgybe



Joined: 01 Jul 2008
Posts: 2899

PostPosted: Thu Apr 04, 2013 9:59 am    Post subject: Reply with quote

coboardhead wrote:
I do not believe that voters will give up the popular parts of the plan

And therein lies the problem with this and with many other government programs. I wonder if future generations will sympathetically understand that we just had to have all these benefits regardless of the enormous costs we will be passing on to them.
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mac



Joined: 07 Mar 1999
Posts: 5581

PostPosted: Thu Apr 04, 2013 11:30 am    Post subject: Reply with quote

Irony and forgetfulness provide low brow amusement for us partisan lefties. We now have mrgybe and NW30 bemoaning the lack of progress on insurance exchanges. If I remember, and I'm old enough to forget a lot, mrgybe repeated one of the few substantive criticisms of ACA, and suggested robust insurance exchanges as a market-based alternative. To be sure, the concept is thoroughly red, proposed at one stage if not initially by the Heritage Foundation. I am just shocked that assembling an implementation plan for the ACA is more complicated than anyone ever realized--that has never before happened in any new ideas. I am equally shocked that defending the program politically and legally has diverted some of the Obama administration's attention. But I am mostly amused by how the right is now blaming Obama for the difficulty he has had implementing their idea. I offer this comment:

Quote:



By: Jon Walker Tuesday April 2, 2013 8:20 am

Private health insurance exchanges, like those created by the Affordable Care Act or in Medicare Advantage, have historically failed to control cost. Part of the reason is the basic economic issue of individuals lacking real market power and actually choosing the “best” insurance option, which is extremely complicated. Another problem is lobbying related.

Whenever you needlessly create private middlemen you also create another layer of lobbyists. You don’t just have providers lobbying for higher prices, you now have private insurances companies lobbying for them as well. Because of their business design these middlemen are even better at lobbying and/or rallying their customers to lobby. This dynamic makes what we have seen happen in Medicare Advantage more likely to occur. From CNN:

CMS had initially proposed a 2.3% reduction in what the government pays the insurance companies that provide the plans — a move that would have saved the government money but potentially would cost the public more.

However, CMS on Monday announced a 3.3% increase instead.

Insurance companies were upset by the proposed cut, and spent the public comment period time lobbying legislators and running ads against it.

The idea is that exchange insurance companies are going to drive down the price by competing over a share of the pie. While they do some of that, they also get together to lobby to make the whole pie bigger.


CB--road biking. The first metric century has 4,500 feet of climbing, so it appears to be a standard. I did the long climb yesterday--with two other guys over 64. Slow but stubborn.
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coboardhead



Joined: 26 Oct 2009
Posts: 2036

PostPosted: Thu Apr 04, 2013 11:37 am    Post subject: Reply with quote

Mrgybe. I hope you will be wrong. We really have to get the cost shifting that occurs in medical care under control, make preventative care a priority and begin to contain costs. We have not maintained our health care system and it is time for us to do that work. It will cost us now to save later on.

Or, we will be forced into a single payer system. We cannot shoulder future generations with estimated health care costs that could eat up a third of our GDP.
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mrgybe



Joined: 01 Jul 2008
Posts: 2899

PostPosted: Thu Apr 04, 2013 11:53 am    Post subject: Reply with quote

mac wrote:
We now have mrgybe and NW30 bemoaning the lack of progress on insurance exchanges. If I remember, and I'm old enough to forget a lot, mrgybe repeated one of the few substantive criticisms of ACA, and suggested robust insurance exchanges as a market-based alternative.

Two more pieces of fiction
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mrgybe



Joined: 01 Jul 2008
Posts: 2899

PostPosted: Thu Apr 04, 2013 12:05 pm    Post subject: Reply with quote

coboardhead wrote:
It will cost us now to save later on.

Unfortunately, it will not cost us now. We will continue to run large deficits, in part caused by ACA, we will borrow the money to fund those deficits, and enough people will continue to profess that debt and deficits don't matter. I've been responsible for a number of large scale reorganizations in my lifetime. I have a very bad feeling about this one both from an economic and from an organizational perspective.
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isobars



Joined: 12 Dec 1999
Posts: 14634

PostPosted: Thu Apr 04, 2013 12:24 pm    Post subject: Reply with quote

coboardhead wrote:
I have long had issues with an electronic medical record system program that relies on a number of vendors integrating their programs. ... the federal government should have supplied this years ago in house.

Such as the vaunted VA electronic record system, which lost all my records twice? If I hadn't obtained and kept (against regulations at the time) all my VA and USAF records, I'd have lost man-years of effort and most of my VA services, maybe permanently.

I repeat: twice.

And once again: Medicare costs 1,000% of its projected costs. Why will Obamacare, as he calls it, be any different?
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swchandler



Joined: 08 Nov 1993
Posts: 6034

PostPosted: Thu Apr 04, 2013 12:55 pm    Post subject: Reply with quote

mrgybe, seemingly you feel it's wrong for the government to help poorer Americans by providing them with ACA coverage at reduced or no cost. What would you propose instead? It's not like poorer Americans will not require medical care, so the unavoidable issue is who is going pay for it? I think that most sensible folks understand that the system that we have been living with before passage of the ACA is not a viable solution.
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