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Pipe dream? Obamacare
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isobars



Joined: 12 Dec 1999
Posts: 13792

PostPosted: Thu Jun 06, 2013 7:06 pm    Post subject: Reply with quote

Last poll: only 19% of Americans think they will benefit from Obamacare.

(Twice as many people think they will be worse off under the new law than those who think they will benefit from it, 38% to 19%, the new Journal/NBC poll found. )

No surprise, since that "47M new people will have health insurance" has plummeted to 15M.

Just one of many gaping flaws in Ocare is this tidbit:
" Former CBO Director Douglas Holtz-Eakin estimated in a study for the American Action Forum that more than 40 million workers would lose their employer coverage due to these perverse incentives. Itís going to be even worse than that, when all of the cost increasing impacts of Obamacare are realized."
from http://tinyurl.com/cd2fnsq .
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nw30



Joined: 21 Dec 2008
Posts: 1535
Location: The eye of the universe, Cen. Cal. coast

PostPosted: Thu Jun 06, 2013 8:17 pm    Post subject: Reply with quote

mac wrote:

It didn't move the dial in California appreciably. We didn't, before the ACA, have a competitive health care system in the United States. It is sad that too few of the conservatives actually understand what barriers there were to competitiveness, or how difficult it is in a system like health care. We have a cartelized and brokered system, with pay for services as the fundamental financial cornerstone. Only too bizarre to blame it on Obama.

Dude, you have successfully identified the problem, but you think that the govrn't stepping in is the solution, however you say this "It is sad that too few of the conservatives actually understand what barriers there were to competitiveness, or how difficult it is in a system like health care", we do, oh so clearly, that is why I keep saying that there is an "easier road" to provide some more competition w/in that sector.
Too many hoops to jump thru, by design.

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swchandler



Joined: 08 Nov 1993
Posts: 5685

PostPosted: Thu Jun 06, 2013 8:22 pm    Post subject: Reply with quote

To coboardhead's point, my first cardiologist suddenly retired, and I found out later that he apparently did so after learning that his yearly malpractice insurance would be $75K. I have to say though, he was in his late 70s, and his client load wasn't that high, so it made sense for him to close his practice.

Today, in the litigious environment that surrounds health care these days, one has to decide what's fair and reasonable when mistakes are made. Certainly, mistakes will be made, and when they do, the victims need to be able to hold doctors and medical practitioners responsible within the bounds of reason. A formidable challenge for Congress to negotiate. One wonders whether the Republicans are up for such a difficult challenge.


Last edited by swchandler on Thu Jun 06, 2013 8:33 pm; edited 1 time in total
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windoggie



Joined: 22 Feb 2002
Posts: 2358

PostPosted: Thu Jun 06, 2013 8:24 pm    Post subject: Reply with quote

It sure is easy to bitch about it when you don't have to actually do anything about it. What a bunch of spoiled whiners.
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windoggie



Joined: 22 Feb 2002
Posts: 2358

PostPosted: Thu Jun 06, 2013 8:27 pm    Post subject: Reply with quote

Sorry, I forgot to add "just sayin"
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isobars



Joined: 12 Dec 1999
Posts: 13792

PostPosted: Thu Jun 06, 2013 9:11 pm    Post subject: Reply with quote

nw30 wrote:
you think that the govrn't stepping in is the solution, however you say this "It is sad that too few of the conservatives actually understand what barriers there were to competitiveness ...

The foremost barrier to health care and health insurance competitiveness is the stated objective of the most powerful man in the world when he said on camera > 5 years ago that he wants single payer government managed health care ... socialized medicine ... within 15-20 years.
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keycocker



Joined: 10 Jul 2005
Posts: 3203

PostPosted: Thu Jun 06, 2013 11:10 pm    Post subject: Reply with quote

To Bushes credit, one of his priorities was what he called tort reform.
He tried to limit the madness, esp. in cases where the lawyers take home ten thousand a day while the plaintiffs each get a Ten dollar gift certificate on a new car when the case is won.
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mac



Joined: 07 Mar 1999
Posts: 4957

PostPosted: Thu Jun 06, 2013 11:19 pm    Post subject: Reply with quote

CB--it is pretty frightening how many people are injured or hurt by bad health care, and there should be some relief. I know little about the Colorado experience--but I trust your honesty.

The idea that we can have an idealized market is an Ayn Rand fantasy. Take just one example--hip replacements. The cost differences, within the Bay area, and from region to region, are staggering--factors of 2 to 3. In addition, there are some inferior products that have been placed in people--malpractice in my book. Now almost nobody shops from hospital to hospital to see what the cheapest hip is--and what additional problems or risks it may involve. People trust their primary care provider and take his/her advice. That's what I almost always do.

So this system completely lacks the transparency and mobility that defines markets. Compounded by the differences in insurance programs, and sometimes deceptive advertising, and exceptions to coverage. Then there is emergency care. When you are in an ambulance with potentially life threatening injuries--something that has happened to me twice--you don't price shop. If NW had bothered to read the Time article I posted here he might be better informed about the barriers to market behavior in the medical arena.

NW--I agree that government is part of the problem--as is the nature of the existing insurance systems. For most of our lives, medical insurance was paid by employers, and not treated or taxed as compensation. It thus sent no price signal to most people, and price elasticity simply didn't exist. Even with the substantially reduced price elasticity that exists in medical products, a compensation system that treated health care benefits as taxable income, and gave consumers broader latitude (and information) in making decisions would result in better decisions about coverage, preventive care, and catastrophic coverage. But such a system doesn't exist.

Some, like Isobars, have likened Obama care to the VA. Nothing could be further from the truth. The more likely model for parts of Obama care is Medicare. Let's go back to the hip replacement question. Medicare establishes what they will pay for procedures like hip replacement, and many insurance companies use that as a guideline for what they will pay. So in the case of the different "prices", which might vary by a factor of three, those insured by Medicare and most insurance companies pay the Medicare amount, and the advertised prices are like the first price you're asked to pay at the Bunny Ranch. Fantasy money.

So while you think that the government is the problem, in this case it actually is the solution. Medicare has held the rate of health care cost increase well below the non-Medicare sector. Perhaps some mythical market system would work better, but Medicare represents about 45% of medical costs, and it is not politically possible to move from here to there.

Health care systems like Kaiser, which use a wellness business model instead of a pay for service business model, have done an excellent job of reducing costs. I am very happy with my Kaiser coverage--through a very expensive car crash, thyroid cancer for one daughter, an emergency C-section and near death of that daughter and her twins, and the cerebral palsy and epilepsy of one of those twins. But such systems are few and far between, and efforts to scale them up haven't been uniformly successful. If you had actually paid any attention to the meat of the health care debate, and looked at some of the bill, you would see that the legislation didn't try to push everything in that direction, although it did include experiments in a number of areas intended to slow cost increases.

Iso's figures about unhappiness with Obama care are nonsense--the ravings of a violent lunatic. While less than a majority favor it as is, that is because many wanted more coverage or a single payer system. That is only one, but a significant reason, that Obama was re-elected. But there are ranters on this forum who, faced with the fact that he managed to finesse the ACA through without any Republican votes--something that has eluded about 6 previous presidents--claim he can't lead. That, dear sirs, is poppycock.
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coboardhead



Joined: 26 Oct 2009
Posts: 1910

PostPosted: Fri Jun 07, 2013 12:02 am    Post subject: Reply with quote

Mac...yes, medical malpractice is an issue and those that are damaged deserve compensation. But, the question is...how much compensation. Tort reform efforts that cap non economic damages make sense to me. We have to draw the line somewhere and define what it is we as a society are willing to provide...including awards for damage due to medical errors.

A physician cannot charge LESS than Medicare allows, but can charge more to other insurance plans. the rule is Medicare has to get the best price...not the other way as you indicated. So, Medicare only sets the low fee...not the high fee. Most physicians do not accept Medicare as the customary fee and do charge more. In my experience Medicare drives UP the cost of private pay because the reimbursement rates have been, historically, low and the costs are shifted.

One thing you brought up that is a very big problem is that fees seem to fluctuate based on little reason except to see what some,one will pay. This is real tough on the consumer.
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mac



Joined: 07 Mar 1999
Posts: 4957

PostPosted: Fri Jun 07, 2013 10:46 am    Post subject: Reply with quote

CB--agree on your comment on tort reform; we do need to work all issues, including overcompensation. My point was that it is not the biggest thing to worry about in bending the curve.

Some insurance companies do pay more than the Medicare amounts. When my wife and I were nearly killed in a car accident, with huge surgery bills (no time to shop), the Wisconsin hospitals and doctors accepted the Medicare fee amounts offered by Kaiser and told me they were happy. The statistics about holding the cost increases down are accurate--but with all averages there are exceptions.

I don't know how you fix big pharma.
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