Obamacare 5 years later. Crow, anyone?

[3point14]

No, but I'm happy to work with you to do an analysis. Why do you think emergency rooms cost so much?

So you thought you'd just say it with no justifcation, investigation or evidence because it strengthened your argument?

You do know you're supposed to put the conclusion after the thinking, don't you?

 

[sunmaster14]

So you thought you'd just say it with no justifcation, investigation or evidence because it strengthened your argument?

You do know you're supposed to put the conclusion after the thinking, don't you?

You asked for proof, which I take to mean some peer-reviewed study or whatnot. I have all kinds of reasons to support my claim, and I've offered to go through them with you. I have laid out some of those reasons why ER prices are inflated and may not reflect true costs:

(1) Captive consumers who don't ask for prices before consuming services;
(2) cross-subsidization of other hospital services, since there is less scrutiny of ER charges;
(3) Inflating the cost of uncompensated care for the purpose of justifying price increases to the government and the public and for the purpose of getting more government money and private contributions;


I have also hinted at some of the reasons why ER prices should actually be lower than for regular, scheduled care:

(1) Extremely efficient use of resources by putting the burden of waiting on the consumers rather than the providers; triage especially increases efficiencies;
(2) Countercyclical usage patterns, so that most ER use is after-hours during a time when hospital resources are usually idle;
(3) Use of doctors being on call rather than at the hospital, so they can be doing something useful whenever there is less than expected demand.


Now, there are actually studies showing that ER prices have far more variability from patient to patient and ER to ER than prices for clinical care. I think this is evidence that ER pricing is more arbitrary, and in fact, opportunistic than for other hospital services. Perhaps there is another explanation though.

Now, how about you explaining why ER costs should be higher than for clinical care. Why should it cost more for a doctor in the ER to prescribe antibiotics for a sinus infection than for an office clinician to do so?

 

[stevea]

I have also hinted at some of the reasons why ER prices should actually be lower than for regular, scheduled care:

(1) Extremely efficient use of resources by putting the burden of waiting on the consumers rather than the providers; triage especially increases efficiencies;
(2) Countercyclical usage patterns, so that most ER use is after-hours during a time when hospital resources are usually idle;
(3) Use of doctors being on call rather than at the hospital, so they can be doing something useful whenever there is less than expected demand.

I think you need to explain which resources you imagine are more efficiently used in this way.

Having a stack of specialists 'on call' awaiting a possible use, or having excess surgery or MRI facility spared against emergency need is certainly not a more efficient use of those resources - just the opposite.

Your countercyclical argument has a major flaw. The ER still needs excess capacity against the event of daytime emergencies. You can't schedule your MRI or surgeries or staff to 100% daytime utilization if they are also used for daytime emergencies.

The inefficiency is due to the statistical nature of the work load and the specialization of both human and equipment resources required. Yes triage helps use the physician resource better, at the cost of making ER patients wait - but it certainly doesn't approach the efficiency of a scheduled procedure. If internists could always stabilize difficult cases (sort of an improved triage), then we could use specialists more efficiently but that doesn't change the fact that load variations can swamp any resource and at other times cause under-utilization.

 

[sunmaster14]

I think you need to explain which resources you imagine are more efficiently used in this way.

Having a stack of specialists 'on call' awaiting a possible use, or having excess surgery or MRI facility spared against emergency need is certainly not a more efficient use of those resources - just the opposite.

Your countercyclical argument has a major flaw. The ER still needs excess capacity against the event of daytime emergencies. You can't schedule your MRI or surgeries or staff to 100% daytime utilization if they are also used for daytime emergencies.

The inefficiency is due to the statistical nature of the work load and the specialization of both human and equipment resources required. If internists could always stabilize difficult cases till normal working hours (sort of an improved triage), then we could use specialists more efficiently but that doesn't change the fact that load variations can swamp any facility and at other times cause under-utilization.

You're confusing the cost of maintaining the infrastructure needed to meet maximum demand (not unlike the electricity grid which must be designed to meet maximum demand on a hot summer day) with the cost imposed by what has been deemed inappropriate or unnecessary use of that infrastructure. It is considered inappropriate and wasteful for somebody to show up to the ER with a sore throat (because he has no health insurance) rather than a doctor's office. But the fact is that guy with the sore throat won't be seen by a nurse in the ER unless and until there is a lull in demand. The performance of triage is key. The patient alone bears the cost of his decision to use the ER by having to wait until the opportunity cost of resources there is low. The fact that he is billed $800 for a brief check up bears no relation to the opportunity cost of the resources he consumes.

 

[Nihilianth]

You asked for proof, which I take to mean some peer-reviewed study or whatnot. I have all kinds of reasons to support my claim, and I've offered to go through them with you. I have laid out some of those reasons why ER prices are inflated and may not reflect true costs:

(1) Captive consumers who don't ask for prices before consuming services;
(2) cross-subsidization of other hospital services, since there is less scrutiny of ER charges;
(3) Inflating the cost of uncompensated care for the purpose of justifying price increases to the government and the public and for the purpose of getting more government money and private contributions;


I have also hinted at some of the reasons why ER prices should actually be lower than for regular, scheduled care:

(1) Extremely efficient use of resources by putting the burden of waiting on the consumers rather than the providers; triage especially increases efficiencies;
(2) Countercyclical usage patterns, so that most ER use is after-hours during a time when hospital resources are usually idle;
(3) Use of doctors being on call rather than at the hospital, so they can be doing something useful whenever there is less than expected demand.


Now, there are actually studies showing that ER prices have far more variability from patient to patient and ER to ER than prices for clinical care. I think this is evidence that ER pricing is more arbitrary, and in fact, opportunistic than for other hospital services. Perhaps there is another explanation though.

Now, how about you explaining why ER costs should be higher than for clinical care. Why should it cost more for a doctor in the ER to prescribe antibiotics for a sinus infection than for an office clinician to do so?

As for 1) "caprive consumers that dont ask for prices."

What, exactly, do you suggest? Hospitals arent exactly like restaurants where you have a plethora of options, and make a choice based on price. As I have said before, a person without insurance have one of two options: go to the er, or not see a doctor at all. Thats it.

 

[Fudbucker]

"Last week Oregon’s insurance commissioner, Laura Cali, announced that the state had approved a 25 percent premium increase for the largest health insurer on the state’s exchanges. The second largest insurer did even better: It received permission to boost its monthly charge to consumers by 33 percent."
http://www.slate.com/articles/busin...care_has_been_solidified_but_it_s_failed.html

Well, that sucks for Oregon residents and is terrible news for Obamacare. If the GOP had actually gelled around a competing plan, they could be pushing it as an alternative, but they got nothin.

My biggest concern always was that the penalty/tax wasn't big enough and was too easy to get around (all one has to do to avoid the penalty/tax is finagle their taxes in a way where one owe's a small amount in April). If there's not enough of a stick, healthy young people aren't going to go for the carrot of moderately-priced high-deductible policies. That leads to an older, sicker pool of insurees.

Unless Oregon is some weird outlier, but it doesn't sound like it is.

 

[Nihilianth]

What's Oregon's politics like? Are they mostly conservative tea bag nutcases? If so, the GOP may lose votes from that state over this.

 

[thaiboxerken]

What's Oregon's politics like? Are they mostly conservative tea bag nutcases? If so, the GOP may lose votes from that state over this.

Mostly Democrats thankfully.

 

[CynicalSkeptic]

No, Oregon is pretty progressive. At least Portland is, I'm sure the rural areas are conservative like most of the US, but Oregon is a very Blue state overall.

 

[Z]

Without weighing in on the larger, enormously complex topic, a suggestion: Instead of eating ramen for the last week of the month, could you scatter your ramen days across the month, so you're only eating ramen one or two days at a time? Seems like it would be healthier and more enjoyable without costing any more.

Actually I just started doing that last month. Works much better.

Because I have only a micro-fridge and a small pantry, I usually buy my day's food each day; but lately I've decided that every time I get groceries I will pick up a dollar's worth of either ramen or rice, and I try to go to the store a little less often by eating some of my carb foods in between.

My food stamps is up for re-cert this month... I think I might be losing them anyway, which would be bad, since my paycheck is only about $20 a week after my rent is paid. ugh.

 

[Fudbucker]

Actually I just started doing that last month. Works much better.

Because I have only a micro-fridge and a small pantry, I usually buy my day's food each day; but lately I've decided that every time I get groceries I will pick up a dollar's worth of either ramen or rice, and I try to go to the store a little less often by eating some of my carb foods in between.

My food stamps is up for re-cert this month... I think I might be losing them anyway, which would be bad, since my paycheck is only about $20 a week after my rent is paid. ugh.

That's ridiculous, that in this country of billionaires, hard working people can't afford decent food.

Expand the Earned Income Credit so that a person who works earns enough to live a normal life. Say, $30,000 a year. Take it straight from the richest people. Direct wealth transfer.

 

[mikegriffith1]

If there's any crow to be eaten, it should consumed by those who still support Obamacare. We've had missed deadline after missed deadline, the Obamacare website debacle, illegal federal subsidies because 34 states refused to set up the insurance exchanges, employees losing hours so they won't qualify as full time so as to avoid Obamacare, nearly half of the exchanges facing large funding gaps because they have not proved to be self-sustaining (contrary to what we were promised), millions of people seeing their rates rise, millions of other people losing their policies and/or being forced to accept inferior policies, etc., etc., etc.

Let's inject some facts into the debate:

http://www.nakedcapitalism.com/2015...xity-quality-coverage-covered-california.html

http://www.forbes.com/sites/scottgo...te-house-saddles-onto-participating-insurers/

http://www.forbes.com/sites/sallypipes/2015/01/12/new-year-new-problems-for-obamacare/

http://www.breitbart.com/big-government/2015/05/25/obamacare-insurance-premiums-to-jump-up-to-51/

http://www.washingtonpost.com/natio...2eeea2-ea03-11e4-aae1-d642717d8afa_story.html

http://www.npr.org/sections/health-...re-policyholders-face-tax-surprises-this-year

 

[Grizzly Bear]

Expand the Earned Income Credit so that a person who works earns enough to live a normal life. Say, $30,000 a year. Take it straight from the richest people. Direct wealth transfer.

The whole tax the rich scheme definitely worked wonders for Greece when they blew through their budgets.... Just sayin' you can preach on taxing the rich all you want, but that money is still not infinite... and it fails to work its wonders as long as the tax loopholes remain.

In fact, that's one of the reasons I don't "eat crow" for berating Obamacare... One of the unintended consequences happens to be the spur of mergers taking place. I.E. lesser choices, moving more the the single payer system, (which leaves one financer).

All the while... still dealing with issues of patenting which continue the inflated healthcare prices...

Stuff I'm sure that can be improved, but everyone either wants the scorched earth policy with killing Obamacare, or wearing their rose colored glasses to dang long

 

[thaiboxerken]

Those austerity measures totally helped Greece recover from their latest recession......

 

[Elf Grinder 3000]

not if you hurry up and die......the conservative plan for healthcare.

The conservative plan is to privatize health care and remove the ability of companies to pay for health care pre tax.


Obamacare premiums are skyrocketing in the first year, why because there are no cost controls and the government has to pay for everything without accountability.

http://www.wsj.com/articles/the-unaffordable-care-act-1436569086

In a study across 45 states, the research outfit Health Pocket reports that mid-level Exclusive Provider Organization plans are 20% more expensive in 2016 on average. HMOs are 19% more expensive, and for all plan types the average is 14%.

President Obama dropped by Nashville last week to claim Tennessee as a state where “the law has worked better than we expected” and “actually ended up costing less than people expected,” so let’s test the reality of those claims. As a baseline, in 2015 premium increases for Tennessee plans ranged from 7.5% to 19.1%.

For 2016 BlueCross BlueShield of Tennessee—one of the state’s two major insurers—is requesting a 36.3% increase. One product line from Community Health Alliance Mutual is rising 32.8%, while another from Time Insurance Co. hits 46.9%. Offerings from Cigna, Humana and UnitedHealthcare range from 11% to 18%. If this means ObamaCare is working better than the President expected, then what, exactly, was he expecting?

So why are the premiums increasing so much??

Underlying health costs continue to rise, but this trend is merely about 3.5% to 7% depending on the state. Health plan profits are capped by ObamaCare price controls, so don’t blame corporate greed either. In a rational market, premiums wouldn’t be soaring in a single year by 49.1%-65% (Blue Cross Blue Shield of New Mexico) or 40.6%-58.4% (Geisinger Health Plans of Pennsylvania).

The detailed, fact-heavy actuarial filings justifying these increases show that they result from ObamaCare’s political regulations. The law bans insurers from charging people prices linked to their health risks in order to force the young and healthy to cross-subsidize their elders. But if premiums don’t cover medical claims, then premiums must rise to fund these cost transfers.

And what kind of people are signing up for Obamacare??

After the first two years of ObamaCare in 2014 and 2015, insurers have more experience with the demographics and expenses of the new enrollees. They seem to be older and have more chronic conditions like diabetes or congestive heart failure than predicted. There are also fewer than expected.

Among those eligible for the ObamaCare exchanges—meaning they lack coverage through a job, spouse or another government program—only about a third have signed up, according to HHS. The number of truants—despite the individual mandate penalty-tax—increases with income and as ObamaCare’s subsidies phase out.

The subsidies are most generous between 100% and 150% above the poverty line, where an ObamaCare policy is essentially free. Some 76% of eligible individuals at that level are enrolled, report the consultants at Avalere Health. But enrollment drops to 41% between 151% and 200% of poverty, and then to 30% at 201%-250%. At 251%-300%, the share is 20%, and 16% for 301%-400%.

Obamacare is a turd and now you're eating it. Pity if you were dumb enough to vote for a plan based on Socialism.

 

[Nihilianth]

If there's any crow to be eaten, it should consumed by those who still support Obamacare. We've had missed deadline after missed deadline, the Obamacare website debacle,

I stopped reading at the bold. Is that STILL a friggin talking point these days!?

What the hell? I mean, it's like complaining that a new road will not work, because your car broke down once.

Just....nevermind. I could write a million word essay, and STILL not be able to explain exactly why the bolded is all sorts of wrong.

 

[Nihilianth]

The conservative plan is to privatize health care and remove the ability of companies to pay for health care pre tax.

Let me make this perfectly clear:

It is already privatized! It has always been privatized! "Privatizing healthcare" is NOT any sort of plan to bring healthcare costs under control! Because....IT'S NOT A PLAN! It already exists!

That's like a general saying "I have a plan for invading Iran, and it's called D-Day!"

Just....GAH!

Sorry, I;m up for more torture.

So why are the premiums increasing so much??

"So much?" You do realize that the increase in premiums is a hell of a lot lower than it has been every single year for the past 20 years, right?

And what kind of people are signing up for Obamacare??

Nobody is "signing up for Obamacare." Obamacare (ACA) is a LAW. Not for anyone to "sign up for!" That's like asking "why are so many people signing up for a speed limit??"

 

[Elf Grinder 3000]

Let me make this perfectly clear:

It is already privatized! It has always been privatized! "Privatizing healthcare" is NOT any sort of plan to bring healthcare costs under control! Because....IT'S NOT A PLAN! It already exists!

That's like a general saying "I have a plan for invading Iran, and it's called D-Day!"

Just....GAH!

Sorry, I;m up for more torture.

The majority of health care dollars are paid by the government, medicare, medicaid.

http://www.forbes.com/sites/chrisco...-make-up-66-of-healthcare-spending-obamacare/

Compare that to healthcare. In 2009, federal, state, and local governments accounted for more than 60 percent of all healthcare spending. (Note: official government figures underestimated the federal share of health spending in 2009 by nearly a third—a difference of $265 billion. Due to accounting conventions that go back to the 1960s, these estimates fail to include the tax expenditures that subsidize insurance coverage and health spending.[2])

You are wrong!

APOLIGIZE!

 

[Elf Grinder 3000]

The ignorance in this thread is completely astounding.

This is evidence why we shouldn't have liberals telling us how we have to spend our own money. If you want health care pay for it yourself.

 

[Nihilianth]

The majority of health care dollars are paid by the government, medicare, medicaid.

http://www.forbes.com/sites/chrisco...-make-up-66-of-healthcare-spending-obamacare/



You are wrong!

APOLIGIZE!

That's like saying "we need to privatize grocery stores," because "FOOD STAMPS!"