Obamacare 5 years later. Crow, anyone?

[Meadmaker]

And if they have skyrocketed because of the restrictions in Obamacare how will making it fully 100% government funded even work?

The same way it works in all of the other places that have it?


I find myself listening to conservative talk radio, and as long as they are talking basic principles, I find myself in agreement. However, when they get down to policies and the general impression of what they say, I find myself saying, "What??????"

One of the principle reasons is statements like yours. There's no reasonable, measured, analysis or consideration. There is "It won't work!" There are claims that the economy will be destroyed. The social fabric of the country wil crumble. Yada, yada, yada.

Of course Obamacare made things more expensive. You don't get something for nothing. However, it didn't destroy the health care system. It isn't solely responsible for cost increases, which have been staggering for years now. Also, and most importantly, we really did get something for our money. Things are better now. More people can get health care than could before, without bankruptcy, and that's a good thing.

So, when I look at the tradeoffs, what I see is a plan that isn't the best, but it could be a whole lot worse. Meanwhile, from your side, I see, "The sky is falling and it's Obama's fault!" So when election day rolls around, I end up going with the people who at least are willing to do something, even if it's not exactly what I would do, and even if I know that it isn't going to be what they promise.

 

[RandFan]

The same way it works in all of the other places that have it?


I find myself listening to conservative talk radio, and as long as they are talking basic principles, I find myself in agreement. However, when they get down to policies and the general impression of what they say, I find myself saying, "What??????"

One of the principle reasons is statements like yours. There's no reasonable, measured, analysis or consideration. There is "It won't work!" There are claims that the economy will be destroyed. The social fabric of the country wil crumble. Yada, yada, yada.

Of course Obamacare made things more expensive. You don't get something for nothing. However, it didn't destroy the health care system. It isn't solely responsible for cost increases, which have been staggering for years now. Also, and most importantly, we really did get something for our money. Things are better now. More people can get health care than could before, without bankruptcy, and that's a good thing.

So, when I look at the tradeoffs, what I see is a plan that isn't the best, but it could be a whole lot worse. Meanwhile, from your side, I see, "The sky is falling and it's Obama's fault!" So when election day rolls around, I end up going with the people who at least are willing to do something, even if it's not exactly what I would do, and even if I know that it isn't going to be what they promise.

Good post. Thank you. I can't find anything to disagree with.

 

[Elf Grinder 3000]

The same way it works in all of the other places that have it?


I find myself listening to conservative talk radio, and as long as they are talking basic principles, I find myself in agreement. However, when they get down to policies and the general impression of what they say, I find myself saying, "What??????"

One of the principle reasons is statements like yours. There's no reasonable, measured, analysis or consideration. There is "It won't work!" There are claims that the economy will be destroyed. The social fabric of the country wil crumble. Yada, yada, yada.

This is basically a lie

The Republicans never talk about absolutes in terms of health care or even welfare. No Republican is talking about abolishing medicaid or medicare. They want to repeal Obamacare but all the plans still spend boatloads of money on the poor.

Most Republican plans slow the growth of spending, I haven't seen a plan that actually cuts anything besides Rand Paul.

Is it extreme to slow the growth of spending? What sounds extreme is refusing to cut a single cent. Not one F%#*$# cent. Now that's extreme!

Please at least be honest

 

[RandFan]

"My goal is to cut government in half in twenty-five years, to get it down to the size where we can drown it in the bathtub." - Grover Norquist

I think Norquist was honest. I wonder where that half will come from? Defense?

 

[Elf Grinder 3000]

"My goal is to cut government in half in twenty-five years, to get it down to the size where we can drown it in the bathtub." - Grover Norquist

I think Norquist was honest. I wonder where that half will come from? Defense?

[qimg]http://s29.postimg.org/atowdreav/Federal_Spending.png[/qimg]

If you cut SS and medicare/medicaid you can cut it by 50% based on your graph

 

[Meadmaker]

This is basically a lie...

Please at least be honest

Everyone else understood what I meant, so there's really no point in trying to explain any farther.

 

[Meadmaker]

If you cut SS and medicare/medicaid you can cut it by 50% based on your graph

It won't happen, though.

The American people voted for a guy who promised national health care. Even his opponents, when they tried to get the court to overturn it a few weeks back, weren't going to go back to the old days.

You are going to have to take comfort in being one of only a very few people who are right, and who understand things, because the vast majority of the country disagrees, and no one promising to do what you suggest above will ever get elected, to any office.

 

[Elf Grinder 3000]

Everyone else understood what I meant, so there's really no point in trying to explain any farther.

Pathetic cop out. You never answered because you have no answer.

Again it is not extreme to cut the growth of spending as Republicans are arguing.

What is extreme is to ignore the enormous amount of money the country spends and the fact that something has to be done or bankruptcy will follow.

Obama has driven the debt up from 8 Trillion to 19 Trillion

Is it extreme to cut spending? Socialists and extremists will never cut spending which is extreme

 

[Nihilianth]

Well... sort of yes and sort of no. Whether or not a service is covered by insurance, and at what level of cost sharing is a decision for your insurer (within the bounds of law). They come in to the equation because other people are paying that cost. The cost of those preventive screenings is what drives premium.


Well, no. Not really. It's cheaper for the individual person given that they have the disease. It's NOT cheaper for the many many people who get screened and DON'T have the disease. The cost of screening is borne by ALL of the policyholders, as is the cost of treatment.

Let me give you a simplified illustration. Let's say that WoT is a disease. Clearly I have this disease .

Let's say that WoT affects about 1 in 1000 people in the US in any given year, and costs $12,000 to treat per course of disease if treated after it has reached the two-paragraph level. There are 360M people in the US, so we expect 360,000 cases per year. The total expected cost is $4.32B (360K cases * $12K per case). If the cost were spread across everyone, as it is for insurance, then it would work out to $12 per person per year (PMPY). Broken into monthly premiums, that would be $1 per person per month (PMPM).

Now, let's say that a screening test is devised that can detect WoT disease at the one-paragraph level. Treatment at the 1pg level is only $1200. The screening test costs $12. Now we have two equations to work with. First, let's replicate the cost of treatment for those with WoT. It's still 360M people, because the incidence rate hasn't changed. But the treatment costs 1/10 what it did before, so the total cost is now $432M instead of 4.32B. That works out to only $1.2 PMPY, or $0.10 PMPM. Clearly, that's less expensive.

But here's the other part: the cost of screening. Everyone gets screened every year. That's 360M people, at a cost of $12 PMPY. That ends up being a cost of $1 PMPM to administer the screening.

Without the screening, WoT costs $1 PMPM. It costs $12,000 per affected individual.
With Screening, WoT costs $1+$0.10 = $1.10 PMPM. It costs $1,200 + $12 = $1212 per person affected.

So you see, it costs less to the person affected, but it costs more in aggregate. Everyone's premiums are just that little bit higher because of the cost of screening. This is a case where the screening is not cost effective at all.

Now... when we look at all preventive measures combined, they're not cost effective. This doesn't mean that no preventive measures are cost effective - some are. It depends on the cost of screening, the reduction in the cost of treatment, and the number of people who should be screened. at the end of the day, there are some screenings that should NOT be done as a standard part of your health care, or should be done much less frequently.

No argument from me on that score!

Thank you for posting this. This is a good explanation. Much appreciated. I have 2 more rebuttals, and will leave it up to those more knowledgeable than me on the subject if you can satisfy these next two points.

1. The numbers you give, assumes that everyone would be screened on a regular basis for a specific disease, using expensive resources. When I say a "basic screening," I mean just regular check-ups with a regular physician, with a physical maybe once every year, or once every couple of years. You and your physician can still determine the level of risk you have for a particular disease; between family history, your own history, and the results of physicals and regular check-ups. For most diseases, this is sufficient to catch those in early stages. Cancer is the number one killer disease, and most of the most common cancers are relatively easy to catch without having to resort to utilizing expensive tests on a regular basis.

2. The numbers you give, and your conclusion: "screening is not cost-effective at all," is sort of putting a price tag on a human life.

 

[Meadmaker]

2. The numbers you give, and your conclusion: "screening is not cost-effective at all," is sort of putting a price tag on a human life.

Of course, sort of.

However, there are two parts of the debate about what government health care should do. There is

1. What should be provided?

and

2. What is the cost?

These questions are, and must be, intertwined.

The problem is that Obamacare was sold in part based on the theory that screening and preventive care would lower costs overall, i.e. that screening was cost effective. Regardless of whether or not we should do it, the part about cost effectiveness just isn't working out, and predictably so.

My opinion is that Obamacare is working out ok, and I'm glad that we now have a health care safety net. I like many aspects of Obamacare, and dislike a few aspects. However, the sales pitch had some fibs in it, chief among which is that it would somehow lower costs. It didn't. There's no "something for nothing".

 

[Meadmaker]

Again it is not extreme to cut the growth of spending as Republicans are arguing.

It also has nothing to do with what I said, but by all means, carry on.

 

[twinstead]

To me it's simple being a Republican: If it has to do with corporate tax breaks and the military industrial complex, those things are just too important not to go into debt for. So, let's put two wars on the ol' credit card and subsidize mega corporations.

But when it comes to heath care or the environment or infrastructure or climate, it's just too damn expensive so we just have to make the hard cuts. Those things just aren't as important.

Politicians all spend wildly. Both parties. It's all about their priorities

 

[RandFan]

The Republicans never talk about absolutes in terms of health care or even welfare. No Republican is talking about abolishing medicaid or medicare.

"My goal is to cut government in half in twenty-five years, to get it down to the size where we can drown it in the bathtub." - Grover Norquist

I think Norquist was honest. I wonder where that half will come from? Defense?

https://en.wikipedia.org/wiki/File:U.S._Federal_Spending_-_FY_2011.pnghttp://s29.postimg.org/atowdreav/Federal_Spending.png

If you cut SS and medicare/medicaid you can cut it by 50% based on your graph

Wait, is it a lie or not? How much do you plan to cut? 99%? Isn't that dishonest to say that it won't be abolished but few if any can get it?

 

[Emily's Cat]

Thank you for posting this. This is a good explanation. Much appreciated. I have 2 more rebuttals, and will leave it up to those more knowledgeable than me on the subject if you can satisfy these next two points.

1. The numbers you give, assumes that everyone would be screened on a regular basis for a specific disease, using expensive resources. When I say a "basic screening," I mean just regular check-ups with a regular physician, with a physical maybe once every year, or once every couple of years. You and your physician can still determine the level of risk you have for a particular disease; between family history, your own history, and the results of physicals and regular check-ups. For most diseases, this is sufficient to catch those in early stages. Cancer is the number one killer disease, and most of the most common cancers are relatively easy to catch without having to resort to utilizing expensive tests on a regular basis.

Yes, of course the example I gave assumed everyone would get the test. The math was easier that way, and that wasn't the point of the illustration.

You are correct, that there are many factors that go into screenings... but I'm afraid you're wrong in assuming that so much consideration goes into it. Consider Mammograms and Prostate exams - those have been recommended to be done regularly, for everyone, regardless of family history or personal history. And neither test is cheap. The rate of discovery for both is only marginally better than the rate of discovery due to more apparent symptoms. The cost of treatment for a cancer discovered marginally sooner is only marginally lower than for the treatment of a slightly more advanced cancer. And there's virtually no difference in survival rates. At the end of the day, neither really adds any real benefit to either society or the patient. They do, however, add a lot of cost.

2. The numbers you give, and your conclusion: "screening is not cost-effective at all," is sort of putting a price tag on a human life.

If you wish to see it that way, there's not really any argument I can make. I don't personally believe that human lives are priceless. I don't think that every human on the planet is a precious soul that should be protected and saved at any cost. Maybe I'm just cold-hearted.

On the other hand, the cost of end-of-life care is staggeringly enormous. The amount of money that we as a country spend to extend a life by a few months, or even a few weeks, is astronomical. You want to know why the US has such incredibly high medical costs with no measurable difference in life expectancy and quality of life? Take a look at how we treat terminal and elderly patients, and the absurd costs involved.

I simply don't think it's reasonable or just to expect society to bear such a massive cost burden for such little return. If it's going to cost huge amounts of money to save your life (or my husband's for that matter), then I'm sorry but yes - I think you should die sooner rather than later. I don't excuse myself, or my family and loved ones from this. I think it's obscene to bankrupt one's family, and push huge costs to everyone else in one's community, simply to gain a few more fleeting moments.

 

[jhunter1163]

If you cut SS and medicare/medicaid you can cut it by 50% based on your graph

Back here in the real world, most people understand that even talking about cutting Social Security or Medicare is political suicide. The AARP is, by far, the largest advocacy group in the country with over 22 million members. You cross them at your peril.

 

[Nihilianth]

Of course, sort of.

However, there are two parts of the debate about what government health care should do. There is

1. What should be provided?

and

2. What is the cost?

These questions are, and must be, intertwined.

The problem is that Obamacare was sold in part based on the theory that screening and preventive care would lower costs overall, i.e. that screening was cost effective. Regardless of whether or not we should do it, the part about cost effectiveness just isn't working out, and predictably so.

My opinion is that Obamacare is working out ok, and I'm glad that we now have a health care safety net. I like many aspects of Obamacare, and dislike a few aspects. However, the sales pitch had some fibs in it, chief among which is that it would somehow lower costs. It didn't. There's no "something for nothing".

I wouldn't expect costs to be lowered either. Question is, are costs rising at a faster, or slower rate than it had been for, say, the past two decades? If slower, then I would say it is being more cost-effective; slowing the rapidly rising costs of healthcare is a victory. I would imagine that, now that people have insurance, they would utilize it by seeing a practicing physician periodically.

Single-payor is still desirable. But this is still better than nothing.

 

[Nihilianth]

Yes, of course the example I gave assumed everyone would get the test. The math was easier that way, and that wasn't the point of the illustration.

You are correct, that there are many factors that go into screenings... but I'm afraid you're wrong in assuming that so much consideration goes into it. Consider Mammograms and Prostate exams - those have been recommended to be done regularly, for everyone, regardless of family history or personal history. And neither test is cheap. The rate of discovery for both is only marginally better than the rate of discovery due to more apparent symptoms. The cost of treatment for a cancer discovered marginally sooner is only marginally lower than for the treatment of a slightly more advanced cancer. And there's virtually no difference in survival rates. At the end of the day, neither really adds any real benefit to either society or the patient. They do, however, add a lot of cost.

Fair enough, but those are just "recommendations." They are not provisions that forces you to go through those tests; As far as I know, it isn't even a provision under the ACA. It is just a general recommendation that was in place for years before Obama was even on the national radar.

Now, I know that Obama made the claim that these tests would lower the costs of healthcare, but I am no longer arguing that, as you have satisfied that claim.

Seeing a physician on a regular basis, whether you show any symptoms for anything, is still "preventative medicine." It can be used as a first-line of defense. At the very least, you can go to a physician if you catch the flue, get medication to reduce the severity and length of the sickness. Without insurance, people would wander into the ER for this. (Or an urgicenter, which is still more expensive than making an appointment with a family physician.)

If you wish to see it that way, there's not really any argument I can make. I don't personally believe that human lives are priceless. I don't think that every human on the planet is a precious soul that should be protected and saved at any cost. Maybe I'm just cold-hearted.

On the other hand, the cost of end-of-life care is staggeringly enormous. The amount of money that we as a country spend to extend a life by a few months, or even a few weeks, is astronomical. You want to know why the US has such incredibly high medical costs with no measurable difference in life expectancy and quality of life? Take a look at how we treat terminal and elderly patients, and the absurd costs involved.

I simply don't think it's reasonable or just to expect society to bear such a massive cost burden for such little return. If it's going to cost huge amounts of money to save your life (or my husband's for that matter), then I'm sorry but yes - I think you should die sooner rather than later. I don't excuse myself, or my family and loved ones from this. I think it's obscene to bankrupt one's family, and push huge costs to everyone else in one's community, simply to gain a few more fleeting moments.

Actually, for end-of-life, I do not at all disagree with this. It isn't actually a point I made. I have great respect for the likes of one Brittany Maynard.

A bit of a story:

My local newspaper (it's a conservative rag, only good for wiping one's ass with,) had a letter to the editor, where a local conservative moron wrote about the "right-to-die" laws. Obviously, being the good little Catholic conservative he or she likely was, opposes those laws. Then it goes on talking about how the government should not interfere with choices people make, and how overly large the government is! (Then, of course, it had to ramble on about gay marriage!)

I dunno where I was going with that.

 

[Emily's Cat]

Fair enough, but those are just "recommendations." They are not provisions that forces you to go through those tests; As far as I know, it isn't even a provision under the ACA. It is just a general recommendation that was in place for years before Obama was even on the national radar.

Now, I know that Obama made the claim that these tests would lower the costs of healthcare, but I am no longer arguing that, as you have satisfied that claim.

Seeing a physician on a regular basis, whether you show any symptoms for anything, is still "preventative medicine." It can be used as a first-line of defense. At the very least, you can go to a physician if you catch the flue, get medication to reduce the severity and length of the sickness. Without insurance, people would wander into the ER for this. (Or an urgicenter, which is still more expensive than making an appointment with a family physician.)

You're right, they are still just recommendations. The unfortunate truth, however, is that medical recommendations are a morass of profit-seeking and ignorance. Most people will do whatever their physician tells them they should do. Physicians generally get paid more for doing more stuff. So the doc says "get a mammogram every 2 years from age 30 on", and people do.

Here's a slightly more concrete example, that also shows where some of the medical community is starting to change their practices (for the better). All my life, it was "recommended" that women get a gynecological exam once per year, every year, no matter what. It's preventive - it checks for all kinds of things that can go wrong, ranging from cervical cancers to STDs to breast cancer. The recommendation was so strong, that doctors won't renew an oral contraceptive prescription without the exam. For many years, women were tied to a pelvic exam every year, no matter what.

Just within the last few years, this has started to change. If you're in a monogamous, long-term relationship, and over the age of 30, they're now recommending every 2 to 3 years. That's a step in the right direction.

Unfortunately, the prescription writing practices haven't yet caught up!

Actually, for end-of-life, I do not at all disagree with this. It isn't actually a point I made. I have great respect for the likes of one Brittany Maynard.

A bit of a story:

My local newspaper (it's a conservative rag, only good for wiping one's ass with,) had a letter to the editor, where a local conservative moron wrote about the "right-to-die" laws. Obviously, being the good little Catholic conservative he or she likely was, opposes those laws. Then it goes on talking about how the government should not interfere with choices people make, and how overly large the government is! (Then, of course, it had to ramble on about gay marriage!)

I dunno where I was going with that.

No worries - good conversations always wander a bit!

 

[lomiller]

How is that supposed to be a positive? All it does is show us that even they know that that know their principles can’t be turned into a fully fleshed out working solution.

IMO If they can’t go into details on why they are proposing or how it’s supposed to work they are just playing you for a fool, promising you something for nothing so they can get elected and use that position to line their own pockets at your expense.

This is basically a lie
No Republican is talking about abolishing medicaid or medicare.

Perfect example. None of them talk about abolishing these but they do want to cut the taxes than fund them. They won’t talk about how they will keep paying for them because they want to promise something for nothing.


How is that supposed to be a positive? All it does is show us that even they know that that know their principles can’t be turned into a fully fleshed out working solution.

IMO If they can’t go into details on why they are proposing or how it’s supposed to work they are just playing you for a fool, promising you something for nothing so they can get elected and use that position to line their own pockets at your expense.

 

[Fudbucker]

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

It doesn't have to be infinite. Just tax enough so the economic gains that we've seen are spread throughout all the income brackets, instead of being concentrated in the top .1% of the richest people.

How else do you solve an income/wealth inequality problem except through taxation? And yes, if people working full time are forced to eat Ramen, we have a problem in this country. That situation should not exist in an advanced society.