Obamacare 5 years later. Crow, anyone?

[theprestige]

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.

The thing about these kinds of recommendations is that doctors can hedge against liability by always following them. If they make a personal judgement that a patient didn't need the recommended screening, and then it turns out the patient did need the screening, they have a liability suit on their hands, because they knew of the recommendation but chose not to follow it.

On the other hand, if they follow the recommendation, then even if something goes wrong, they can at least say that they were always scrupulously compliant with the best practices and expert recommendations in their field.

So where there is a risk of liability, I think mere "recommendations" have a lot more force than one might expect from a naive interpretation of the term.

 

[theprestige]

How else do you solve an income/wealth inequality problem except through taxation?

You're begging the question that it's a problem.

 

[Fudbucker]

I think I may have mentioned this previously, but I'm not sure.

Oregon has a particular problem: A set of highly competitive companies with deep pockets set their rates significantly lower than expected cost for 2015. It was essentially predatory pricing. The prices were out of alignment with what they should be.

The Insurance commissioner has a duty to ensure fair pricing that ensures the solvency of the carrier. Predatory pricing drives competition out of the market, and endangers solvency.

At least two of the large carriers were directed to raise their rates by double digits... they only asked for low single digit increases.

If Oregon is an outlier, it's not a problem. Even if there are a couple states that approve 20-30% hikes by big carriers, it's not a problem.

The problem arises if a non-trivial amount of states approve huge premium increases, and most of the other states approve larger than expected increases (say, in the high single digits, or low double digits).

It's too far out to say if Oregon is unique or not, but other states also have companies asking for very high premium hikes.

I'm leaning towards Oregon being a canary in a coal mine (i.e., large premium increases being a systemic problem in a lot of states) because the mandate doesn't have enough "teeth", and the cheapest entry-level product available to avoid having to pay the penalty is Bronze level insurance, with it's very high deductible.

 

[Fudbucker]

You're begging the question that it's a problem.

No, I said people who work full time shouldn't have to buy ramen after the rent is paid. The way to solve that problem is to expand the EITC by raising taxes on wealthy people, so that full-time workers can afford BOTH rent, and decent food.

Then someone brought up infinite taxation, which is a red herring.

If you want evidence for why high wealth/income inequality is a problem, check out the thread I made on the subject:\http://www.internationalskeptics.com/forums/showthread.php?t=295195

 

[RandFan]

You're begging the question that it's a problem.

That is NOT begging the question. Not even close. How do we know? He's asking you a ******** question. He's not asserting a claim. He's asking you a very legitimate question. Here's an example of begging the question.

"Paranormal activity is real because I have experienced what can only be described as paranormal activity."

I understand that the fallacy contains the word "question". But that misses the point. A fallacy is an attempt to establish a proposition by assuming the conclusion.

You are being asked to provide an alternate explanation. There is no more honest and logically valid form of inquiry.

 

[theprestige]

No, I said people who work full time shouldn't have to buy ramen after the rent is paid.

Why?

At least you're paying for it via taxes, rather than artificially inflating wages until they have no relationship to the amount and quality of the work, and no relationship to the demand for the work.

But paying for it with taxes also divorces the payment from considerations of amount, quality, and demand--the things we normally use to estimate the value of the work.

So at this point, you're not really paying a person for working full time. You're just paying them for being a person. You're basically arguing that every citizen should receive a stipend from the government regardless of the amount, quality, or demand of the work they do, or even if they do no work at all. This policy has the benefit of making minimum wage irrelevant and unnecessary (and redundant).

 

[Trebuchet]

If you want health care pay for it yourself.

Or just die already, because we conservatives don't give a ****.

 

[Fudbucker]

Why?

At least you're paying for it via taxes, rather than artificially inflating wages until they have no relationship to the amount and quality of the work, and no relationship to the demand for the work.

But paying for it with taxes also divorces the payment from considerations of amount, quality, and demand--the things we normally use to estimate the value of the work.

So at this point, you're not really paying a person for working full time. You're just paying them for being a person. You're basically arguing that every citizen should receive a stipend from the government regardless of the amount, quality, or demand of the work they do, or even if they do no work at all. This policy has the benefit of making minimum wage irrelevant and unnecessary (and redundant).

This is an Obamacare thread. I don't want to derail it (more than I already have). Post your comment on the "Solutions to income inequality" thread.

 

[Elf Grinder 3000]

Or just die already, because we conservatives don't give a ****.

Another lie

No one dies. Since the 1970's the government is required to provide health care coverage to prevent people dying in the streets.

Why can't we purchase our own coverage?
Why can't I choose what coverage I want?
Why do I have to pay for breast exams and prenatal care?

I real program gives people choices to choose what care they want. Our current system is causing skyrocketing premiums, it limits coverage.

Its another socialism fail for the democrats

 

[3point14]

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?

I think you miss my point.

I'm not saying that you're right or that you're wrong, I'm criticising your debating technique for stating as fact that which you later reveal to be speculation. It took me three posts to get to the crux of the matter which is, as stated, you stating as fact that which is actually speculation. It's tremendously dishonest.

Please stop it.

 

[RandFan]

No one dies. Since the 1970's the government is required to provide health care coverage to prevent people dying in the streets.

There is no free lunch. Someone has to pay for that health care. It's passed on to everyone who can pay. You don't want to pay for that health care.

It's no lie.

 

[sunmaster14]

I think you miss my point.

I'm not saying that you're right or that you're wrong, I'm criticising your debating technique for stating as fact that which you later reveal to be speculation. It took me three posts to get to the crux of the matter which is, as stated, you stating as fact that which is actually speculation. It's tremendously dishonest.

You have got to be kidding me. That is the most ridiculous accusation of dishonesty I've ever seen.

Please stop it.

Instead of asking me to stop writing logical and informative posts, how about if you start? It's actually fun, although I'll admit it takes a little thought and patience.

 

[3point14]

You have got to be kidding me. That is the most ridiculous accusation of dishonesty I've ever seen.



Instead of asking me to stop writing logical and informative posts, how about if you start? It's actually fun, although I'll admit it takes a little thought and patience.

Statement of fact:

The ER is actually a rather efficient use of resources, since the patients are queued up and ready to go. You don't have a problem with no-shows that you do with doctor's appointments either.

Enquiry as to veracity:

Can you prove this?

Reluctant confession that stuff is being made up:

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

Equivocation:

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?

The bottom line is that you present, without qualification, the 'fact' at the top of this list. A statment made as fact and, by your own later confession, just your guess.

It's dishonest. Please stop it.

 

[sunmaster14]

Statement of fact:

The ER is actually a rather efficient use of resources, since the patients are queued up and ready to go. You don't have a problem with no-shows that you do with doctor's appointments either.

What part of that statement do you have a problem with? Do you dispute that patients are queued up and ready to go? Do you dispute that you don't have a problem with no-shows in the ER? My statement is true on its face. When you asked for evidence, I thought you wanted studies showing actual cost comparisons (as opposed to price comparisons) between clinical care and ER care.

<snip childish nonsense>

 

[The Greater Fool]

Another lie

No one dies. Since the 1970's the government is required to provide health care coverage to prevent people dying in the streets.

True, hospitals are required to get critical patients stable, so they don't die (now).

Hospitals are not required to treat your cancer, TB, and other disease processes that will not kill you (now). Nor are they required to test for these disease processes, so the disease remains unknown and untreated until it is about to kill someone (now), which is too late.

So... not a lie. Not providing healthcare *IS* telling the poor to die, slowly.

 

[sunmaster14]

True, hospitals are required to get critical patients stable, so they don't die (now).

Hospitals are not required to treat your cancer, TB, and other disease processes that will not kill you (now). Nor are they required to test for these disease processes, so the disease remains unknown and untreated until it is about to kill someone (now), which is too late.

So... not a lie. Not providing healthcare *IS* telling the poor to die, slowly.

That's not quite true. If you go bankrupt, you are eligible for Medicaid. So really society is saying "your money or your life." Actually, they say that to everybody. The rich and the insured, though, don't sweat the decision very much.

 

[RandFan]

This is information prior to the ACA.

Health Insurance and Mortality in US Adults

"Lack of health insurance is associated with as many as 44,789 deaths in the United States, more than those caused by kidney disease."

 

[RandFan]

That's not quite true. If you go bankrupt, you are eligible for Medicaid. So really society is saying "your money or your life." Actually, they say that to everybody. The rich and the insured, though, don't sweat the decision very much.

Don't you want to get rid of medicaid? If you could would you allow hospitals to turn away patients who couldn't pay?

 

[sunmaster14]

Don't you want to get rid of medicaid? If you could would you allow hospitals to turn away patients who couldn't pay?

No and no.

 

[RandFan]

No and no.

Then what's the problem? Prior to the ACA our costs were higher than most if not all other industrialized nations, the costs were rising faster also and we had the worst outcomes.

The money for medicaid and ER visits must come from somewhere. There is no free lunch. You pay for it.

Dead last in health care? US, 15 other nations ranked

Once again, U.S. has most expensive, least effective health

The data for the 2014 report was collected before the Affordable Care Act (aka Obamacare) went into full effect, so that reform may eventually boost the U.S. out of last place by providing health insurance to some of the 50 million people who lacked it. But, according to the study, the problems of our health-care system remain so pervasive that it will take more than better access and equity to resolve them.