Heeeeeeere's Obamacare!

[applecorped]

It might over the long run, relative to doing nothing.

It might make things worse and waste lots of money and time.

I guess we'll just have to wait and see.

 

[barehl]

It might make things worse and waste lots of money and time.

Could you give a scenario how this might happen?

I guess we'll just have to wait and see.

Which part are you waiting on?

 

[Shalamar]

Where dat Obamacare? Here dat Obamacare!

http://www.politico.com/story/2013/12/obamacare-heroin-massachusetts-101383.html

Like Barack Caesar says, "Maybe you're better off not having the surgery, but taking the painkiller."

Don't worry, everything will be better when the GOP outlaws the Democrats, repeals Obamacare, and institutes a one party conservative system where only conservatives are allowed to vote and hold power!

 

[Ampulla of Vater]

Could you give a scenario how this might happen?

I can. Let's say the whole thing just plain old doesn't work. How much time and money have been wasted? Here is the newest thing: apparently hospitals, once someone is admitted without insurance or without adequate insurance, are signing the patient up for Obamacare and paying the premium. Then they can turn around and bill the insurance for the hospital stay after forking over a small premium. This is one of the problems inherent in allowing people to buy insurance once they need it and in eliminating the pre-existing condition clauses.

I am hoping auto insurance follows suit. Then I can stop paying for it until I get into a wreck.

 

[Fast Eddie B]

Could you give a scenario how this might happen?

Bear in mind I want it to work out, but how's this...

...increased rates make insurance less affordable and many who had insurance coverage before drop it, putting more of a burden on the ER system.

...many doctors, not wanting to accept lower payments for their services get out of the business entirely.

...hospitals face decreased payments for services, and some close.

...more patients (insured and uninsured) chasing after fewer services drive the prices of those services up even higher...

...requiring insurance providers to raise their rates even higher, and...

...we're back to my first point with even more unable to purchase insurance.


Not saying it WILL turn out this way - its too early to tell.

I just had an idea early on that Obama was never schooled in basic economics. As such, he probably really believed, and may still believe, that his plan will drive health costs down.

Which part are you waiting on?

Let's see how things trend as the act gets put into place. The time frame is a moving target, since as I also said Obama seems to be changing the rules in midstream by edict.

Again, a year or two or ten down the road we'll have some real numbers and see how it played out. Until then its all speculation, either informed or otherwise.

 

[Shalamar]

I can. Let's say the whole thing just plain old doesn't work. How much time and money have been wasted? Here is the newest thing: apparently hospitals, once someone is admitted without insurance or without adequate insurance, are signing the patient up for Obamacare and paying the premium. Then they can turn around and bill the insurance for the hospital stay after forking over a small premium. This is one of the problems inherent in allowing people to buy insurance once they need it and in eliminating the pre-existing condition clauses.

I am hoping auto insurance follows suit. Then I can stop paying for it until I get into a wreck.

Unless I'm mistaken, one can only sign up for insurance during a limited set period, much like employment health insurance. Makes it difficult to just get insurance when you get sick.

 

[Unabogie]

I can. Let's say the whole thing just plain old doesn't work. How much time and money have been wasted? Here is the newest thing: apparently hospitals, once someone is admitted without insurance or without adequate insurance, are signing the patient up for Obamacare and paying the premium. Then they can turn around and bill the insurance for the hospital stay after forking over a small premium. This is one of the problems inherent in allowing people to buy insurance once they need it and in eliminating the pre-existing condition clauses.

I am hoping auto insurance follows suit. Then I can stop paying for it until I get into a wreck.

Where are you getting this from? The law specifically sets up fixed enrollment periods, and doesn't allow insurance to be bought to cover events that occurred prior to signing up, such as car accidents. Is this yet another lie making the rounds on Fox News?

 

[Charlie Wilkes]

I can. Let's say the whole thing just plain old doesn't work. How much time and money have been wasted? Here is the newest thing: apparently hospitals, once someone is admitted without insurance or without adequate insurance, are signing the patient up for Obamacare and paying the premium. Then they can turn around and bill the insurance for the hospital stay after forking over a small premium. This is one of the problems inherent in allowing people to buy insurance once they need it and in eliminating the pre-existing condition clauses.

I am hoping auto insurance follows suit. Then I can stop paying for it until I get into a wreck.

What did hospitals do before the ACA? They had to provide care anyway. I personally know someone who has had three or four heart surgeries at this point. He has no insurance, and he has never paid a dime for any of it. He just shows up in the ER and expects them to deal with his problems, which they do because otherwise he would die.

Providers go after assets, if there are any, they try to get the people on Medicaid if they are indigent and require extensive care, or they eat the costs and pass them in the form of higher costs for insured patients. Is that better than the ACA?

The core concept of the ACA is mandatory health insurance for the same reason car insurance is mandatory. Someone is going to be on the hook when the worst happens. If politicians start chipping away at the individual mandate on the basis of a hardship arguments, sure, it will all fall apart. People say they can't afford health insurance. How unfortunate. A week in the hospital will cost $100k, and I imagine they can afford that even less. But it will happen to a certain number of any given population, just as a certain number of people will get into car accidents. Someone has to pay.

 

[Charlie Wilkes]

It might make things worse and waste lots of money and time.

I guess we'll just have to wait and see.

That could be said about any major policy.

The GOP position on health care, as described on their official websites, sounds quite a bit like the ACA. What they are pushing out to their base is hollow libertarian ideology that does not line up with the actual decisions people make when they need medical services and have no means to pay for it. What they are pushing in op-ed pieces are anecdotal problems and dire projections that may or may not pan out, but could just as easily be written about the US health care industry without the ACA.

This has credibility with right-wing voters who get their politics off a bumper sticker. It doesn't have credibility with anyone who has even a passing understanding of the issues at stake.

 

[Charlie Wilkes]

Bear in mind I want it to work out, but how's this...

...increased rates make insurance less affordable and many who had insurance coverage before drop it, putting more of a burden on the ER system.

...many doctors, not wanting to accept lower payments for their services get out of the business entirely.

...hospitals face decreased payments for services, and some close.

...more patients (insured and uninsured) chasing after fewer services drive the prices of those services up even higher...

...requiring insurance providers to raise their rates even higher, and...

...we're back to my first point with even more unable to purchase insurance.


Not saying it WILL turn out this way - its too early to tell.

I just had an idea early on that Obama was never schooled in basic economics. As such, he probably really believed, and may still believe, that his plan will drive health costs down.



Let's see how things trend as the act gets put into place. The time frame is a moving target, since as I also said Obama seems to be changing the rules in midstream by edict.

Again, a year or two or ten down the road we'll have some real numbers and see how it played out. Until then its all speculation, either informed or otherwise.

I agree. But what we have now is a situation where many people can't afford insurance, they don't carry it, and they place a financial strain on providers because they need care anyway.

Providers then make up for it by marketing high-end services to insured patients. Clinics and hospitals compete to showcase the latest high-tech wizardry, clogging certain markets with redundant capacity, and MDs over-prescribe the most expensive treatments, medications and diagnostic techniques. This exacts a toll on payers and encourages them to game the system by pushing high-cost patients off their rolls. People who have financial assets but no insurance really get hosed, paying sky-high "chargemaster" rates when they land in the hospital. Meanwhile, overall costs spiral up.

What we have is an unsustainable mess and an aging population that will make it far more expensive in the near future. The ACA is an imperfect, politically compromised step toward possibly cleaning up some aspects of the mess and exerting some control over costs. As you say, it will take awhile to figure out if it is a net positive.

 

[Grizzly Bear]

What we have is an unsustainable mess and an aging population that will make it far more expensive in the near future. The ACA is an imperfect, politically compromised step toward possibly cleaning up some aspects of the mess and exerting some control over costs. As you say, it will take awhile to figure out if it is a net positive.

I'm unsure how the ACA is supposed to exert controls on costs, since the only real metric where it grants that sort of of control is on subsidies and taxes. The base costs of medical treatments don't change, and if anything the market environment is such that the care prices are already astronomically expensive and still increasing. The current effect of the ACA is throwing off the insurance market badly enough that I'd argue it's worse right now than the status quo. Maybe that situation will resolve itself eventually (I'm personally of low confidence), but I feel Obama, or any other POTUS for that matter focusing an agenda of this healthcare overhaul should have spent the big political fight dealing with the mechanisms that have led to the outrageous costs of care in the first place. Those cost issues place a huge burden even on the insurance mode, and a future model for health care coverage would have benefited greatly from having those problems ironed out.

 

[Ziggurat]

I'm unsure how the ACA is supposed to exert controls on costs

Well, Obama once implied that doctors were cutting people's feet off for profit (or was it for fun?), and that somehow they'd stop that practice since it was expensive. But details were vague.

 

[Charlie Wilkes]

I'm unsure how the ACA is supposed to exert controls on costs, since the only real metric where it grants that sort of of control is on subsidies and taxes. The base costs of medical treatments don't change, and if anything the market environment is such that the care prices are already astronomically expensive and still increasing. The current effect of the ACA is throwing off the insurance market badly enough that I'd argue it's worse right now than the status quo. Maybe that situation will resolve itself eventually (I'm personally of low confidence), but I feel Obama, or any other POTUS for that matter focusing an agenda of this healthcare overhaul should have spent the big political fight dealing with the mechanisms that have led to the outrageous costs of care in the first place. Those cost issues place a huge burden even on the insurance mode, and a future model for health care coverage would have benefited greatly from having those problems ironed out.

The outrageous costs stem from an industry where ordinary market forces do not pertain, as they would if providers were free to deny care to critically ill people who couldn't pay, or if patients were paying for care out of their own pockets. Providers charge wildly different rates to different payers, depending on what they can get away with, and they pile on expensive charges for insured patients, but they also provide a lot of care for which they are not compensated. Ironing out those problems requires a major revamping of the entire industry.

This is why many countries have gone to a single payer model with standardized rates, along with a national formulary and schedules to regulate what kind of care is provided.

But the conservative mantra in the US is that an unregulated market is always rational and always leads to the greatest good for the greatest number, and gov't programs are always inefficient and wasteful. Conservatives refuse to see that health care is a special problem.

The ACA is far from ideal. It can at least cut down on the amount of uncompensated care that providers have to dispense, and it might consolidate the payer system enough so that vast rate discrepancies and gouging are less prevalent. We'll see.

 

[barehl]

Bear in mind I want it to work out, but how's this...

...increased rates make insurance less affordable and many who had insurance coverage before drop it, putting more of a burden on the ER system.

How would the rates go up? You only have three choices: medical costs rise, more claims are paid, or more profit is made. More profit is not possible because these are capped. There's nothing about the ACA which would cause costs to rise; in fact, the costs should go down because it removes the ability to make more money by doing unnecessary tests. That would only leave paying more claims. I'm not sure how this would happen since uninsured people do end up at emergency rooms and these costs are already being paid. So, where would the extra cost come from?

...many doctors, not wanting to accept lower payments for their services get out of the business entirely.

Actually, under the ACA, doctors get paid according to their time instead of just a fixed fee. Secondly, we are training nurse practitioners to take over more of the general practice work.

...hospitals face decreased payments for services, and some close.

They get decreased payments when more people show up with insurance? How does that work?

...more patients (insured and uninsured) chasing after fewer services drive the prices of those services up even higher...

I think you meant to say that the fact that preventative care is always covered reduces the overall cost because people don't put off seeing a doctor.

I just had an idea early on that Obama was never schooled in basic economics. As such, he probably really believed, and may still believe, that his plan will drive health costs down.

Well, there are two things here: First, Obama doesn't have to be an expert in the medical field because he has advisers for that. One of the main people who helped write the ACA law was Max Baucus, chairman of the U.S. Senate Finance Committee. Are you claiming that he doesn't understand basic economics? Secondly, specific details can always be adjusted. For example, Medicare part C was created in 1997 but was changed in 2003 and then changed again in 2013.

Let's see how things trend as the act gets put into place. The time frame is a moving target, since as I also said Obama seems to be changing the rules in midstream by edict.

The laws have been in effect for years now. Where are the disasters you've been talking about? I also love the use of the word "edict" which makes Obama sound like a dictator. The fact is that all agencies write policy and these policies are subject to change. Why are you unaware of this?

Again, a year or two or ten down the road we'll have some real numbers and see how it played out. Until then its all speculation, either informed or otherwise.

I love that attitude. Whenever someone sees some scrap of evidence that they believe is bad for the ACA then the train wreck is happening right now and we can't wait one more second to repeal it. But, when things aren't looking bad then the proof is years in the future. If we leave out the change for pre-existing conditions then the ACA has no fundamental alteration to the insurance of something like 80% of people. It has small changes to around 10%. So, you are apparently expecting some tremendous effect from that last 10%. Is that actually logical?

 

[barehl]

Well, Obama once implied that doctors were cutting people's feet off for profit (or was it for fun?), and that somehow they'd stop that practice since it was expensive. But details were vague.

I've seen people on here make jackass comments but you get a special prize for distortion. If you watch the video without your head stuck up your behind then you can plainly see that your description is false. What he actually said is that the old system was broken because it was willing to pay for an amputation but not for preventative care. This was in no way directed at the character of the doctors. The new system under the ACA does indeed pay for preventative care.

 

[Ziggurat]

There's nothing about the ACA which would cause costs to rise

Yes there is. Start with the tax on medical devices.

in fact, the costs should go down because it removes the ability to make more money by doing unnecessary tests.

Insurance companies have capped profit margins. I don't think health care providers do, but even if they do, that's only a limiting factor if they're already up against that cap. If they're not up against the cap, then why wouldn't they? And extra profits aren't the only motive for doing unnecessary tests either. Does Obamacare decrease other motives for doing unnecessary testing?

That would only leave paying more claims. I'm not sure how this would happen since uninsured people do end up at emergency rooms and these costs are already being paid. So, where would the extra cost come from?

Do you imagine that emergency room visits are the only medical costs in play here? Do you imagine that there are no medical services that patients themselves may elect to take advantage of when they don't pay for it out of pocket?

Actually, under the ACA, doctors get paid according to their time instead of just a fixed fee.

Because nobody could ever game that system.

I think you meant to say that the fact that preventative care is always covered reduces the overall cost because people don't put off seeing a doctor.

In general, preventive care does NOT reduce overall costs. The reason is simple: most people seeking preventive care don't actually need it (but they don't know that until they get it). Preventive care is often worth doing because of the improved health outcomes it can provide, but it is generally NOT a source of any significant cost savings.

The laws have been in effect for years now. Where are the disasters you've been talking about? I also love the use of the word "edict" which makes Obama sound like a dictator. The fact is that all agencies write policy and these policies are subject to change. Why are you unaware of this?

Regulations (not policies) have the force of law when they are authorized by law. But the law which authorizes them also specifies how those regulations can be written, and it's not arbitrary. Many of the changes that Obama has been making lately he does not actually have the legal authority to make.

 

[Ziggurat]

I've seen people on here make jackass comments but you get a special prize for distortion.

 

[barehl]

Providers charge wildly different rates to different payers, depending on what they can get away with, and they pile on expensive charges for insured patients, but they also provide a lot of care for which they are not compensated.

You left out the fact that insurance is also now antagonistic. Allstate insurance used to be so profitable for Sears that it paid for the construction of the Sears Tower in Chicago. That was back in 1973 or forty years ago. In 1993, Sears divested itself of Allstate Insurance. Prior to the ACA, the general goal of any insurance company was to pay doctors and hospitals as little as possible. Unfortunately, one of the ways they did that was by not paying for preventative care.

This is why many countries have gone to a single payer model with standardized rates, along with a national formulary and schedules to regulate what kind of care is provided.

That works in Canada because it doesn't cost a small fortune to go to medical school. To make that work in the US, you would need to change medical school as well.

But the conservative mantra in the US is that an unregulated market is always rational and always leads to the greatest good for the greatest number, and gov't programs are always inefficient and wasteful. Conservatives refuse to see that health care is a special problem.

The best system would probably be one where everyone gets a basic insurance plan. Then you allow private companies to add supplemental insurance like they do now for Medicare. One of the reasons that we see opposition to this is that this basic plan would be the largest plan in the world and would be able to get group rates for everything. Companies who sell medical supplies don't want to accept group discounts from a lucrative market. Keep in mind that these are the same companies that sell drugs in Canada at 1/3rd the price they do in the US. This could effect research money to develop new drugs so a change like this might also require kicking back more money for research.

 

[Fast Eddie B]

Wow.

Just, wow.

My wife and I currently pay $363/month for a high deductible Aetna plan - $10,000 annual deductible each.

It's what we want and can afford.

Waiting until the last minute, we just registered on HealthCare.gov.

Aetna has told us our plan qualifies, and is good until next August. Still, wanted to see if the government might offer cheaper plans or better plans for the same money.

A few glitches, but after about 30 minutes we got quotes for us (both non-smokers).

Kinda shocking - and they call this the Affordable Care Act!

Anyway, next August I qualify for Medicare, which will change the equation, but still.

 

[barehl]

Yes there is. Start with the tax on medical devices.

Fair enough. These companies get to deduct the 2.3% excise tax as part of business expenses so the actual increase to them is about 1.5%. This amounts to about $2.9 billion per year in new cost. That is almost exactly 0.1% of what the US spends on healthcare each year. In 2013, costs rose 7%. Well, it was still a nice try.

And extra profits aren't the only motive for doing unnecessary tests either.

Enlighten us. What are the other motives?

Do you imagine that emergency room visits are the only medical costs in play here? Do you imagine that there are no medical services that patients themselves may elect to take advantage of when they don't pay for it out of pocket?

Like what?

Because nobody could ever game that system.

Well, they could until they lose their medical license and spend time in prison. But, we aren't talking about fraud (which existed in the old system as well); we are talking about letting doctors do their job. Are you against that?

In general, preventive care does NOT reduce overall costs. The reason is simple: most people seeking preventive care don't actually need it (but they don't know that until they get it). Preventive care is often worth doing because of the improved health outcomes it can provide, but it is generally NOT a source of any significant cost savings.

I have to give you credit on that one (in terms of debating skill, not accuracy) because that argument is one of the best false arguments I've seen on this topic. The sieve metric where you screen large numbers of people for a rare condition is accurate in terms of cost of testing to cost savings. However, that metric is in isolation. It doesn't take into consideration the benefit of having a family doctor. In the real world, you don't use broad screening for rare conditions; you let people see a doctor on their own whenever they notice a problem. This is quite cost effective, but it relies on having a doctor you know.

Regulations (not policies) have the force of law when they are authorized by law. But the law which authorizes them also specifies how those regulations can be written, and it's not arbitrary. Many of the changes that Obama has been making lately he does not actually have the legal authority to make.

The policies that were changed were written in 2010. So, why weren't these policies challenged in Federal court since (according to you) there was no legal authority to write them? I know that this claim has been pumped up a lot by Fox, Rush Limbaugh, NewsMax, and the Weekly Standard. However, I'm not aware of any credible source that is making this claim such as the dean of a major law school (Columbia, Harvard, Yale, etc.).