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Heeeeeeere's Obamacare!

The health care sector in the US accounts for around 15% of our GDP. Other nations that are otherwise similar to the US have as good or better outcomes for about half of what we spend per capita.

A medical clinic in Canada typically has one assistant who handles scheduling, greeting patients and paperwork for one doctor. In the US, it is common to see two or three assistants for each physician. They are needed to the massive paperwork demands of the health insurance companies. This army of clerks does nothing to improve patient care.
 
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Kestrel said:
The health care sector in the US accounts for around 15% of our GDP. Other nations that are otherwise similar to the US have as good or better outcomes for about half of what we spend per capita.

A medical clinic in Canada typically has one assistant who handles scheduling, greeting patients and paperwork for one doctor. In the US, it is common to see two or three assistants for each physician. They are needed to the massive paperwork demands of the health insurance companies. This army of clerks does nothing to improve patient care.
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Ms. E.Cat can perhaps better address but iirc the massive paperwork is in response to govt regulations, and it will increase dramatically under ACA.
 
AlBell said:
Ms. E.Cat can perhaps better address but iirc the massive paperwork is in response to govt regulations, and it will increase dramatically under ACA.
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Reality is that the US market driven system generates more paperwork per patient than any other system. Each insurance company has it's own forms, proceedures and rules for coding. The ACA enforced some sanity on this mess, such as requiring that all insurance cards be machine readable but more needs to be done.
 
Unabogie said:
There are estimates that some 45,000 people die every year because the current private system prices them out of care. While it would suck for people to endure financial hardships, I would place a higher priority on preventing that than I would protecting health insurance jobs. Besides, smart folks with experience could find work with the a single payer regime. They'd still need actuaries and analysts and administrators.
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45000 per year from lack of insurance . . . So that means we have to pass a law requiring everyone to buy insurance or even better, create a single payer system. By that logic, there are 300,000 deaths due to obesity every year; should we pass a law requiring everyone to join gyms? Smoking causes 480,000 deaths per year; should we ban smoking?

ETA: Accidentally hit send . . .

If the idea is to prevent death and improve healthcare outcomes, there are much bigger problems than lack of healthcare. People are killing themselves through the food they eat, their sedentary lifestyles and their addiction to a drug. If forcing people to buy health insurance will only save 45,000 lives a year then why aren't we addressing the much bigger problems through laws that force people to behave in healthier ways?
 
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xjx388 said:
45000 per year from lack of insurance . . . So that means we have to pass a law requiring everyone to buy insurance or even better, create a single payer system. By that logic, there are 300,000 deaths due to obesity every year; should we pass a law requiring everyone to join gyms? Smoking causes 480,000 deaths per year; should we ban smoking?

ETA: Accidentally hit send . . .

If the idea is to prevent death and improve healthcare outcomes, there are much bigger problems than lack of healthcare. People are killing themselves through the food they eat, their sedentary lifestyles and their addiction to a drug. If forcing people to buy health insurance will only save 45,000 lives a year then why aren't we addressing the much bigger problems through laws that force people to behave in healthier ways?
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You're suggesting laws that enforce lifestyle changes instead of a law that aids poor people. Being poor is not usually a choice.
 
ehcks said:
You're suggesting laws that enforce lifestyle changes instead of a law that aids poor people. Being poor is not usually a choice.
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But how does it help poor people? They get insurance so they don't die of preventible causes. The purpose, ostensibly, is to save their lives. Another purpose of ACA was to lower health costs.

So, I'm suggesting laws that will solve the biggest health issues of our times. The deaths from smoking and obesity dwarf those from lack of insurance amongst the poor. And the amount of money we spend on healthcare as a result of these two deadly conditions is crazy. So if we want to save lives and reduce healthcare costs on a much larger scale, why not ban junk food and cigarettes while forcing everyone to pay for gym memberships?

Or maybe we can admit that ACA is merely a feel-good piece of legislation that won't save many lives or affect healthcare spending all that much?

And ACA does enforce lifestyle changes. I used to have an insurance plan that met my needs perfectly. Now I am no longer legally allowed to buy that plan. I have to change the way I conduct my personal affairs because of ACA.
 
Unabogie said:
There are estimates that some 45,000 people die every year because the current private system prices them out of care. While it would suck for people to endure financial hardships, I would place a higher priority on preventing that than I would protecting health insurance jobs. Besides, smart folks with experience could find work with the a single payer regime. They'd still need actuaries and analysts and administrators.
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That didn't actually answer my question... or even address it a little bit. It pretty much dodged it.
 
AlBell said:
Ms. E.Cat can perhaps better address but iirc the massive paperwork is in response to govt regulations, and it will increase dramatically under ACA.
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Little from column A, little from column B. You're both right, in a way.

The fact that we're NOT single payer introduces a significant amount of paperwork, no matter which way you cut it. Insurance companies have very complicated contracts, and it creates no small amount of record-keeping. In addition to the forms and claims necessary for submission to insurance companies, there are also lots of non-medical workers whose job is to help the providers maximize their revenue from the insurer through "maximal coding" - not necessarily fraudulent, but making sure that the doctor's and hospital's procedures are coded in such a way as to maximize the amount that insurers will be required to pay.

And since we're not single payer, but have several different approaches to community-provided health, there's no small amount of paperwork on that side too. Medicare, Medicaid, and various state and county provided health services all come with their share of paperwork... and each one is different. The government in it's various forms is also very fond of audits, so record keeping can be very burdensome.

Because ACA introduces a new aspect of government-subsidized care, as well as expanding Medicaid, there's likely to be an increase in paperwork due to that. In addition, carriers have been putting significant pressure on providers for much lower rates for ACA... so they're likely to seek even more ways to increase their revenue from carriers. And because ACA has introduced risk adjustment into the market, most carriers are looking to audit providers coding practices, and are seeking more robust coding, which will also increase the paperwork.

At the end of the day, the more systems you have, and the more they work against each other for their own profits, the more non-essential personnel you're going to have. That's true of any organization, it's not unique to health care.
 
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Requiring all insurers to use a common electronic billing form and set of coding rules would be a good step. I believe that such a requirement was in the ACA at one point, but it didn't make it into the final version.
 
Kestrel said:
The health care sector in the US accounts for around 15% of our GDP. Other nations that are otherwise similar to the US have as good or better outcomes for about half of what we spend per capita.

A medical clinic in Canada typically has one assistant who handles scheduling, greeting patients and paperwork for one doctor. In the US, it is common to see two or three assistants for each physician. They are needed to the massive paperwork demands of the health insurance companies. This army of clerks does nothing to improve patient care.
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This paper supports your assertion.

Health care administration in the United States and Canada: micromanagement, macro costs.
Woolhandler S1, Campbell T, Himmelstein DU.
Author information
Abstract

A decade ago, U.S. health administration costs greatly exceeded Canada's. Have the computerization of billing and the adoption of a more business-like approach to care cut administrative costs? For the United States and Canada, the authors calculated the 1999 administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies; they analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies; they used census surveys to explore time trends in administrative employment in health care settings. Health administration costs totaled at least dollar 294.3 billion, dollar 1,059 per capita, in the United States vs. dollar 9.4 billion, dollar 307 per capita, in Canada. After exclusions, health administration accounted for 31.0 percent of U.S. health expenditures vs. 16.7 percent of Canadian. Canada's national health insurance program had an overhead of 1.3 percent, but overhead among Canada's private insurers was higher than in the U.S.: 13.2 vs. 11.7 percent. Providers' administrative costs were far lower in Canada. Between 1969 and 1999 administrative workers' share of the U.S. health labor force grew from 18.2 to 27.3 percent; in Canada it grew from 16.0 percent in 1971 to 19.1 percent in 1996. Reducing U.S. administrative costs to Canadian levels would save at least dollar 209 billion annually, enough to fund universal coverage.
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xjx388 said:
But how does it help poor people? They get insurance so they don't die of preventible causes. The purpose, ostensibly, is to save their lives. Another purpose of ACA was to lower health costs.

So, I'm suggesting laws that will solve the biggest health issues of our times. The deaths from smoking and obesity dwarf those from lack of insurance amongst the poor. And the amount of money we spend on healthcare as a result of these two deadly conditions is crazy. So if we want to save lives and reduce healthcare costs on a much larger scale, why not ban junk food and cigarettes while forcing everyone to pay for gym memberships?

Or maybe we can admit that ACA is merely a feel-good piece of legislation that won't save many lives or affect healthcare spending all that much?

And ACA does enforce lifestyle changes. I used to have an insurance plan that met my needs perfectly. Now I am no longer legally allowed to buy that plan. I have to change the way I conduct my personal affairs because of ACA.
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I like how Republicans have shifted their arguments from "it will never work" or "there isn't really a problem" to "do people really need health care after all?"

:)
 
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Peephole said:
I like how Republicans have shifted their arguments from "it will never work" or "there isn't really a problem" to "do people really need health care after all?"

:)
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Which is made slightly more ironic because there were complains about the single payer putting employees out of business. However, it's not being suggested that we ban fast food, and smoking, closing two industries that would result in WAY more unemployment than those in the health insurance industry.
 
You do realize there are other shoes to drop?

Many aspects of Obamacare hasn't went into effect yet.

Think it's a little early to proclaim what a grand success it is.
 
Unabogie said:
It's just a flesh wound.
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the 40% excise taxes on "cadillac plans"

How businesses adapt to the new requirements as the mandate for them kicks in...

The former.... I can see that one creeping up on the middle class if it's not adjusted down the line to account for inflation.

The latter... might be a wild card. Obama conveniently moved that deadline to after the midterms, just to be safe ;)
 
Grizzly Bear said:
the 40% excise taxes on "cadillac plans"

How businesses adapt to the new requirements as the mandate for them kicks in...

The former.... I can see that one creeping up on the middle class if it's not adjusted down the line to account for inflation.

The latter... might be a wild card. Obama conveniently moved that deadline to after the midterms, just to be safe ;)
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And for five years we've been warned of the coming collapse of America if the ACA was passed. One by one, the dire warnings have fallen to the wayside.

Remember just six months ago, when the broken website was going to result in a death spiral? And that no young people were signing up? And that no one had paid their premiums yet? Yeah, those sound silly to me too now.
 
Unabogie said:
And for five years we've been warned of the coming collapse of America if the ACA was passed. One by one, the dire warnings have fallen to the wayside.

Remember just six months ago, when the broken website was going to result in a death spiral? And that no young people were signing up? And that no one had paid their premiums yet? Yeah, those sound silly to me too now.
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Don't forget "death panels" :rolleyes:
 
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