Heeeeeeere's Obamacare!

[Unabogie]

Oh he's not refusing to work with them anymore. We'll just be footing the bill if we wish to continue using him. We can't afford that, so we'll have to find someone new that our insurance will pay. I'll, hopefully, know more when I speak to someone about it tomorrow.

By "them", I meant your insurer, not your kids. Sorry if I don't always write well.

 

[MattusMaximus]

I'm sure it's a complete coincidence... But for now, he's the best target I have to blame at the moment. I'm very pissed about this. Money we don't have out of my pocket for now, followed by the joy of looking for a new children's neurologist, that takes our insurance. All before the next time we need their prescriptions filled again.

Yep, a complete coincidence, I'm sure.

That's a bummer, man. Have you considered switching insurance plans? I think you might be able to make an argument with the healthcare.gov folks (or whoever runs your state exchange) that you need to shop for new insurance. Who knows? You might get a better deal than you currently have; I know people who have definitely traded up like that through the marketplace sites.

 

[MattusMaximus]

If anecdotes like Mike!'s help inform us a bit, then what of all the anecdotes I've heard from my friends and family who finally have affordable health coverage for the first time? Do those anecdotes count, or just the one's grousing about how the ACA is doomed to fail?

 

[phunk]

Purely anecdotal, I know, but, my wife informed me today, that we were billed for our last visit to my kid's neurologist. Seems after ten plus years he's no longer accepting the insurance we get thought my wife's job, at the biggest hospital in St. Louis. We liked him too.

They didn't tell you before the visit that your insurance wasn't accepted anymore?

 

[Mike!]

They didn't tell you before the visit that your insurance wasn't accepted anymore?

I honestly don't know what the deal was. The visit was two months ago. We presented our insurance card, paid the co-pay and went on with the appointment. Bill arrived in Fridays mail. This gives me the impression, and this is pure speculation on my part for now, that the doctors office wasn't aware of any issues at that time and attempted to make their claim to the insurance company, who then declined to pay them, for whatever reason. Again, I'll know more later today, hopefully.

 

[sunmaster14]

If anecdotes like Mike!'s help inform us a bit, then what of all the anecdotes I've heard from my friends and family who finally have affordable health coverage for the first time? Do those anecdotes count, or just the one's grousing about how the ACA is doomed to fail?

The anecdotes don't tell us anything we couldn't have already known. Millions of people will be helped a lot by Obamacare, millions of people will be hurt a lot by Obamacare, and the vast majority of people will be affected in subtle ways that for the most part they won't notice (mostly bad IMHO, but that's a separate discussion).

If you look at the big picture for Obamacare, it doesn't have much net effect on the supply of health care, and yet it increases the demand for health care by expanding Medicaid and providing a whole range of implicit and explicit subsidies for people who were priced out of the market before.

The increased demand from these people (i.e. the poor, those with pre-existing conditions, those in high cost demographic groups, those with specialized needs which weren't covered by many plans) necessarily must be offset by decreased demand from those who already had good coverage. The decreased demand is enforced through some combination of higher premiums, higher deductibles, higher OOP caps, higher copays, and more restricted networks.

Whether this is good or bad is not something that can be objectively measured. You're helping some people at the expense of other people, and whether it is worthwhile doing is a matter of opinion and the essence of politics. I have some major issues with Obamacare as policy, but I do not deny that there are some good aspects to it. It is helping millions of people certainly.

But the anecdotes of how people have been hurt is more important to see, because I don't think people were honestly warned about those negative effects before the law was passed. I think Obamacare was sold dishonestly, and it is important that the salesmen take a political hit for that.

 

[Fast Eddie B]

Nice post.

Thanks for taking the time - it's appreciated.

 

[wareyin]

The increased demand from these people (i.e. the poor, those with pre-existing conditions, those in high cost demographic groups, those with specialized needs which weren't covered by many plans) necessarily must be offset by decreased demand from those who already had good coverage. The decreased demand is enforced through some combination of higher premiums, higher deductibles, higher OOP caps, higher copays, and more restricted networks.

I'm not so sure that 'the poor, those with pre-existing conditions, etc' are increasing the demand for healthcare now that they have insurance. People always used healthcare, it's just prior to the ACA, the demographics you are talking about had to use it in the most expensive and inefficient way possible. Now that they have access to affordable insurance, I'd like to see some evidence that they will use more healthcare in the long run, rather than just spreading the pool of insured people, thereby causing costs to actually drop (or not rise as fast) for those who were previously insured.

 

[Unabogie]

But the anecdotes of how people have been hurt is more important to see, because I don't think people were honestly warned about those negative effects before the law was passed. I think Obamacare was sold dishonestly, and it is important that the salesmen take a political hit for that.

The problem with most of these anecdotes is that they attempt to lay blame on Obamacare without actually demonstrating how these things are the fault of Obamacare. It's not enough to simply lay every bad outcome at Obama's feet. We've had dozens on pages of argument in this thread about the number of people who had their plans canceled and then had to pay more for a new plan instead of less. The best estimates I've seen say this only affects ~1% of the population, which is people who had private health insurance, don't get it through work, carried a low quality, high deductible plan, but make too much money to qualify for Medicaid or subsidies. While on the other side,the best estimates are that the ranks of the uninsured have dropped dramatically.

http://www.gallup.com/poll/168821/uninsured-rate-drops.aspx

So if we're just attempting to create a ledger of better off/ worse off, then Obamacare is running away with the game.

If's Mike!'s unfortunate situation is the fault of the ACA, it should be easy to explain why. It's not good enough for him to demand that we show how it's not the fault of the law. And no, your "common sense" won't cut it either.

There's a reason the GOP is suddenly going all BENGHAZI!!11!

 

[Mooseman]

From what I understand, the additional paperwork generated by the ACA is related to quality control.

For example, many hospitals have mandated the use of checklists to cut down on medical errors. These function much the same as the checklists used in aviation.

We are all taking HRO (High Reliability Organization) training. Based on Naval, Nuke Reactor, or Airline models.

 

[sunmaster14]

I'm not so sure that 'the poor, those with pre-existing conditions, etc' are increasing the demand for healthcare now that they have insurance. People always used healthcare, it's just prior to the ACA, the demographics you are talking about had to use it in the most expensive and inefficient way possible.

Studies have generally shown that increased use of preventative health care actually costs more, even in the long run. Which is not to say that it's a bad thing because there's more to human health than just cost (well-being is important too of course). But from the point of view of health care consumption, more preventative care increases consumption.

As for the issue of emergency room use (which is claimed to be inefficient and expensive), there was a very well done study in Oregon which showed that when people were given Medicare, their emergency room use actually went up.

That being said, I have always been skeptical of the claim that emergency room use is more expensive in terms of real resources. When you think about, it seems like a very efficient use of resources. Much of the use happens at night when most of the hospital facilities would otherwise be idle, the patients are queued up so that doctors waste no time waiting to see a patient (or even worse waiting for a no-show), and the doctors get to use a full range of their skills and training rather than only in the area in which they've specialized. Emergency rooms are bad for patients (who sometimes have to wait many hours to see a doctor), but I never understood why they should cost so much. I suspect that the high cost of ER treatment is to some degree an accounting fiction. Hospitals have an incentive to use the ER as a dumping ground for expenses because that's where most of the uncompensated care hits. Thus they can make it look like they're suffering more from uncompensated care than they really are.

Now that they have access to affordable insurance, I'd like to see some evidence that they will use more healthcare in the long run, rather than just spreading the pool of insured people, thereby causing costs to actually drop (or not rise as fast) for those who were previously insured.

You're adding new people to the roles, so aggregate demand will go up, even if average demand per capita goes down. In order to boost aggregate supply to meet this aggregate demand, cost has to go up. The only other way to balance things is if aggregate demand were to be curtailed through other forms of rationing (e.g. restricting networks or having long queues for services).

Another way of looking at it is that the vast majority of the new people being added to the roles are either implicitly or explicitly subsidized. Implicit subsidization comes in the form of higher costs for those who are not subsidized. Explicit subsidization comes from the government in the form of higher taxes.

Obamacare is supposed to try to dampen the high rate of health care cost growth overall, but it starts out making the task harder by subsidizing health care consumption. The move to higher out of pocket costs, as well as less flexible networks, will definitely help to control cost growth, but whether that is sufficient to dominate over the effect of increasing demand from subsidized people remains to be seen.

Perhaps the most effective cost reduction measure will be the Cadillac health care tax, but that doesn't kick in until 2018, and, frankly, I think it's unlikely it will ever kick in.

 

[sunmaster14]

The problem with most of these anecdotes is that they attempt to lay blame on Obamacare without actually demonstrating how these things are the fault of Obamacare. It's not enough to simply lay every bad outcome at Obama's feet.

I agree that in many cases it is unclear, but that's more of a signal to noise problem. Health insurance has always been in flux, so it's difficult to ascribe definitively one bad effect on one family to the implementation of Obamacare. I think this subject will keep health care economists as happy as pigs in slop for years to come, and hundreds of statistical studies will have to be done before we can prove anything.

That being said, the bad effects must be there and must be happening to some people. The best analogy I can think of is global warming (personally, I'm still skeptical of AGW, but leave that aside for now). Climate scientists know that there is this big new forcing term in the balance of heat flow across the Earth's boundary, so they know that the temperature has to rise. But pinpointing that rise, let alone finding examples of the negative effect of that rise, is difficult over short timescales.

 

[Unabogie]

Studies have generally shown that increased use of preventative health care actually costs more, even in the long run.

Cite?

As for the issue of emergency room use (which is claimed to be inefficient and expensive), there was a very well done study in Oregon which showed that when people were given Medicare, their emergency room use actually went up.

Actually, the Oregon study wasn't well done, but there's been a much more comprehensive study done based on Romneycare that shows that expanding Medicaid will save tens of thousands of lives every year.

http://annals.org/article.aspx?articleid=1867050

 

[DavidJames]

...personally, I'm still skeptical of AGW, but leave that aside for now). Climate scientists know that there is this big new forcing term in the balance of heat flow across the Earth's boundary, so they know that the temperature has to rise. But pinpointing that rise, let alone finding examples of the negative effect of that rise, is difficult over short timescales.

LOL - you're smarter then all the scientists as well. Can't say I'm surprised.

 

[Unabogie]

(personally, I'm still skeptical of AGW, but leave that aside for now).

Of course.

 

[wareyin]

Studies have generally shown that increased use of preventative health care actually costs more, even in the long run. Which is not to say that it's a bad thing because there's more to human health than just cost (well-being is important too of course). But from the point of view of health care consumption, more preventative care increases consumption.

As for the issue of emergency room use (which is claimed to be inefficient and expensive), there was a very well done study in Oregon which showed that when people were given Medicare, their emergency room use actually went up.

I haven't seen that study, so allow me to ask, was it a temporary spike, or a long term increase in emergency room use? It is my understanding that countries with universal coverage do not use more healthcare services than the US, so I do not see why adding insurance coverage entails more usage in the US over the long term.

That being said, I have always been skeptical of the claim that emergency room use is more expensive in terms of real resources. When you think about, it seems like a very efficient use of resources. Much of the use happens at night when most of the hospital facilities would otherwise be idle, the patients are queued up so that doctors waste no time waiting to see a patient (or even worse waiting for a no-show), and the doctors get to use a full range of their skills and training rather than only in the area in which they've specialized. Emergency rooms are bad for patients (who sometimes have to wait many hours to see a doctor), but I never understood why they should cost so much. I suspect that the high cost of ER treatment is to some degree an accounting fiction. Hospitals have an incentive to use the ER as a dumping ground for expenses because that's where most of the uncompensated care hits. Thus they can make it look like they're suffering more from uncompensated care than they really are.

You may be right about that, but I doubt you'll get anyone in health care to admit it!

You're adding new people to the roles, so aggregate demand will go up, even if average demand per capita goes down. In order to boost aggregate supply to meet this aggregate demand, cost has to go up. The only other way to balance things is if aggregate demand were to be curtailed through other forms of rationing (e.g. restricting networks or having long queues for services).

I'm still unclear how having more people paying in to a pool of insurance is evidence of usage of health insurance going up. When most (if not all, I'm unsure) US states began mandating car insurance, did car insurance claims go up?

 

[sunmaster14]

I haven't seen that study, so allow me to ask, was it a temporary spike, or a long term increase in emergency room use?

The study is here. I don't have time to dig into it, but it looks like they measured usage and outcomes over 18mths. The study started in 2008 and was published in 2012, so at least we know it was less than 4 years. It is a highly regarded study because the experiment was almost perfectly set up. On the other hand, it only pertains to one small area of the country, in one particular time period.

It is my understanding that countries with universal coverage do not use more healthcare services than the US, so I do not see why adding insurance coverage entails more usage in the US over the long term.

Well, in countries with universal coverage, the government decides how much in health care resources it wants to pay for, and then allocates that. Essentially it fixes the price, which fixes the supply, and then rations out the supply. Adding more people to that system, just means the average person gets less (usually this is accomplished through denial of procedures or longer queues). How much these countries spend in aggregate on health care is a political decision, rather than a market-driven decision. The fact that it results in lower per capita health care consumption is clear, but it's irrelevant to what is happening in the US, which up until now has used a much different system. But the bottom line is that if you add more people to a system where their health care is mostly paid for by a 3rd party, you will have greater aggregate demand.

I'm still unclear how having more people paying in to a pool of insurance is evidence of usage of health insurance going up. When most (if not all, I'm unsure) US states began mandating car insurance, did car insurance claims go up?

I don't have any studies available, but I'm sure it did. If you didn't have auto insurance and you dented your fender, you would probably not pay the auto body shop $1,500 to fix it. If you had insurance, and it only cost a $250 deductible, you probably would.

Any service that is covered by insurance will increase demand for that service because the insured will not be paying anywhere near the true marginal cost of that service. In effect, it's a subsidy.

 

[sunmaster14]

Cite?

Here is the 2nd thing which popped up on Google for me. The 1st thing is a Tufts study which requires a big investment in time to understand, but I think says the same thing.

Actually, the Oregon study wasn't well done, but there's been a much more comprehensive study done based on Romneycare that shows that expanding Medicaid will save tens of thousands of lives every year.

http://annals.org/article.aspx?articleid=1867050

None of that is responsive to the specific point I made about the Oregon study, which is that emergency room use did not go down when insurance coverage was expanded. Paradoxically it went up. Actually, I don't think it's so paradoxical.

That being said, I don't think unnecessary ER usage contributes materially to the financial cost of health care. I do think it contributes materially to the unpleasantness of the ER experience for patients, however.

 

[johnny karate]

I think Obamacare was sold dishonestly, and it is important that the salesmen take a political hit for that.

Is it important that any politician who lied about Obamacare take a "political hit", or only Democrats?

 

[sunmaster14]

Is it important that any politician who lied about Obamacare take a "political hit", or only Democrats?

It depends on how important the lie was. How egregious it was, how widely it was believed, and the impact on the political landscape.

Since Obamacare passed by a whisker (in fact, it probably wasn't even passed legally, let alone legitimately), and the lies told to facilitate its passage were both material and widely believed (thanks to misplaced trust in the President and his allies in the media), the impact was probably decisive.

I would be interested to see some examples of Obamacare lies told by Republicans, however (you have some good ones, right?). If those lies were important, there should be political blowback for those who disseminated them.