Heeeeeeere's Obamacare!

[The_Animus]

Operative word?

"Choice".

Or at least it used to be.

As others stated it wasn't a choice for many as they were excluded.

As others have stated, and which I believe you well know, the old way wasn't working so well for both many individuals as well as when compared to other countries.

Were you equally upset and vocal when car insurance became mandatory?

 

[3point14]

Or god forbid, they pay for their own required care. No wonder you don't understand Eddie's point.

That's absolutely fine. If such an individual can reserve an amount of, say US$10,000,000* to be able to be certain of being able to cover any and all medical expenses that may occur then there's no risk of them calling upon anyone else to cover their costs.

If they are unable to reserve that much money then they cannot be certain they will be able to cover their own medical expenses out of pocket.


ETA: the ten million may be over-egging it slighty. ICU costs ut to about 10K/day.

 

[sunmaster14]

That's absolutely fine. If such an individual can reserve an amount of, say US$10,000,000* to be able to be certain of being able to cover any and all medical expenses that may occur then there's no risk of them calling upon anyone else to cover their costs.

If they are unable to reserve that much money then they cannot be certain they will be able to cover their own medical expenses out of pocket.


ETA: the ten million may be over-egging it slighty. ICU costs ut to about 10K/day.

Shouldn't the amount of the reserve be the present value of one year's worth of premiums they would have otherwise have paid for the highest deductible plan plus the amount of the deductible?

And once you understand that, do you also understand that giving the uninsured large subsidies to buy insurance doesn't actually save money?

 

[3point14]

Shouldn't the amount of the reserve be the present value of one year's worth of premiums they would have otherwise have paid for the highest deductible plan plus the amount of the deductible?

No. That's just paying the premium after the event had happened. If we could do that, I'd only pay my car insurance in years I had a crash and my home contents insurance in years when I was burgled. If people can pay premiums after they've claimed then everyone does that and the cost of their premium is exactly the cost of the medical care they receive. Plus administrative costs.

And once you understand that, do you also understand that giving the uninsured large subsidies to buy insurance doesn't actually save money?

What it might do, and I hope it does, is move the costs of the care to where they are cheapest, when symptoms first appear rather than ER care, which is the most expensive way to deal with things.

I would hope that it would also decrease the costs involved in each procedure simply because hospitals will have someone to charge for ER care that they were previously forced to give away for free and recoup by bumping up the bills of the insured.

I suspect that's moot though, I thought the point of the ACA was supposed to ensure everyone was insured, not to save money.

Single payer would have been better.

 

[sunmaster14]

No. That's just paying the premium after the event had happened. If we could do that, I'd only pay my car insurance in years I had a crash and my home contents insurance in years when I was burgled. If people can pay premiums after they've claimed then everyone does that and the cost of their premium is exactly the cost of the medical care they receive. Plus administrative costs.

I was just talking about the reserve. Of course the uninsured would still be on the hook for everything else until they went bankrupt and Medicaid kicked in.

The point is, all you're getting the uninsured to pay each year is the value of the subsidized premiums, which is not terribly much money and probably money they had available to pay for unexpected medical care anyway until Medicaid kicked in. The cost of medical care for the poor is still borne largely by the rest of society, whether or not they have insurance.

What it might do, and I hope it does, is move the costs of the care to where they are cheapest, when symptoms first appear rather than ER care, which is the most expensive way to deal with things.

Yeah, I'm not really sure that's true. The ER is a dumping ground for hospital costs because that's where the uncompensated care hits, and the bean counters try to maximize the reported cost of uncompensated care, but I don't see a good reason for it to be more expensive. The nice thing about the ER is that the patients are queued up and ready to go, most patients are seen at night when the hospital resources are largely idle, and the doctors get to use a wide range of their skills. Apparently, 1/3 of all doctor's appointments under Medicaid turn out to be no-shows. That doesn't happen in the ER of course.

I would hope that it would also decrease the costs involved in each procedure simply because hospitals will have someone to charge for ER care that they were previously forced to give away for free and recoup by bumping up the bills of the insured.

The hospitals like everybody having insurance, but the costs of care get dumped on everybody else anyway - either those with unsubsidized insurance or taxpayers. The only thing forcing everybody to buy insurance does is suck out those extra little bit of subsidized premiums from the poor who otherwise would have gone without insurance and wouldn't have the money to pay for their medical bills when and if the time came.

I suspect that's moot though, I thought the point of the ACA was supposed to ensure everyone was insured, not to save money.

Single payer would have been better.

Well, one of the main points was to save money. Another point was to protect people from going bankrupt. Insurance doesn't actually give you medical care after all. It just protects you from financial loss if you need it.

 

[3point14]

I was just talking about the reserve. Of course the uninsured would still be on the hook for everything else until they went bankrupt and Medicaid kicked in.

This confuses me. The contention was that someone should be allowed to be uninsured if they're going to pay their medical expenses out of pocket. I suggested a value of a reserve that would allow them to do this and now you're talking about medicaid indicating that this, hypothetical, patient is in no position to cover their own medical expenses. I really don't get it.



The rest is up for discussion and I really don't know if moving care from one spot to another makes it cheaper. I do know that providing healthcare at the first sign of illness rather than waiting for it to become ER-worthy will save money. I will concede that there's no way to be certain that money will be saved due to the ACA. I do think, though, that more people will get healthcare sooner and thus be able to pay more taxes.

 

[johnny karate]

Or god forbid, they pay for their own required care.

Sounds like you just solved your own problem:

I am a small business owner. Up until now, our premiums have been based on the average age of the group. Now, under the ACA, the premiums are determined by each individual's age. I have a 60-year old whose premium is going from $329/mo to over $800/mo. She is the oldest, but there are several others in their 50's whose premiums are also going up astronomically.

Should I can all the old people and start hiring young ones or should I just stop offering health insurance as a benefit?

 

[Fast Eddie B]

How's that working out for your country?

In one word?

Horribly.

A substantial portion of the population one major illness away from bankruptcy, and many forgoing preventive care due to costs.

To repeat, I think basic medical care should be a right, and a society should come up with a way to provide it, one way or another.

I just do not see the ACA as an efficient way to provide reasonably priced coverage.

Were I not going on Medicare shortly, my insurance bill would have gone from $363 to about $1,100 or more, albeit for moderately better coverage.

Unless this is an aberration, a lot of families are going to have their finances adversely affected.

I really, really want to be surprised and to read a 5 year report about how well the ACA worked.

I'll be patient. And hopeful. And not "upset" regardless.

 

[3point14]

In one word?

Horribly.

A substantial portion of the population one major illness away from bankruptcy, and many forgoing preventive care due to costs.

To repeat, I think basic medical care should be a right, and a society should come up with a way to provide it, one way or another.

I just do not see the ACA as an efficient way to provide reasonably priced coverage.

Were I not going on Medicare shortly, my insurance bill would have gone from $363 to about $1,100 or more, albeit for moderately better coverage.

Unless this is an aberration, a lot of families are going to have their finances adversely affected.

I really, really want to be surprised and to read a 5 year report about how well the ACA worked.

I'll be patient. And hopeful. And not "upset" regardless.

It's almost certainly not the most efficient way. With practically all of Western Europe as a petri-dish it's a damning indictment of the US political system (which the UK one is rapidly approaching, sadly) that you've ended up with this mess of crap. I do think it will be better than the previous 'system' for more people than it will be worse for.

I think the major benefit will be that hospital's will have someone to charge for every patient that they treat. (Some) US hospitals will, and I mean this very literally, charge what they think they can get away with, the costs only vaguely related to the care provided, to such an extent that there's a whole industry devoted to dealing with this.

 

[Fast Eddie B]

It has been forecast that some hospitals may closer, with scheduled payments under the ACA being insufficient to cover overhead.

I do not know the credibility of this site, but it came up quickly on Google.

http://dailycaller.com/2014/02/18/fourth-georgia-hospital-closes-due-to-obamacare-payment-cuts/

 

[Unabogie]

It has been forecast that some hospitals may closer, with scheduled payments under the ACA being insufficient to cover overhead.

I do not know the credibility of this site, but it came up quickly on Google.

http://dailycaller.com/2014/02/18/fourth-georgia-hospital-closes-due-to-obamacare-payment-cuts/

Daily Caller? Seriously? That rag is notoriously stupid and dishonest.

http://en.wikipedia.org/wiki/The_Da...rostitution_controversy_and_FBI_investigation

 

[johnny karate]

It has been forecast that some hospitals may closer, with scheduled payments under the ACA being insufficient to cover overhead.

...in states that rejected Medicaid expansion.

Which is somehow Obama's fault.

 

[Kestrel]

...in states that rejected Medicaid expansion.

Which is somehow Obama's fault.

A few Republican states such a Arizona figured out that Medicaid expansion funds actually went to medical providers.

ETA: One part of funding the ACA was to reduce direct subsidies to hospitals because more of the patients would be covered by insurance or Medicaid. But in states that rejected Medicaid expansion, the uninsured patient load did not go down as far as expected.

 

[Fast Eddie B]

Just came up as the top hit on Google.

Typed in "Obamacare Hospital Closing" got lots of hits.

Whether it's Obama's fault or Georgia's fault or some combination, Georgia has hospitals closing that allegedly had managed to stay open until the law changed.

Again, maybe it's a necessary culling of inefficient hospitals in red states and nothing more.

To repeat: time will tell.

 

[Unabogie]

Just came up as the top hit on Google.

Typed in "Obamacare Hospital Closing" got lots of hits.

Whether it's Obama's fault or Georgia's fault or some combination, Georgia has hospitals closing that allegedly had managed to stay open until the law changed.

Again, maybe it's a necessary culling of inefficient hospitals in red states and nothing more.

To repeat: time will tell.

The law is already working.

http://www.vox.com/2014/6/18/5820772/the-phony-obamacare-debate-is-over-time-for-the-real-one

 

[Unabogie]

Just came up as the top hit on Google.

Typed in "Obamacare Hospital Closing" got lots of hits.

Whether it's Obama's fault or Georgia's fault or some combination, Georgia has hospitals closing that allegedly had managed to stay open until the law changed.

Again, maybe it's a necessary culling of inefficient hospitals in red states and nothing more.

To repeat: time will tell.

By the way, you'll have to explain to me how a giant influx of new patients causes hospitals to go out of business. I was under the odd impression that hospitals were like any other business in that more customers equals more success.

 

[Drysdale]

New customers equals more success only if they are paying customers.

 

[Unabogie]

New customers equals more success only if they are paying customers.

You mean as opposed to before, when they had no insurance at all? Have you really thought this through? By the way, what percentage of these patients are you claiming haven't paid? And how would people who haven't paid their premiums hurt the hospital? Would that hurt the insurer?

 

[johnny karate]

Just came up as the top hit on Google.

Typed in "Obamacare Hospital Closing" got lots of hits.

Whether it's Obama's fault or Georgia's fault or some combination, Georgia has hospitals closing that allegedly had managed to stay open until the law changed.

Again, maybe it's a necessary culling of inefficient hospitals in red states and nothing more.

To repeat: time will tell.

Since you seem to be confounded by the source of this phenomenon, here's a fun exercise for you: Compare hospital closures in states that rejected Medicaid expansion with states that didn't.

Perhaps that will shed some light on this fathomless mystery.

 

[Fast Eddie B]

I will attempt to educate myself.

Do you think the decision to "reject Medicare expansion" could be a rational one?

To be honest, I'm not really sure what it means.

Would not mind being pointed to an objective analysis.