Obamacare 5 years later. Crow, anyone?

[sunmaster14]

LOL. I would have certainly picked Lennon. In collaboration with Yoko.

 

[sunmaster14]

Greece has absolutely nothing to do with anything. In fact, you are falling for the oldest fallacy in the book, False causation (correlation does not imply causation) and you are doing it by cherry picking your data while ignoring all of the data points unique to Greece. That of course would be honest but time consuming.

To say, "weak sauce" would not be fair as it isn't even a valid argument. Please try again.

Please tell us the data points unique to Greece that EG is ignoring.

 

[sunmaster14]

Let me make this perfectly clear:

It is already privatized! It has always been privatized! "Privatizing healthcare" is NOT any sort of plan to bring healthcare costs under control! Because....IT'S NOT A PLAN! It already exists!

That's like a general saying "I have a plan for invading Iran, and it's called D-Day!"

No, the US health care market was not a free one at all. It's heavily distorted by government programs, government tax subsidies, and government regulations, which leaves even the private sector intermediated by insurance companies which separates the consumer from the cost of his consumption decisions. Now it is even less free.

<snip>

"So much?" You do realize that the increase in premiums is a hell of a lot lower than it has been every single year for the past 20 years, right?

The low increases in recent years all happened before Obamacare was fully implemented and were due mainly to the Great Recession. Obamacare has clearly driven a large increase in health care costs for non-subsidized people since it was fully implemented. Some of this increase has been masked in the form of higher deductibles and narrower networks. By the architects' own admission, Obamacare is not about cost control. It has almost no cost control in it other than vague claims that more preventative medicine and more electronic recordkeeping will save money (both have likely led to an increase in costs actually). Obamacare is about wealth redistribution. It was not sold that way, but there is no question that that is its fundamental purpose.

Nobody is "signing up for Obamacare." Obamacare (ACA) is a LAW. Not for anyone to "sign up for!" That's like asking "why are so many people signing up for a speed limit??"

I suspect that EG is using "signing up for Obamacare" as a metaphor for complying with the law. There has apparently been more selection bias than had previously been expected among those remaining uninsured or underinsured. If a higher percentage of young and healthy people choose to pay the penalty rather than purchase health insurance, then the health insurance companies will have to raise premiums because the people signing up will be more costly than expected. That seems to be what's happening.

 

[varwoche]

Try this experiment with your crazy conservative uncle. Quote to him Eisenhower WITHOUT atribution and give him a multiple choice quiz.

Was that Marx?
Was that Eisenhower?
Was the Lennon?
Was that Reagan?

Odds are extremely likely he WON'T pick Eisenhower even though it was in fact Eisenhower. If he were alive today Eisenhower would not only be a bleeding heart liberal. He would be a traitor. Never mind that whole "winning WWII thing".

Same deal with Nixon's insurance proposal, which went far beyond Obamacare.

 

[Nihilianth]

The health care dollars come from the taxpayers, which is paid to private comapnies. Thus the 60% is from taxpayers not private entities.

This is government funded insurance which was my point and which was linked.

I linked the increase in premiums to the WSJ article.

Oh my FREAKING GOD!

It doesn't matter WHERE the money comes from! Virtually all health insurance companies are privately-owned (or publically-traded.) The government does not own a single insurance company. The government does not sell a single insurance policy. Period.

The money can come from bum **** egypt. INSURANCE COMPANIES ARE STILL PRIVATE ENTITIES.

Military contractor. They are own by private investors, NOT by the government. Yet, they get the vast majority of their business from government contracts. For the third time in this post: IT DOES NOT MATTER WHERE THE MONEY COMES FROM! IT IS STILL A PRIVATE INDUSTRY! Always has been, and still is.

 

[Nihilianth]

No, the US health care market was not a free one at all. It's heavily distorted by government programs, government tax subsidies, and government regulations, which leaves even the private sector intermediated by insurance companies which separates the consumer from the cost of his consumption decisions. Now it is even less free.

How is it "less free?" Oh! I know! Not because it matters where the money comes from!

It's "less free" because now insurance companies do not have the option to turn people away who have, what they arbitrarily determine to be, "pre-existing conditions." Cry me a friggin river!

 

[DavidJames]

Nihilianth - As often stated, "you can't reason someone out of a position they didn't reason themselves into".

 

[RandFan]

Please tell us the data points unique to Greece that EG is ignoring.

I apologize for the title of the following article. It's not meant as a dig I assure you.

An Idiot’s Guide to the Greek Debt Crisis

The problem is that Greece is also infamous for mass tax evasion. That means severely limited revenue. So when the money ran out, Athens turned to European banks for loans. Soon, the government was borrowing billions and those debts, like subprime mortgages in the United States, were often repackaged and sold off around the Continent. Everyone, especially banks in France and Germany, wanted a piece. Now they have it.

 

[RandFan]

Perfectly fair point. However, this has not always been so. Eisenhower understood the importance of social spending over defense spending.

Dwight D. Eisenhower: The Chance for Peace

"Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed."

Try this experiment with your crazy conservative uncle. Quote to him Eisenhower WITHOUT atribution and give him a multiple choice quiz.

Was that Marx?
Was that Eisenhower?
Was the Lennon Lenin?
Was that Reagan?

Odds are extremely likely he WON'T pick Eisenhower even though it was in fact Eisenhower. If he were alive today Eisenhower would not only be a bleeding heart liberal. He would be a traitor. Never mind that whole "winning WWII thing".

Same deal with Nixon's insurance proposal, which went far beyond Obamacare.

Here's the thing, politics is not conducive to skepticism and critical thinking. We all fall short. However, the GOP has made an art of it.

 

[Emily's Cat]

If I go see my primary care physician, it would cost about $75 or so, and a cheap prescription for a drug that could shorten the length of time I am sick. If I had to go to the ER, $800 right off the bat, just for stepping foot in the place, while taking up valuable space that someone else with a more serious condition may need. If I dont go to see a doctor at all, it would prolong my sickness, and possibly keep me out of work longer and/or spread the sickness my coworkers, potentially costing the company in productivity. If a more serious condition, like say, cancer, it may be discovered in a later stage, thereby, potentially shortening my life. Preventing disease and shortening a sickness is far more valuable than treating a disease or sickness that has already set in

For the individual person, preventive medicine that identifies the condition early absolutely saves money.

The problem really shows up when you aggregate it, though. Take Mammograms, for example. Current best practice recommendations is to have screenings every 5 years between the age of 50 and 75. It used to be every 3 years for anyone over 30.

The problem is twofold: mammograms are expensive, and breast cancer is very treatable.

A mammogram every 3 years for women age 30 and up adds up to a LOT of cost. Mammograms miss about 16% of breast cancers. They also have a false-positive rate of about 5% (it's a 50% rate of false positive over 10 exams). It correctly identifies 78% of women who actually have breast cancer. The rate of breast cancer is approximately 1 in 8 women in the US.

That's actually a pretty high incidence rate... but at about $250 per screening, there's a very high price tag on them. And a largish number (I don't have actual stats, sorry) of breast cancers are caught via a gynecologist's breast exam - the mammogram is a diagnostic follow-up, not a screening tool.

The false positives trigger additional tests at additional prices. Treating breast cancer ranges between $20K to $100K depending on complexity, variation of cancer, and stage.

At the end of the day, when you do the math, it ends up costing MORE to administer that many mammograms than it saves by early detection. That's part of the reason that the recommended frequency of mammograms has reduced.

 

[Nihilianth]

Nihilianth - As often stated, "you can't reason someone out of a position they didn't reason themselves into".

Yeesh, tell me about it!

 

[Emily's Cat]

"Last week Oregon’s insurance commissioner, Laura Cali, announced that the state had approved a 25 percent premium increase for the largest health insurer on the state’s exchanges. The second largest insurer did even better: It received permission to boost its monthly charge to consumers by 33 percent."
http://www.slate.com/articles/busin...care_has_been_solidified_but_it_s_failed.html

Well, that sucks for Oregon residents and is terrible news for Obamacare. If the GOP had actually gelled around a competing plan, they could be pushing it as an alternative, but they got nothin.

My biggest concern always was that the penalty/tax wasn't big enough and was too easy to get around (all one has to do to avoid the penalty/tax is finagle their taxes in a way where one owe's a small amount in April). If there's not enough of a stick, healthy young people aren't going to go for the carrot of moderately-priced high-deductible policies. That leads to an older, sicker pool of insurees.

Unless Oregon is some weird outlier, but it doesn't sound like it is.

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.

 

[Nihilianth]

For the individual person, preventive medicine that identifies the condition early absolutely saves money.

The problem really shows up when you aggregate it, though. Take Mammograms, for example. Current best practice recommendations is to have screenings every 5 years between the age of 50 and 75. It used to be every 3 years for anyone over 30.

The problem is twofold: mammograms are expensive, and breast cancer is very treatable.

A mammogram every 3 years for women age 30 and up adds up to a LOT of cost. Mammograms miss about 16% of breast cancers. They also have a false-positive rate of about 5% (it's a 50% rate of false positive over 10 exams). It correctly identifies 78% of women who actually have breast cancer. The rate of breast cancer is approximately 1 in 8 women in the US.

That's actually a pretty high incidence rate... but at about $250 per screening, there's a very high price tag on them. And a largish number (I don't have actual stats, sorry) of breast cancers are caught via a gynecologist's breast exam - the mammogram is a diagnostic follow-up, not a screening tool.

The false positives trigger additional tests at additional prices. Treating breast cancer ranges between $20K to $100K depending on complexity, variation of cancer, and stage.

At the end of the day, when you do the math, it ends up costing MORE to administer that many mammograms than it saves by early detection. That's part of the reason that the recommended frequency of mammograms has reduced.

Makes sense. But these are issues that can be decided between you and your doctor. The important thing, is to make sure everyone is covered by health insurance, so they don't have to make the choice between getting treated, or going bankrupt. The problem with healthcare in this country, is that so many Americans were not covered, going bankrupt, or not getting treated when they need to be treated.

Regular check-ups with a family physician is not all that expensive. Like, at all. And is a great first step in the screening process.

Oh, there's a lump on that breast or testicle? Now we can get that mammogram. It's been 5 years since your last mammogram, and you are a 45 year old female? We can do that.

You're heart rate is irregular? Let's do a bit of blood work.

Let's check your eyesight. Perhaps it is correctable before it gets worse?

Go to the dentist and check for cavities. (I was 28 years old when I got my first cavity. I only just got insurance for the firs time, before Obamacare, went to the dentist, and there was a small cavity on a molar. The dentist fixed it right then and there. If not for that dental insurance at that time, it would have been 4 years or more before I went to the dentist. Got me a new, better job this past year. Who knows how far that cavity would have progressed? It could very easily have turned into a bigger deal. A bigger job. More uncomfortable for me as a patient. When he filled it in, he didn't even use any anesthetic, it was that small. Again, if not for that check-up, it would never have been caught.)

Mammograms, and the surgery to remove a small lump, is still cheaper, both in terms of resources and saving lives, than treating a full-blown disease. People without insurance were not getting regular check-ups with a family physician. And there were 50 million of them. Next we need to include the ENTIRE body for one comprehensive insurance package. Teeth and eyes are still a part of the human body, and can affect your health. They should be included in HEALTH insurance. They should not be separate.

 

[Giordano]

Eugene V. Debs is quoted as stating, "I would not lead you into the promised land if I could, because if I led you in, some one else would lead you out. You must use your heads..."

Of course, Debbs was an official "Socialist," so you can't trust anything he said

 

[Emily's Cat]

Makes sense. But these are issues that can be decided between you and your doctor.

Well... sort of yes and sort of no. Whether or not a service is covered by insurance, and at what level of cost sharing is a decision for your insurer (within the bounds of law). They come in to the equation because other people are paying that cost. The cost of those preventive screenings is what drives premium.

The important thing, is to make sure everyone is covered by health insurance, so they don't have to make the choice between getting treated, or going bankrupt. The problem with healthcare in this country, is that so many Americans were not covered, going bankrupt, or not getting treated when they need to be treated.

Regular check-ups with a family physician is not all that expensive. Like, at all. And is a great first step in the screening process.

Oh, there's a lump on that breast or testicle? Now we can get that mammogram. It's been 5 years since your last mammogram, and you are a 45 year old female? We can do that.

You're heart rate is irregular? Let's do a bit of blood work.

Let's check your eyesight. Perhaps it is correctable before it gets worse?

Go to the dentist and check for cavities. (I was 28 years old when I got my first cavity. I only just got insurance for the firs time, before Obamacare, went to the dentist, and there was a small cavity on a molar. The dentist fixed it right then and there. If not for that dental insurance at that time, it would have been 4 years or more before I went to the dentist. Got me a new, better job this past year. Who knows how far that cavity would have progressed? It could very easily have turned into a bigger deal. A bigger job. More uncomfortable for me as a patient. When he filled it in, he didn't even use any anesthetic, it was that small. Again, if not for that check-up, it would never have been caught.)

Mammograms, and the surgery to remove a small lump, is still cheaper, both in terms of resources and saving lives, than treating a full-blown disease.

Well, no. Not really. It's cheaper for the individual person given that they have the disease. It's NOT cheaper for the many many people who get screened and DON'T have the disease. The cost of screening is borne by ALL of the policyholders, as is the cost of treatment.

Let me give you a simplified illustration. Let's say that WoT is a disease. Clearly I have this disease .

Let's say that WoT affects about 1 in 1000 people in the US in any given year, and costs $12,000 to treat per course of disease if treated after it has reached the two-paragraph level. There are 360M people in the US, so we expect 360,000 cases per year. The total expected cost is $4.32B (360K cases * $12K per case). If the cost were spread across everyone, as it is for insurance, then it would work out to $12 per person per year (PMPY). Broken into monthly premiums, that would be $1 per person per month (PMPM).

Now, let's say that a screening test is devised that can detect WoT disease at the one-paragraph level. Treatment at the 1pg level is only $1200. The screening test costs $12. Now we have two equations to work with. First, let's replicate the cost of treatment for those with WoT. It's still 360M people, because the incidence rate hasn't changed. But the treatment costs 1/10 what it did before, so the total cost is now $432M instead of 4.32B. That works out to only $1.2 PMPY, or $0.10 PMPM. Clearly, that's less expensive.

But here's the other part: the cost of screening. Everyone gets screened every year. That's 360M people, at a cost of $12 PMPY. That ends up being a cost of $1 PMPM to administer the screening.

Without the screening, WoT costs $1 PMPM. It costs $12,000 per affected individual.
With Screening, WoT costs $1+$0.10 = $1.10 PMPM. It costs $1,200 + $12 = $1212 per person affected.

So you see, it costs less to the person affected, but it costs more in aggregate. Everyone's premiums are just that little bit higher because of the cost of screening. This is a case where the screening is not cost effective at all.

Now... when we look at all preventive measures combined, they're not cost effective. This doesn't mean that no preventive measures are cost effective - some are. It depends on the cost of screening, the reduction in the cost of treatment, and the number of people who should be screened. at the end of the day, there are some screenings that should NOT be done as a standard part of your health care, or should be done much less frequently.

Next we need to include the ENTIRE body for one comprehensive insurance package. Teeth and eyes are still a part of the human body, and can affect your health. They should be included in HEALTH insurance. They should not be separate.

No argument from me on that score!

 

[Dr. Keith]

You are dodging the issue.

• 60% of all health care spending is from the government, therefore we do not have privatized insurance

• 
  
  You hit on something here that you may want to take a closer look at. Others will point out that much of that spending is directly into private insurance companies or providers, but I think the bigger issue is that we already spend enough to be a full single payor system is we just took the insurance companies out of the mix completely.
  
  From our fellow forum member's sig line:
  
  

  OECD healthcare spending
  
  http://www.oecd.org/els/health-syste...uesteddata.htmlink is 2013 data (2011 Data below):
  UK 9.4% of GDP of which 82.8% is state expenditure = 7.8% of GDP from taxes
  US 17.7% of GDP of which 47.2% is state expenditure = 8.5% of GDP from taxes

 

[Tony Stark]

Republicans, the good guys won. The bad guys (you) lost. Get over it. The greatest legislative accomplishment in a generation is here to stay.

 

[Elf Grinder 3000]

You hit on something here that you may want to take a closer look at. Others will point out that much of that spending is directly into private insurance companies or providers, but I think the bigger issue is that we already spend enough to be a full single payor system is we just took the insurance companies out of the mix completely.

From our fellow forum member's sig line:

How do we already spend enough to be a single payor system?

Why have premiums skyrocketed?

http://www.wsj.com/articles/the-unaffordable-care-act-1436569086

In a study across 45 states, the research outfit Health Pocket reports that mid-level Exclusive Provider Organization plans are 20% more expensive in 2016 on average. HMOs are 19% more expensive, and for all plan types the average is 14%.

And if they have skyrocketed because of the restrictions in Obamacare how will making it fully 100% government funded even work?

If you are a socialist and want the government to pay for everything why don't you make this optional and have the other socialists join your single payer utopia?

Why doesn't everyone want to sign up for Doctor Keith's plan?

 

[twinstead]

My medical insurance premiums were skyrocketing way before Obama was elected, and had been for years

 

[Border Reiver]

How do we already spend enough to be a single payor system?



Why have premiums skyrocketed?



http://www.wsj.com/articles/the-unaffordable-care-act-1436569086





And if they have skyrocketed because of the restrictions in Obamacare how will making it fully 100% government funded even work?



If you are a socialist and want the government to pay for everything why don't you make this optional and have the other socialists join your single payer utopia?



Why doesn't everyone want to sign up for Doctor Keith's plan?

Most countries in the western world fund medical services for their citizens for results equal to or better than the U.S. for less than what the U.S. spends.