Obamacare: lower than expected premium rates.

[WildCat]

Don't forget the 7-figure executive salaries and the staggering amount of money they spend on lobbying Congress.

It's pretty amazing the lengths conservatives in this country will go to to defend and protect excessive corporate profits. This is why we can't have nice things, like a decent universal health care system that every other modern nation manages to provide for their citizens.

I hope you're not referring to me, I've long been a critic of the for-profit model of healthcare in the USA. It seems like I hear at least a dozen radio/TV ads a day for this hospital or that one.

Long ago here I advocated putting doctors on salary, and ending the "pay per procedure" model since that seems to result in more procedures, even unnecessary ones.

 

[WildCat]

Personally I'm not happy with the ACA. I'd rather have UHC but it's a move in the right direction.

I fear that rather than "a move in the right direction" the ACA further entrenches the current model, making future reforms more difficult.

 

[maxpower1227]

I hope you're not referring to me, I've long been a critic of the for-profit model of healthcare in the USA. It seems like I hear at least a dozen radio/TV ads a day for this hospital or that one.

Long ago here I advocated putting doctors on salary, and ending the "pay per procedure" model since that seems to result in more procedures, even unnecessary ones.

No, I was mainly referring in this instance to DGM and his, shall we say, creative attempts to explain the high costs in American health care.

 

[RandFan]

I fear that rather than "a move in the right direction" the ACA further entrenches the current model, making future reforms more difficult.

Given the GOP resistence to any and all change it's the first move. We demonstrated we could have change. It's a move in the right direction and will make future reforms easier. Once we realize we can have what other nations have for so much less money I think we will make the switch.

 

[balrog666]

No, I was mainly referring in this instance to DGM and his, shall we say, creative attempts to explain the high costs in American health care.

The cost of some single element is irrelevant to their need for enough revenue to sustain the hospital, so one way or another they either cover their total expense (with exorbitant markups) or they go out of business. And they naturally charge whatever the market Medicare/Insurance allows.

It really isn't that difficult.

 

[ZirconBlue]

The only way to reduce cost (to the end user) is to reduce demand. Wellness programs would go along way if people only gave a crap. Americans love to get fixed once we break ourselves. That's why we pay so much for healthcare. God (or whatever you chose) bless us.

That's not the only way to reduce costs. Off the top of my head, 2 other ways that are addressed by the ACA:

A) Get more (young, healthy) people in the risk pool. The individual mandate encourages people currently without insurance to get it. The more people paying in, the lower the average cost.

2) Encourage people to use cheaper, more appropriate healthcare. Those without coverage wait until illness or injury is serious and then go to the Emergency Room, where they cannot be turned away for inability to pay. Giving those people access to coverage, either through the Medicaid expansion, or through the exchanges, allows them to get preventative care, and to see a primary care physician, rather than the much more expensive ER.

 

[Kestrel]

Some ways the ACA reduced costs for the Medicare and Medicaid programs:

1. The ACA funds "medical hot spotting". Identifying patients that keep showing up at the emergency room and assigning a nurse practitioner to monitor their care.
   
2. The ACA penalizes hospitals for readmissions of patients due to hospital acquired infections and similar complications. This has forced most institutions to implement quality control programs that should lead to both better care and lower costs for al patients.
   
3. Cutting back on Medicare plus programs that cost around 15% more per patient than traditional Medicare while delivering similar results.

 

[JoeTheJuggler]

I fear that rather than "a move in the right direction" the ACA further entrenches the current model, making future reforms more difficult.

That was probably my biggest misgiving about the ACA. I voiced that point in virtually those same words. It entrenches insurance as how we "do" healthcare in the U.S.

However, there clearly wasn't going to be any better thing passed. We absolutely had to end the pre-existing conditions nonsense (including rescission and post-claim underwriting). Unless we switched to a radically different system--such as a single payer system--the only way to achieve this is to entrench insurance and add the individual mandate to the reform package.

 

[RandFan]

That was probably my biggest misgiving about the ACA. I voiced that point in virtually those same words. It entrenches insurance as how we "do" healthcare in the U.S.

Okay, I'm willing to consider that point. Perhaps I'm wrong and it won't make future reforms easier.

However, there clearly wasn't going to be any better thing passed. We absolutely had to end the pre-existing conditions nonsense (including rescission and post-claim underwriting). Unless we switched to a radically different system--such as a single payer system--the only way to achieve this is to entrench insurance and add the individual mandate to the reform package.

Agreed.

 

[JoeTheJuggler]

Long ago here I advocated putting doctors on salary, and ending the "pay per procedure" model since that seems to result in more procedures, even unnecessary ones.

I'm all for it. Such a radical change (basically banning a doctor from hanging a shingle and charging patients for services provided) would never pass. I'm sure you'd hear people talking about Big Brother repressing individual entrepreneurship and so on.

There are many people who would claim that such a regulation is socialism. It would essentially do away with many market forces. (And I assume the government would be the entity that pays that "salary" you speak of.)

Or maybe you weren't proposing this be done legislatively, and were you merely proposing that HMOs and hospitals should be allowed to put doctors on salary?

In other words, proposing no change over the status quo whatsoever?

 

[JoeTheJuggler]

Okay, I'm willing to consider that point. Perhaps I'm wrong and it won't make future reforms easier.

I think it means the only way to a single payer system is to keep expanding the market percentage that has government coverage. I guess it's not impossible, but it doesn't seem too likely. We couldn't keep the "public option" in this package.

My understanding is that really close to 50% of all healthcare dollars spent are taxpayer dollars (Medicaid, Medicare, VA, and probably a few programs I'm missing). That was before the ACA. Many states are accepting the expansion of Medicaid, so I guess the public "market share" is even bigger now.