ok, so first and foremost, don't go partisan in discussing it, but....
What is the essence of the affordable care act?
As best this poor soul can figure out, there are two basics:
you must have insurance. if you're poor enough, the gov't will subsidize it. if you're not poor enough, the gov't will penalize you for not having it.
the act makes it easy for your work place to not cover you when you retire. It may just be coincidence, but starting in 2015, almost everywhere, when you retire, you're on your own.
So, all you believers, convince me. What else did the affordable care act do to make the health care business more affordable.
I really hope this isn't political, but it's something I've been thinking about, and most of what I'm thinking is I must be missing something. Tell me what I'm missing.
Healthcare cannot, and will not, ever be run without government intervention.
But, as Canadian economist Robert Evans has pointed out, and that people forget to remember:
"Nations do not borrow other nations' institutions. The Canadian system may be "better" than the American...It would not fit because you do not see the world, or the individual, or the state, as we do..."
Just my humble opinion.
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
Here's an article on it. Kentucky has expanded Medicare and is seeing more ER use:
Plus, some patients who have been uninsured for years don't have regular doctors and are accustomed to using ERs, even though it is much more expensive.
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I see the access to care, which I refer to as subsidization, but what I'm asking is what is the rest of it? How is ACA addressing anything other than access to care?
2. The "tiers" of service favor those who are wealthier. This is, again, a feature of any healthcare delivery system found around the world. Hence, the redistributive nature of tax-financed systems.
3. All healthcare delivery systems create some form of rationing of care; even the private insurance market. What kind of care is rationed depends on the specifics of the system, but it happens to all.
Great point. I agree. There is a reason that of the 5 hospitals in my county, 1 isn't owned by the county healthcare systems. And no one who knows better will go to the one. They have taken over every doctors office under their umbrella. It's happening everywhere in the country. They just got awarded more money per procedure for medicare for their "efficiency".
Don't cry for the insurance companies. They are selling more product. That means more profit.
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the market is up over 100% since Bush left office.
Well pumping money that is borrowed into the market will do that. Plus interests rates are non-existant so there is no where else to put your money. But that will change and it won't be pretty.
Short the market when this pumping thing ends. Sounds easy enough.
Nice that the dollar is so strong now.
SS is a government program. The ACA is just a law to require you to buy insurance from an insurance company with some new regulations. Don't want to get into it again, but we do need an actual government program like SS to provide medical care. No shopping around, no getting ripped off, no confusing multitude of companies and plans ...if you are a citizen, you're covered, period, just like SS.
I see the access to care, which I refer to as subsidization, but what I'm asking is what is the rest of it? How is ACA addressing anything other than access to care?
What did the ACA try to do? The implementation of these features is debatable, but the goals are not.
Health outcomes by reduced price preventive services, or attempting to minimize the use of ER's as the PCP. Attempts to use managed care organizations (MCO's), which act as gatekeeper models to promote prevention.
Also, an attempt to mitigate the "cadillac" plans, which mean that people spend more of the first few dollars out of their own pocket, which incentivizes them to be more cautious stewards of their own health.
Costs by using MCO's (prevent people from running to the specialist), and using payment systems where doctors receive fixed payments per patient, and get to keep anything if they contain costs.
Quality of care by meeting certain health outcome guidelines, and by limiting the use of unnecessary referrals and supply-induced demand (i.e., doctors telling patients what they need because it benefits the doctors, and may or may not benefit the patients).
I see the access to care, which I refer to as subsidization, but what I'm asking is what is the rest of it? How is ACA addressing anything other than access to care?
I think there is a lot of funding for information exchange and study. Essentially best practices for care to let doctors know what tests/care actually has positive results. E.g. there was something about routine prostate testing not leading to better health outcomes, and therefore being wasteful. And of course end of life counseling (the dreaded Death Panels). End of life care is INSANELY expensive. 25% of Medicare $$ is used on the 5% of beneficiaries who die each year. Lots of people are getting care they dont even want -- it literally just happens because they have a proactive doctor and they're too old/frail/etc. to say "enough".
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
It was a report on the local news IIR. With it so cold up north and it being season, it's so crowded down here it isn't funny. I thought it mentioned nationwide. ER's are always the easiest ports in a storm. It really is a hassle to go to a doctor for a lot of lower income people.
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
Not too long ago doctors regularly had office hours on Saturdays and one or two evenings a week. The running joke was ... "if you need to see a doctor on Wednesday you have to go to a golf course". I didn't have to take time off to see a doctor and when my kids were young I never missed going with my wife to an appointment. The doctors themselves have shrunk access and it happened way before the ACA.
yeah, it's time for me to go to bed, because I can't wrap my head around the idea that affordable health coverage (as in, I have a problem, I can go see my doctor without paying 100% of the bill until I meet my deductible) is somehow a bad thing.
good night all. I thank those of you have made an attempt at positive contribution. If morning finds this thread a mess, I'll delete it.
That was for River Mike
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
Few physicians know the cost of a lot of stuff they order. For some of this stuff there is no way to even know -- every insurer pays differently. Doc could send you for an MRI, and depending on where you go, the cost to insurance could be 10x what it is down the road. It's an insane "market".
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
yeah, it's time for me to go to bed, because I can't wrap my head around the idea that affordable health coverage (as in, I have a problem, I can go see my doctor without paying 100% of the bill until I meet my deductible) is somehow a bad thing.
good night all. I thank those of you have made an attempt at positive contribution. If morning finds this thread a mess, I'll delete it.
Yes; the goal is to get people to pay first-dollar coverage. So, they won't run to a provider because it is cheap. Something like for each $7 of health care spent, a Cadillac plan makes each person pay $1.
A Cadillac plan is an inefficient subsidy. An extremely inefficient subsidy that puts a strain on the system because providers have to give care every time Timmy gets a sniffle.
It's meant to ease the burden on the providers, but also as a way limit unnecessary trips by a patient that could typically be solved using prevention.
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they are shit out of luck. All those doctor appointments you've made, you better cancel them. You scheduled surgery? No surgery for you. You finally feel like you are part of society? Back to second class no insurance status for you
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
through the end of the year, right?
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Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
Few physicians know the cost of a lot of stuff they order. For some of this stuff there is no way to even know -- every insurer pays differently. Doc could send you for an MRI, and depending on where you go, the cost to insurance could be 10x what it is down the road. It's an insane "market".
Well, yes and no.
Sure, since there are a variety of cost codes, it is impossible for a doctor to know the current costs incurred by the system as a whole.
But, certainly, we can use historical costs (up to a year before the doctor orders it) as a guidepost; that is what I meant by the proper cost-benefit decisions that a physician makes.
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In comment 12164131 ctc in ftmyers said:
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
It was a report on the local news IIR. With it so cold up north and it being season, it's so crowded down here it isn't funny. I thought it mentioned nationwide. ER's are always the easiest ports in a storm. It really is a hassle to go to a doctor for a lot of lower income people.
ERs are also more profitable than they have been in a while. More patients with insurance and high deductibles means they get to go after everybody (insurer and patient for $$). So ERs are expanding to accomodate more visits and make more $$. Ironic that some think that the increased business means that the system is stressed out. Hospitals administrators are laughing all the way to the bank.
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And poor people often can't take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.
Not too long ago doctors regularly had office hours on Saturdays and one or two evenings a week. The running joke was ... "if you need to see a doctor on Wednesday you have to go to a golf course". I didn't have to take time off to see a doctor and when my kids were young I never missed going with my wife to an appointment. The doctors themselves have shrunk access and it happened way before the ACA.
I'm not going to disagree. But the point is that reduced use of expensive ERs was on of the perks of the ACA. There was a lot of talk about doctor shortages, but it was all brushed aside.
I'm not denying that something had to be done. But the ACA is just a political boondoggle that doesn't really solve any problems.
ERs are also more profitable than they have been in a while. More patients with insurance and high deductibles means they get to go after everybody (insurer and patient for $$). So ERs are expanding to accomodate more visits and make more $$. Ironic that some think that the increased business means that the system is stressed out. Hospitals administrators are laughing all the way to the bank.
So was the goal to make ERs more profitable? Is that what you are arguing now? Most of the increase in ER use is by Medicaid patients. So that 'profit' is just coming out of our pockets. More tax dollars spent. Just what we need.
There were provisions in earlier versions of the bill to encourage and pay for people to speak with their doctors about their desired end of life care.
This was derided as "Death panels for seniors" and removed from the bill.
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In comment 12164248 kicker said:
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Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
Few physicians know the cost of a lot of stuff they order. For some of this stuff there is no way to even know -- every insurer pays differently. Doc could send you for an MRI, and depending on where you go, the cost to insurance could be 10x what it is down the road. It's an insane "market".
Well, yes and no.
Sure, since there are a variety of cost codes, it is impossible for a doctor to know the current costs incurred by the system as a whole.
But, certainly, we can use historical costs (up to a year before the doctor orders it) as a guidepost; that is what I meant by the proper cost-benefit decisions that a physician makes.
So big data will solve the real time cost issue, thats the easy part. The benefit part of the cost-benefit ratio is where the money is....if you know how to answer this in real time there is no limit to the amount of money you can make....
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In comment 12164159 Headhunter said:
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they are shit out of luck. All those doctor appointments you've made, you better cancel them. You scheduled surgery? No surgery for you. You finally feel like you are part of society? Back to second class no insurance status for you
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
through the end of the year, right?
Why do you want to make this political? I aint biting. read and learn from a lot of the good back and forth on this thread and learn.
I truly don't understand why you always want to derail threads that have good information being asked for and given?
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
While there has been no real plan forthcoming from the majority the states ...
Five Republican state governors say they will not rescue a crucial part of Obamacare if it is struck down by the Supreme Court ... In response to Reuters' queries, spokespeople for the Republican governors of Louisiana, Mississippi, Nebraska, South Carolina and Wisconsin said the states were not willing to create a local exchange to keep subsidies flowing ... State government officials in Georgia, Missouri, Montana and Tennessee - a mix of Republicans and Democrats - said that opposition by majority Republican state legislators could make it all but impossible to set up a new exchange ... Six states - Delaware, Maine, Ohio, Pennsylvania, South Dakota and Virginia - are discussing contingency plans to keep the subsidies but each faces substantial logistical or political barriers, according to officials ... Ten states did not respond to Reuters queries, while three others had no comment. Iowa, Wyoming, Oklahoma and West Virginia said they were not currently considering setting up exchanges; Alaska said it has not ruled it out
Link - ( New Window )
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
The problem is that when the data conflict with personal experience or received wisdom or financial interests, the results are derided or discarded.
As an example, a long and comprehensive study on mammography has revealed that strongly suggests that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care.
But essentially nobody believes this or says they don't believe it. There are a lot of entrenched interests in the business of encouraging women to get annual mammograms and they're not giving up without a fight.
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to utilize best practices, and share that information with providers across regions.
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
The problem is that when the data conflict with personal experience or received wisdom or financial interests, the results are derided or discarded.
As an example, a long and comprehensive study on mammography has revealed that strongly suggests that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care.
But essentially nobody believes this or says they don't believe it. There are a lot of entrenched interests in the business of encouraging women to get annual mammograms and they're not giving up without a fight.
Including by breast cancer survivors themselves.
But your points above are also why the early provisions to constrain end-of-life costs would not have mattered much, if at all.
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In comment 12164176 sphinx said:
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In comment 12164131 ctc in ftmyers said:
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
It was a report on the local news IIR. With it so cold up north and it being season, it's so crowded down here it isn't funny. I thought it mentioned nationwide. ER's are always the easiest ports in a storm. It really is a hassle to go to a doctor for a lot of lower income people.
ERs are also more profitable than they have been in a while. More patients with insurance and high deductibles means they get to go after everybody (insurer and patient for $$). So ERs are expanding to accomodate more visits and make more $$. Ironic that some think that the increased business means that the system is stressed out. Hospitals administrators are laughing all the way to the bank.
I have a buddy of mine who is on the hospital board. Haven't seen him for a while and we are due to get together. I'll run a lot of this by him. I know the government is dictating, through money(imagine that), a lot how the operate.
in 2013. He came back on and doubled down that 2014 was the year when it kicks in that 1/6 of the economy was going down in flames
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to utilize best practices, and share that information with providers across regions.
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
The problem is that when the data conflict with personal experience or received wisdom or financial interests, the results are derided or discarded.
As an example, a long and comprehensive study on mammography has revealed that strongly suggests that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care.
But essentially nobody believes this or says they don't believe it. There are a lot of entrenched interests in the business of encouraging women to get annual mammograms and they're not giving up without a fight.
Gary serving up softballs...
The referenced study is a Canadian semi-randomized study from over 25 years ago. Terrible mammograhy equipment and technique and patients were pre-screened by physical examination for breast masses. And it's updated every five years with flawed analysis and propogated in the lay press to the harm of many. Considering there are multiple other studies documenting a 30% reduction in mortality with mammography in the 45-65 age group, why did you select that study and what point are you trying to make? That we don't really know how to calculate the benefit of many of the practices in use today?
$61,500 for each year life is extended for annual breast exam and mammography for women aged 55-65.
$22,000 for annual breast exam for this same group.
Genetic variant of unknown significance?
Gail risk asessment/low risk?
Or just any fucking patient including a few trannys that want to get off on the mammo machine?
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In comment 12164159 Headhunter said:Quote:they are shit out of luck. All those doctor appointments you've made, you better cancel them. You scheduled surgery? No surgery for you. You finally feel like you are part of society? Back to second class no insurance status for you
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
While there has been no real plan forthcoming from the majority the states ...
Five Republican state governors say they will not rescue a crucial part of Obamacare if it is struck down by the Supreme Court ... In response to Reuters' queries, spokespeople for the Republican governors of Louisiana, Mississippi, Nebraska, South Carolina and Wisconsin said the states were not willing to create a local exchange to keep subsidies flowing ... State government officials in Georgia, Missouri, Montana and Tennessee - a mix of Republicans and Democrats - said that opposition by majority Republican state legislators could make it all but impossible to set up a new exchange ... Six states - Delaware, Maine, Ohio, Pennsylvania, South Dakota and Virginia - are discussing contingency plans to keep the subsidies but each faces substantial logistical or political barriers, according to officials ... Ten states did not respond to Reuters queries, while three others had no comment. Iowa, Wyoming, Oklahoma and West Virginia said they were not currently considering setting up exchanges; Alaska said it has not ruled it out
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Article from a few days ago. reports I hear on fox today were that the GOP isn't going to let the subsides lapse no matter the ruling. All's it takes is a little congressional action. You think Obama will veto it? Talk radio is furious from the little I was in the truck today. Win for everyone around. Doomsday doesn't happen.
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Ah, so you prefer to wallow in ignorance. Considering that there are plenty of links to newer studies that confirm a variety of the findings.
Got it.
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Real-time individualized risk/benfit assesment is the holy grail, and nothing from 1997 is going to be of any use in 2015 and beyond.
Ah, so you prefer to wallow in ignorance. Considering that there are plenty of links to newer studies that confirm a variety of the findings.
Got it.
So some of the findings are confirmed? Wow! But not all? Oh you mean things might be a little different? We might have learned a little more since 1997 and need to update that review? So if those original numbers are used in a risk/benefit model, the model will get pounded by one with more accurate data? And you would put your money on what?
But, you would have known that had you chosen to actually look at something and read it.
By the way, they use the exact same procedures that the purported "big data" enthusiasts champion. You should check it out; may learn how individualized risk-benefit assessments are being widely considered no-go's among a variety of experts, and how more variegated averages are being used.
But, yet again, that would actually require reading...
So, ctc, are you really confident that the most conservative component of the House is going to let Boehner pass a fix that is fairly simnilar to the ACA itself in terms of its impact? Really?
And then, ctc there is this, also from your link:
It's always fun when someone with an opposing view makes your strongest arguments for you. Thanks.
Seriously?
But, you would have known that had you chosen to actually look at something and read it.
By the way, they use the exact same procedures that the purported "big data" enthusiasts champion. You should check it out; may learn how individualized risk-benefit assessments are being widely considered no-go's among a variety of experts, and how more variegated averages are being used.
But, yet again, that would actually require reading...
No-go because they can't calculate it? Really? An expert said that?
An expert in 2015 is just a fool in 2020.
Its a pleasure speaking with you, though I have to go read now....hmm, I don't see a single link....1997?