The problem was affordable healthcare. So instead of making it affordable congress created a massive entitlement. No tort reform, no prescription drug cost reduction, no one held accountable for the overprescription of drugs, no fraud prevention. It's kind d of like the Iran deal, he felt he had to do something, it's just not the right thing
True, elections do have consequences. But the country is still evenly divide, and when one side completely shuts out the other side on something so important, and so far reaching, Obamacare is the mess that you get. Which is a big reason why many of those involved were shown the door during the last two election cycles.
The same thing will happen to the republicans when they are back in the driver’s seat, if they take the same attitude that they don’t have to include the other side in such critical legislation.
My healthcare went up exponentially after obamacare Â
1. I have yet to meet someone whose out of pocket healthcare costs have decreased. NOT A SINGLE PERSON
2. For those who are now forced to buy healthcare when they didn't have it before, it is NOT affordable for them...AT ALL.
3. The fine for not buying healthcare is cheaper than buying healthcare....and you can still walk into a hospital and get treated.
4. The creators of the ACA said that they need everyone under the age of 30 to sign up so that the whole thing can get funded. Without them, the whole thing is financially upside down. So, WHY add the provision that people 26yrs and younger can be covered under their parent's plan? Where is the money supposed to come from?
Just curious, where in the process the GOP was shut out? The months of hearings? The months of negotiations? The more that 160 GOP sponsored amendments that were accepted in the Senate bill? Or is it just that in a staggeringly cynical move, the GOP rejected the concept of the individual mandate which had previously been on its platform and which had been supported by McCain and enacted by Romney before the big bad Obama was for it. Indeed, Obama only ever pursued the individual mandate as a compromise -- foolishly believing that the GOP would not be so cynical as to reject its own policy proposal out of hand.
The GOP wasnt shut out. They simply voted against the bill.
Just curious, where in the process the GOP was shut out? The months of hearings? The months of negotiations? The more that 160 GOP sponsored amendments that were accepted in the Senate bill? Or is it just that in a staggeringly cynical move, the GOP rejected the concept of the individual mandate which had previously been on its platform and which had been supported by McCain and enacted by Romney before the big bad Obama was for it. Indeed, Obama only ever pursued the individual mandate as a compromise -- foolishly believing that the GOP would not be so cynical as to reject its own policy proposal out of hand.
The GOP wasnt shut out. They simply voted against the bill.
It just doesn't matter what happened 6 years ago. System is still broke and needs fixed.
We changed the law of the land, not by much, and our health system is still out of control.
but if you just want to reform the system, you need to identify the culprit.
- It's not the drug cos: drug spend just isnt that big
- It's not the insurance cos: they're actually working to reduce spending, although not that hard except on drugs
- It's not the plaintiff's lawyers: someone mentioned tort reform, but where enacted it did not lead to cheaper care, less testing (ie defensive medicine), or lower malpractice premiums. It was a red herring in the reform movement.
So who is the bad guy? Hospitals. Plain and simple. Particularly hospitals in midsize/smaller markets who are buying up medical practices and rivals and effectively ending competition, and then dictating massive rate increases. You cant sell medical insurance within 50 miles of Pittsburgh and not have the university medical center on your plan, because they've bought up all competition. The university knows it, and charges monopoly prices. Insurance cos dont totally care -- so long as everyone has to pay the hire rates, the cost can be passed along to policy holders.
There are a lot more fixes, but getting some cost control in the hospital market would be huge (especially as private doctors offices are being bought up and hospitalized -- that is getting the higher reimbursement rates paid for in-hospital treatment rather than private office treatment).
you get to the PP&E spend. Grossly unnecessary expansions costing 8 and 9 figures.
And the equipment. Oh the equipment. You have a perfectly fine $3 million MRI. It's a few years old. But you're a "leading medical center" and god damnit there is a new shiny. So you buy the new shiny. And then you jack up your MRI charge because, god damnit, it's a new generation machine so its better and in any event you need to earn your investment back. So you also go to your doctors and remind them that there is this great new MRI and we need to use it and MRIs are great and by the way it helps the hospital to do more MRIs. Everyone gets the drill. That new MRI is a fucking cash cow ... for about 3 years, when a newer shiny comes on the market.
into the bill. No tort reform, no selling insurance across state lines, nothing.
The idea that the GOP wanted individual mandates is silly. It was one person who proposed it and it never went anywhere.
Tort reform is not a serious proposal. It doesnt move the needle one inch (and states are free to address them). Selling insurance across state lines is a red herring -- there is plenty of competition among insurer in big states and the costs are still spiraling. The problem isnt that big insurers are excluded from smaller states; the problem is that the healthcare services market in this country is really thousands of separate markets (e.g. Pittsburgh-area), and as to each of those markets the hospitals tend to have the bargaining power, b/c the Univ. of Pittburgh can do without Deej Ins. Co's business, but Deej Ins. Co cant really sell insurance near Pittsburgh if it doesnt have a contract with the dominant hospital "system".
These are just not serious proposals. It's painting the trim and re-potting flowers on a burned down building.
some very smart people argue that while single payer could have been implemented 50 years ago, there is simply no way to convert America to a single payer at this point.
I dont have an opinion on that, but it is worth acknowledging that we cant snap our fingers and be where other countries are easy-peasy.
It's not "hospital centralization", unless you consider a Â
predominantly Northeastern problem representative of the United States as a whole.
What people are seeing are large, one-time cost increases as physicians are shifted towards other centers (located around the hospital, in the hospital, or in a centralized location), where hospitals are also buying the equipment.
This "binge" has led to a considerable "cost" and "price" hike, even though it's a different good being produced. In fact, some evidence from large scale datasets have shown that costs have started to moderate, compared to non-employee physicians, partially because supply-induced demand has been eliminated (i.e., fee-for-service).
Another reason the "cost bump" has occurred is because of the patients that doctors have been seeing. They are not the same. If, in fact, you control for patient quality (or patient outcome), you get that per-patient costs are on par with hospital employed physicians.
firsthand experience with people that have lower costs because of the ACA it generalizes to the population as a whole is utter horseshit.
Firstly, the plans are different. When there is a shift in plans, costs shift. Unless you think comparing VCR's to DVD players is a viable comparison (which I don't doubt some here do), it's a pretty fucking simple statement.
Secondly, what do you think happens when HI companies are allowed to cost shift to their clientele more than what they are normally allowed to do, because of a change in the structure of the system? And that this cost shift is largely a one-time event? This didn't happen? Well, I'd love for you to meet some of the people that I know.
Thirdly, how the fuck can people think healthcare, both reform and implementation, is simple at all?
Lastly, this notion that we can evaluate cost trends of the ACA a few years after implementation is moronic. I hate the bill with a passion, but everyone with a functioning IQ would realize that there are parts of the bill (such as preventive care, mandating coverage, and mandating minimal standards of care) that may change long-term behavior.
Single payer can cut costs quite considerably by delaying or cutting care, which incentivizes either a quite significant travel market or secondary private market. Both of which we see in a variety of countries.
It's probably the best system for where we are (some form of minimal standards supported by the government with an additional private market), but has quite deficient flaws as well.
Including rather atrocious reimbursement rates for physicians.
if we are to believe that physician acquisitions are going to lead to a long-term bump in costs.
It is quite the opposite in the Southeast, Midwest, Southwest, Northwest, and West Coast.
Physicians may be acquired by insurers (such as Kaiser), but there are a variety of channels whereby costs per patient are lowered, quite considerably.
I'd hesitate to lump in reimbursement rates for physicians as one category. My doctor gets screwed on a long office visit -- gets paid less per hour than you'd pay a guy to come fix your computer. Specialists often get paid a lot more. Some procedures get great reimbursement rates. And rates paid for in-hospital evaluations, procedures etc. can often vastly exceed what is paid for the same work in non-hospital offices.
Pre-ACA I was reading about how they set Medicare reimbursement rates for doctors. It was mindboggling. Essentially the docs put together their own panel of 30 docs (20+ specialists), who ranked everything a doctor does based on stuff like necessary skill, "difficulty", and time. These rankings were the basis for the differences in pay rates for different procedures. The specialists just teamed up against the GPs, and made all the specialist work more expensive. The private insurers just plussed up the Medicare rates. So that is why GPs cant make a living (and no one goes into GP).
The reimbursement schedules of physicians is an awfully interesting topic. Although focus has been placed on readmission rates as a carrot/stick for payment, it has always been that way.
Perhaps the more interesting question is how much centralization or "contracting" can alleviate (or exacerbate) these issues.
There are a couple of other issues with regards to reimbursement, namely the rapid expansion of diagnosable illnesses (I'm not quite sure that a diagnosis related group, DRG, is a solution), but the specialists have also been able to facilitate very micro-level diagnoses, whereas GP's have limited ability to do it.
New phone and didn't have the new password when I re logged in after the hack.
Rates were going up before ACA and are now. Deductibles have surely risen.
Big fallacy. The uninsured were not being treated before the ACA. Yeah they were and being paid for by our tax dollars.
All it was is a dollar shift with the middle class taking it the butt again.
It now takes me 2/3 months to schedule a doctors apportionment. So much for reducing emergency visits.
It always gets pushed on to the the consumer.
My thoughts? Single payer is inevitable.
Where are the rich Canadians going to go?
My premiums began skyrocketing right around 2003 with the demise of the HMO. I guess I'm lucky in that we had to change to a high deductible plan back then with premiums that were also more than HMO plans in addition to contributing to an HSA.
I don't know why, but I haven't seen a difference since the ACA was put into place. My premiums haven't gone crazy, and I have pretty much the se coverage.
When my company moved away from the HMO plans, we were told that it was because they just weren't sustainable. Is it possible that my company was a little ahead of the curve and didn't try to stick with something that they knew couldn't last? Maybe.
What I can tell you that I notice whenever these threads pop up is people upset about plans (that weren't sustainable regardless of the ACA) bitching that now they are changing and blaming it on the ACA. They were going to change anyway, and I suspect that it would have been worse without the ACA.
It reminds me much of people bitching about "union retirement plans" that are unsustainable and placing all of the blame on the university me while ignoring that without the companies agreeing to them, they would have never existed.
Anyway- I agree with you and do think single payer is where we will end up.
Of course we've also got to get people to stop eating cheeseburgers.
no preapprovals for tests. Everyone takes it. I go for cosmetic surgery, they will probably pay for it. So you whiners keep on working to keep me covered
You really are a cunt
LTS, I've always been a fan of your posts since the CJ Spiller draft, but posts like these make me an even bigger fan!
1. I have yet to meet someone whose out of pocket healthcare costs have decreased. NOT A SINGLE PERSON
2. For those who are now forced to buy healthcare when they didn't have it before, it is NOT affordable for them...AT ALL.
3. The fine for not buying healthcare is cheaper than buying healthcare....and you can still walk into a hospital and get treated.
4. The creators of the ACA said that they need everyone under the age of 30 to sign up so that the whole thing can get funded. Without them, the whole thing is financially upside down. So, WHY add the provision that people 26yrs and younger can be covered under their parent's plan? Where is the money supposed to come from?
My premiums went down last year. Deductibles went up, but not enough to offset the decrease. Also - better benefits than the year before thanks to being able to count prescriptions toward the deductible - that was ACA policy nationwide. Everyone got it.
So you can't say you never heard of one person anymore. Ny state rulz!
Elections have consequences.
True, elections do have consequences. But the country is still evenly divide, and when one side completely shuts out the other side on something so important, and so far reaching, Obamacare is the mess that you get. Which is a big reason why many of those involved were shown the door during the last two election cycles.
The same thing will happen to the republicans when they are back in the driver’s seat, if they take the same attitude that they don’t have to include the other side in such critical legislation.
Rates were going up before ACA and are now. Deductibles have surely risen.
Big fallacy. The uninsured were not being treated before the ACA. Yeah they were and being paid for by our tax dollars.
All it was is a dollar shift with the middle class taking it the butt again.
It now takes me 2/3 months to schedule a doctors apportionment. So much for reducing emergency visits.
It always gets pushed on to the the consumer.
My thoughts? Single payer is inevitable.
Where are the rich Canadians going to go?
2. For those who are now forced to buy healthcare when they didn't have it before, it is NOT affordable for them...AT ALL.
3. The fine for not buying healthcare is cheaper than buying healthcare....and you can still walk into a hospital and get treated.
4. The creators of the ACA said that they need everyone under the age of 30 to sign up so that the whole thing can get funded. Without them, the whole thing is financially upside down. So, WHY add the provision that people 26yrs and younger can be covered under their parent's plan? Where is the money supposed to come from?
The GOP wasnt shut out. They simply voted against the bill.
The GOP wasnt shut out. They simply voted against the bill.
It just doesn't matter what happened 6 years ago. System is still broke and needs fixed.
We changed the law of the land, not by much, and our health system is still out of control.
Where do we go next is the question.
- It's not the drug cos: drug spend just isnt that big
- It's not the insurance cos: they're actually working to reduce spending, although not that hard except on drugs
- It's not the plaintiff's lawyers: someone mentioned tort reform, but where enacted it did not lead to cheaper care, less testing (ie defensive medicine), or lower malpractice premiums. It was a red herring in the reform movement.
So who is the bad guy? Hospitals. Plain and simple. Particularly hospitals in midsize/smaller markets who are buying up medical practices and rivals and effectively ending competition, and then dictating massive rate increases. You cant sell medical insurance within 50 miles of Pittsburgh and not have the university medical center on your plan, because they've bought up all competition. The university knows it, and charges monopoly prices. Insurance cos dont totally care -- so long as everyone has to pay the hire rates, the cost can be passed along to policy holders.
There are a lot more fixes, but getting some cost control in the hospital market would be huge (especially as private doctors offices are being bought up and hospitalized -- that is getting the higher reimbursement rates paid for in-hospital treatment rather than private office treatment).
The idea that the GOP wanted individual mandates is silly. It was one person who proposed it and it never went anywhere.
Once you take competition out, bad things happen. It's happening here and around the country.
Didn't say I agree with single payer, just where we eventually end up.
And the equipment. Oh the equipment. You have a perfectly fine $3 million MRI. It's a few years old. But you're a "leading medical center" and god damnit there is a new shiny. So you buy the new shiny. And then you jack up your MRI charge because, god damnit, it's a new generation machine so its better and in any event you need to earn your investment back. So you also go to your doctors and remind them that there is this great new MRI and we need to use it and MRIs are great and by the way it helps the hospital to do more MRIs. Everyone gets the drill. That new MRI is a fucking cash cow ... for about 3 years, when a newer shiny comes on the market.
The idea that the GOP wanted individual mandates is silly. It was one person who proposed it and it never went anywhere.
Tort reform is not a serious proposal. It doesnt move the needle one inch (and states are free to address them). Selling insurance across state lines is a red herring -- there is plenty of competition among insurer in big states and the costs are still spiraling. The problem isnt that big insurers are excluded from smaller states; the problem is that the healthcare services market in this country is really thousands of separate markets (e.g. Pittsburgh-area), and as to each of those markets the hospitals tend to have the bargaining power, b/c the Univ. of Pittburgh can do without Deej Ins. Co's business, but Deej Ins. Co cant really sell insurance near Pittsburgh if it doesnt have a contract with the dominant hospital "system".
These are just not serious proposals. It's painting the trim and re-potting flowers on a burned down building.
I dont have an opinion on that, but it is worth acknowledging that we cant snap our fingers and be where other countries are easy-peasy.
What people are seeing are large, one-time cost increases as physicians are shifted towards other centers (located around the hospital, in the hospital, or in a centralized location), where hospitals are also buying the equipment.
This "binge" has led to a considerable "cost" and "price" hike, even though it's a different good being produced. In fact, some evidence from large scale datasets have shown that costs have started to moderate, compared to non-employee physicians, partially because supply-induced demand has been eliminated (i.e., fee-for-service).
Another reason the "cost bump" has occurred is because of the patients that doctors have been seeing. They are not the same. If, in fact, you control for patient quality (or patient outcome), you get that per-patient costs are on par with hospital employed physicians.
Link - ( New Window )
Firstly, the plans are different. When there is a shift in plans, costs shift. Unless you think comparing VCR's to DVD players is a viable comparison (which I don't doubt some here do), it's a pretty fucking simple statement.
Secondly, what do you think happens when HI companies are allowed to cost shift to their clientele more than what they are normally allowed to do, because of a change in the structure of the system? And that this cost shift is largely a one-time event? This didn't happen? Well, I'd love for you to meet some of the people that I know.
Thirdly, how the fuck can people think healthcare, both reform and implementation, is simple at all?
Lastly, this notion that we can evaluate cost trends of the ACA a few years after implementation is moronic. I hate the bill with a passion, but everyone with a functioning IQ would realize that there are parts of the bill (such as preventive care, mandating coverage, and mandating minimal standards of care) that may change long-term behavior.
It's probably the best system for where we are (some form of minimal standards supported by the government with an additional private market), but has quite deficient flaws as well.
Including rather atrocious reimbursement rates for physicians.
It is quite the opposite in the Southeast, Midwest, Southwest, Northwest, and West Coast.
Physicians may be acquired by insurers (such as Kaiser), but there are a variety of channels whereby costs per patient are lowered, quite considerably.
I'd hesitate to lump in reimbursement rates for physicians as one category. My doctor gets screwed on a long office visit -- gets paid less per hour than you'd pay a guy to come fix your computer. Specialists often get paid a lot more. Some procedures get great reimbursement rates. And rates paid for in-hospital evaluations, procedures etc. can often vastly exceed what is paid for the same work in non-hospital offices.
Pre-ACA I was reading about how they set Medicare reimbursement rates for doctors. It was mindboggling. Essentially the docs put together their own panel of 30 docs (20+ specialists), who ranked everything a doctor does based on stuff like necessary skill, "difficulty", and time. These rankings were the basis for the differences in pay rates for different procedures. The specialists just teamed up against the GPs, and made all the specialist work more expensive. The private insurers just plussed up the Medicare rates. So that is why GPs cant make a living (and no one goes into GP).
Perhaps the more interesting question is how much centralization or "contracting" can alleviate (or exacerbate) these issues.
There are a couple of other issues with regards to reimbursement, namely the rapid expansion of diagnosable illnesses (I'm not quite sure that a diagnosis related group, DRG, is a solution), but the specialists have also been able to facilitate very micro-level diagnoses, whereas GP's have limited ability to do it.
Rates were going up before ACA and are now. Deductibles have surely risen.
Big fallacy. The uninsured were not being treated before the ACA. Yeah they were and being paid for by our tax dollars.
All it was is a dollar shift with the middle class taking it the butt again.
It now takes me 2/3 months to schedule a doctors apportionment. So much for reducing emergency visits.
It always gets pushed on to the the consumer.
My thoughts? Single payer is inevitable.
Where are the rich Canadians going to go?
My premiums began skyrocketing right around 2003 with the demise of the HMO. I guess I'm lucky in that we had to change to a high deductible plan back then with premiums that were also more than HMO plans in addition to contributing to an HSA.
I don't know why, but I haven't seen a difference since the ACA was put into place. My premiums haven't gone crazy, and I have pretty much the se coverage.
When my company moved away from the HMO plans, we were told that it was because they just weren't sustainable. Is it possible that my company was a little ahead of the curve and didn't try to stick with something that they knew couldn't last? Maybe.
What I can tell you that I notice whenever these threads pop up is people upset about plans (that weren't sustainable regardless of the ACA) bitching that now they are changing and blaming it on the ACA. They were going to change anyway, and I suspect that it would have been worse without the ACA.
It reminds me much of people bitching about "union retirement plans" that are unsustainable and placing all of the blame on the university me while ignoring that without the companies agreeing to them, they would have never existed.
Anyway- I agree with you and do think single payer is where we will end up.
Of course we've also got to get people to stop eating cheeseburgers.
Quote:
no preapprovals for tests. Everyone takes it. I go for cosmetic surgery, they will probably pay for it. So you whiners keep on working to keep me covered
You really are a cunt
LTS, I've always been a fan of your posts since the CJ Spiller draft, but posts like these make me an even bigger fan!
Care to answer for your anti-female post last night?
2. For those who are now forced to buy healthcare when they didn't have it before, it is NOT affordable for them...AT ALL.
3. The fine for not buying healthcare is cheaper than buying healthcare....and you can still walk into a hospital and get treated.
4. The creators of the ACA said that they need everyone under the age of 30 to sign up so that the whole thing can get funded. Without them, the whole thing is financially upside down. So, WHY add the provision that people 26yrs and younger can be covered under their parent's plan? Where is the money supposed to come from?
My premiums went down last year. Deductibles went up, but not enough to offset the decrease. Also - better benefits than the year before thanks to being able to count prescriptions toward the deductible - that was ACA policy nationwide. Everyone got it.
So you can't say you never heard of one person anymore. Ny state rulz!