[besson3c]

Originally Posted by climber 

I am not on the right. I am in favor of open markets. That is I would be against regulations either on a national or state basis that limit in any way insurance companies ability to offer policies across the country. The free market only works if is actually a free market. Even under the ACA we have much of this country served by one or two carriers.

How would you handle cases of fraud and abuse then? You can't really "live and learn" after your claim is denied because of some fabricated BS like a pre-existing condition after you've dilligantly gave the insurance company your hard earned dollars for many months/years.

[besson3c]

I haven't really come across anybody too outspoken against the pre-existing condition loophole plug, as the administration calls it. Is this because most people are cool with this part of the ACA, or are my perceptions flawed?

If they are, this is obviously a form of regulation. To me the question of regulation is a question of balance/trust/power. This is a worthwhile question to debate, but I just can't get onboard with the notion that we don't have to worry about this issue, and that we can just deregulate and call it a day.

As ebuddy has so well pointed out, this regulation needs to be very careful and thoughtful, with mechanisms to prevent funny business in government/by companies/within the legislation itself, but to me this is where we should focus, not in simply pretending that this need doesn't exist.

[climber]

Originally Posted by besson3c 

How would you handle cases of fraud and abuse then? You can't really "live and learn" after your claim is denied because of some fabricated BS like a pre-existing condition after you've dilligantly gave the insurance company your hard earned dollars for many months/years.

I assume you mean fraud by the insurance companies. Fraud is a crime and subject to criminal and civil liabilities. I am not sure that is really the problem that people were complaining about. The headlines I saw, that generated outrage by many were about new cancer treatments that were not covered, or some other limit or "fine print" in the policy. With the old system and now under the ACA act the largest purchase of insurance is the Employer not the Employee. Why would you expect the Insurers to do right by you when you are not the customer, The Employer is? I suggest If you want better service, this is the better direction to solve those issues.

I am not sure I have a complete answer on pre existing conditions, but I have given it some thought. I don't think we can't expect everyone to afford or pay for a Cadillac policy. And by that I mean the coverage required by the ACA. Their is significant cost to no lifetime limits, pre existing conditions covered, and almost unlimited wellness health care. I think the real problem is the American public thinks that everyone can have unlimited health care and someone else can pay for it. That someone being the rich, the insurers, or the providers.

On the other hand we can't have a system that allows someone to take the catastrophic policy, that has a super high deducible, to upgrade his policy as soon as he gets sick. Likewise to pay the penalty now and as soon as they are diagnosed with a lifetime ailment like diabetes,expect it will still be covered.

So how do we reward those that are diligent, who do the right thing and pay for insurance, above those who might choose to take a risk without? What if pre existing coverage was dependent on your coverage at the time you were diagnosed. If you had no coverage when you tore your knee up, then you can't get coverage in the future to cover that injury. If you had a policy then your coverage in future was based on that fact. I guess the point is to reward those who are insured above those who are not, but more importantly allow and even encourage portability of insurance based on service and price. That is when I find out that Geiko sucks and I want to move to Allstate, they are not allowed to either deny me coverage.

[besson3c]

Originally Posted by climber 

I assume you mean fraud by the insurance companies. Fraud is a crime and subject to criminal and civil liabilities. I am not sure that is really the problem that people were complaining about. The headlines I saw, that generated outrage by many were about new cancer treatments that were not covered, or some other limit or "fine print" in the policy. With the old system and now under the ACA act the largest purchase of insurance is the Employer not the Employee. Why would you expect the Insurers to do right by you when you are not the customer, The Employer is? I suggest If you want better service, this is the better direction to solve those issues.

I am not sure I have a complete answer on pre existing conditions, but I have given it some thought. I don't think we can't expect everyone to afford or pay for a Cadillac policy. And by that I mean the coverage required by the ACA. Their is significant cost to no lifetime limits, pre existing conditions covered, and almost unlimited wellness health care. I think the real problem is the American public thinks that everyone can have unlimited health care and someone else can pay for it. That someone being the rich, the insurers, or the providers.

On the other hand we can't have a system that allows someone to take the catastrophic policy, that has a super high deducible, to upgrade his policy as soon as he gets sick. Likewise to pay the penalty now and as soon as they are diagnosed with a lifetime ailment like diabetes,expect it will still be covered.

So how do we reward those that are diligent, who do the right thing and pay for insurance, above those who might choose to take a risk without? What if pre existing coverage was dependent on your coverage at the time you were diagnosed. If you had no coverage when you tore your knee up, then you can't get coverage in the future to cover that injury. If you had a policy then your coverage in future was based on that fact. I guess the point is to reward those who are insured above those who are not, but more importantly allow and even encourage portability of insurance based on service and price. That is when I find out that Geiko sucks and I want to move to Allstate, they are not allowed to either deny me coverage.

What would an ideal health care system look like to you, in a nutshell?

[Shaddim]

Very very tiny.

[besson3c]

Originally Posted by Shaddim 

Very very tiny.

Heh, I like that your answer keeps changing, it sounds like you're still in exploration mode a little? Before you were in favor of Medicare expansion for some income brackets, which is not so tiny.

[ebuddy]

Originally Posted by The Final Dakar 

See, I'm still not seeing the connection. How does the shutdown look responsible if the Democrats poll numbers fall long after the fact? They're mutually exclusive.

During the shutdown, I was asked why Republicans would force this knowing it would hurt them politically and wouldn't work in repealing/delaying Obamacare. While I still believe it takes both sides to force a shutdown, Republicans were using the prospect of a shutdown as political leverage in solidifying folks' records for or against the legislation. You didn't accept that analysis and we essentially agreed to disagree. Flash-forward; Obamacare is now taking a hit in popularity and so it follows that Democrats would be taking a hit in popularity, but how is it that Republicans have (at the same time, not mutually exclusive) gained 5% in popularity since before the shutdown? They've done nothing differently. They went forward with the shutdown.

Most people aren't political junkies like we are, participating in political forums or discussions nearly every day. Most don't know about this bill or that bill or this filibuster and that cloture vote that happen every day in Washington. It is not every day that Washington shuts down. A shutdown brings greater attention to the crux of disagreement; in this case the ACA. People were content with; "Republicans are just mean-spirited drama queens that hate Obama" and "Democrats are just trying to help poor people" until the folly of this legislation and its expenses ended up at their doorsteps.

I believe a portion of that 5% gain in Republican popularity has to do with; "Oh shit, the ACA really does suck this bad. Perhaps the Republicans weren't just being anti-Obama drama queens after all."

[ebuddy]

Originally Posted by OAW 

Well this is my point exactly. Do I think it was a "setup"? I see no reason to attribute to a political conspiracy what can easily be explained as simple corporate greed. Insurance companies make a nice chunk of change selling junk health insurance policies. They collect regular premiums knowing they won't have to shell out much because they don't cover things like hospitalization, prescription drugs, maternity, mental health, etc. Now imagine if they can sell such polices from March 2010 - October 2013. 3.5 years worth of premiums with an even lower likelihood they would have to payout on the policies because their lifespan is capped. Where's the financial incentive to inform these customers that the plans being peddled to them will be canceled within a few years?

OAW

I'm fascinated that you'd see such stability in the US' legislative process. If I were an insurer, knowing that there is staunch disagreement over the mandates and other provisions of the ACA, why would I jump through hoops to adjust my business model prematurely?

If anything, the delayed cancellations were among the few things that allowed the legislation to get even this far into implementation. Same goes for the employer mandates and the numbers of policies that will be canceled next year. While being demonized as evil, greedy bastards, they've only tried to comply with the ever-changing face of this legislation and in fact have been facilitating the President's vision throughout.

I mean... maybe the Insurers should send out the remainder of cancellations now so we can finally end this ACA debacle once and for all, right?

[The Final Dakar]

Originally Posted by ebuddy 

During the shutdown, I was asked why Republicans would force this knowing it would hurt them politically and wouldn't work in repealing/delaying Obamacare. While I still believe it takes both sides to force a shutdown, Republicans were using the prospect of a shutdown as political leverage in solidifying folks' records for or against the legislation. You didn't accept that analysis and we essentially agreed to disagree. Flash-forward; Obamacare is now taking a hit in popularity and so it follows that Democrats would be taking a hit in popularity, but how is it that Republicans have (at the same time, not mutually exclusive) gained 5% in popularity since before the shutdown? They've done nothing differently. They went forward with the shutdown.

Most people aren't political junkies like we are, participating in political forums or discussions nearly every day. Most don't know about this bill or that bill or this filibuster and that cloture vote that happen every day in Washington. It is not every day that Washington shuts down. A shutdown brings greater attention to the crux of disagreement; in this case the ACA. People were content with; "Republicans are just mean-spirited drama queens that hate Obama" and "Democrats are just trying to help poor people" until the folly of this legislation and its expenses ended up at their doorsteps.

I believe a portion of that 5% gain in Republican popularity has to do with; "Oh shit, the ACA really does suck this bad. Perhaps the Republicans weren't just being anti-Obama drama queens after all."

We'll continue to disagree then. The shutdown took three weeks of attention away from the website issues. So the GOP took a political hit while delaying any Dem one. I don't think it's unreasonable to surmise the GOP numbers would be even better and Democrats even worse had the shutdown not happened.

[ebuddy]

Originally Posted by The Final Dakar 

We'll continue to disagree then. The shutdown took three weeks of attention away from the website issues. So the GOP took a political hit while delaying any Dem one. I don't think it's unreasonable to surmise the GOP numbers would be even better and Democrats even worse had the shutdown not happened.

Both parties took a political hit. Republicans had done nothing differently from before the shutdown to gain momentum, other than the shutdown itself. I don't think it's unreasonable to conclude that at least a portion of that 5% gain from before the shutdown has to do with the attention they brought to the issue through it. They will gain more as they more effectively express alternatives, but for now I believe they've reached their pinnacle in popularity.

What is not arguable is the irresponsibility of plugging forward with something you know is nowhere near ready simply because you want it badly enough.

[BadKosh]

The Owebama Admin just announced they arew DELAYING the 2015 sign up UNTIL A WEEK AFTER THE MID-TERM ELECTIONS!
Can they be any more panicked or obvious?

2015 Obamacare Enrollment Will Be Delayed Until Just After the Midterms

[ebuddy]

Originally Posted by besson3c 

I haven't really come across anybody too outspoken against the pre-existing condition loophole plug, as the administration calls it. Is this because most people are cool with this part of the ACA, or are my perceptions flawed?

Your perceptions are dead-on. People think in terms of WIIFM (what's in it for me) and NIMBY (not in my back yard). Period.

• Yes we need a pipeline, BUT not through my State.
• Yes we need higher taxes, BUT only on those earning way more than me.
• Yes we need pre-existing conditions, BUT WAIT -- I'm not paying for them!
• Yes we want universal coverage, BUT not at the risk of damaging my Union's collective bargaining scheme.
• Yes, we need regulation, but not on my business or industry.
• Yes, taxes on cigarettes and alcohol are great, BUT not on fast food and soft drinks.

[ghporter]

One major problem with Medicare (over its entire lifespan) has been with fraud, and that's due to the way Medicare handles payments. A claim is filed, and unless it is grossly improper or incomplete, it gets paid on a "net 30" or "net 90" basis.

Only later does the Medicare system evaluate claims to see if they are legit, and if there's a problem, they come back MUCH later and scour records to find ANY problems. If there's a real issue, such as fraud, they eventually manage to do something about it. Do a search on "the Scooter Store" in Texas... Those folks were so blatant that my cat could see they weren't on the up and up, but it took many years before they finally got shut down.

But if there's only a minor documentation issue, they still scour records for the whole facility. In some cases, Medicare examiners have been able to demand repayment of millions of dollars from hospitals and rehab facilities simply because they didn't like the way legitimate procedures were documented. Unfortunately that means that costs go up even more because a business can't just sit there and have to fork over a couple million bucks without effective recourse.

None of the major insurers has any history of fraud, but they do have a lot of "gotchas" based on Medicare practices. Instead of costing providers money, these cost the customer money. A lot of it. Because they want to avoid overpayments and the appearance they are being defrauded, bean counters at an insurance company can decide arbitrarily that procedures aren't medically necessary (sounds like practicing medicine without a license, right?) and deny coverage until they (and maybe a doctor that works for the insurance company) are satisfied that it really was necessary all along. The catch with this is that a lot of hospitals and clinics require pre-approval before they'll do anything that isn't an emergency procedure. Catch 22? No it's Catch 2222 - the patient can't get services they really need because someone who is not a medical professional thinks it's not needed, often based on almost no background information. That isn't "fraud," it's just bad business, and bad for consumers.

[OAW]

Originally Posted by ebuddy 

Your perceptions are dead-on. People think in terms of WIIFM (what's in it for me) and NIMBY (not in my back yard). Period.

• Yes we need a pipeline, BUT not through my State.
• Yes we need higher taxes, BUT only on those earning way more than me.
• Yes we need pre-existing conditions, BUT WAIT -- I'm not paying for them!
• Yes we want universal coverage, BUT not at the risk of damaging my Union's collective bargaining scheme.
• Yes, we need regulation, but not on my business or industry.
• Yes, taxes on cigarettes and alcohol are great, BUT not on fast food and soft drinks.

Truer words were never spoken.

OAW

[ebuddy]

I'm still trying to wrap my mind around the lack of an attempt to reconcile all this Administration's harsh rhetoric on outsourcing with their use of a foreign company for building healthcare.gov. I mean this is arguably one of the largest rollouts of a program in US history, wouldn't this have been an opportune time to put our money where their mouths are and buy American?

“Pioneers! Let me tell you, Tampa, we do not need an outsourcing pioneer in the Oval Office. We need a president who will fight for American jobs and American manufacturing. That’s what my plan will do.”
— President Obama, June 22, 2012

“The Washington Post has just revealed that Romney’s companies were pioneers in shipping U.S. jobs overseas.... Does Iowa really want an outsourcer-in-chief in the White House?”

“This is one of the contrasts. Whereas my opponent, in his private business, was investing in companies that the Washington Post called ‘pioneers of outsourcing,’ I believe in insourcing,” Obama said at Centreville High School here.

Folks, we have a President whose BS is shameless. Absolutely shameless.

[turtle777]

It's been clear from even before when Obama became president that his greatest asset was his ability to sell snake oil. And selling he is.

-t

[ghporter]

I missed the overseas outsourcing bit, but I think the primary failure in building that site is the failure to have a designated lead agency (or lead contractor) responsible for tying it all together. That's a huge management oversight.

I'll also blame all the states that decided to put off building their own sites, which shifted their citizens to the national site. No system can handle an unknown level of traffic with a huge range of potential directions to navigate and an equally huge range of data sources. States (like mine, sadly) whose governors decided to stonewall the legal mandate for marketplaces simply made the load on the healthcare.gov site unmanageable, even if it had been crafted perfectly.

[ebuddy]

Originally Posted by ghporter 

I missed the overseas outsourcing bit, but I think the primary failure in building that site is the failure to have a designated lead agency (or lead contractor) responsible for tying it all together. That's a huge management oversight.

I'll also blame all the states that decided to put off building their own sites, which shifted their citizens to the national site. No system can handle an unknown level of traffic with a huge range of potential directions to navigate and an equally huge range of data sources. States (like mine, sadly) whose governors decided to stonewall the legal mandate for marketplaces simply made the load on the healthcare.gov site unmanageable, even if it had been crafted perfectly.

I couldn't disagree more. With 3.5 years and several hundred million dollars spent, the only difference between HC.gov and private enterprise is a high regard for customers. The customer experience will never be as important to government as political wrangling and the last thing Texas or anyone else wants is inevitible, unfunded mandates. The only thing this law will do is grow Medicaid in the most bizarre and ineffective way possible. No one knows for sure what to expect and these governors can't trust a word that comes out of Washington. There's a reason why a significant majority of States opted out of their own exchanges and I'm not so sure they aren't the wiser.

There isn't an expert around who believes the problems with HC.gov had to do with an extraordinary traffic load as that had dropped by more than 80% within the first week of meltdown with little improvement in site stability.

[OAW]

I've said it before and I'll say it again.

Q: Why are healthcare costs so astronomically high?

A: Because they can.

With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.

On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.

Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”

In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.

At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point.

Chelsea Manning in St. Clair, Mich., in November. She tripped and fell in the driveway of her home, and needed six stitches for which she was billed close to $3,000.

The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.

Rising costs of drugs, medical equipment and other services, and fees from layers of middlemen, play a significant role in escalating hospital bills, of course. But just as important is that mergers and consolidation have resulted in a couple of hospital chains — like Partners in Boston, or Banner in Phoenix — dominating many parts of the country, allowing them to command high prices from insurers and employers.

Sutter Health, California Pacific Medical Center’s parent company, operates more than two dozen community hospitals in Northern California, almost all in middle-class or high-income neighborhoods. Its clout has helped California Pacific Medical Center, the state’s largest private nonprofit hospital, also earn the highest net income in California. Prices for many of the procedures at the San Francisco hospital are among the top 20 percent in the country, according to a New York Times analysis of data released by the federal government.

“Sutter is a leader — a pioneer — in figuring out how to amass market power to raise prices and decrease competition,” said Glenn Melnick, a professor of health economics at the University of Southern California. “How do hospitals set prices? They set prices to maximize revenue, and they raise prices as much as they can — all the research supports that.”

As Hospital Prices Soar, a Stitch Tops $500 | NYTimes.com

OAW

[climber]

So the president is saying today that no one should fear going broke if they get sick. His solution...Make them all afraid of going broke buying mandated and overpriced insurance instead.

[BadKosh]

He was just trying a new shade of lipstick on the pig.

[ebuddy]

Originally Posted by OAW 

I've said it before and I'll say it again.

Q: Why are healthcare costs so astronomically high?

A: Because they can.

OAW

And the reason they can is because they're not charging you, they're charging Blue Cross Blue Shield or the Federal Government. They're also required to carry preposterous insurances and comply with a wealth of other regulations both State and Federal. This is what happens in a distorted marketplace. What the story missed was; Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11 of which she was expected to pay about $450.00. Otherwise, cash-only doctors are a hell of a lot cheaper, schedule their fees, and while they only represent 4% of the market, grew 1% from less than a year ago. Procedures generally deemed uninsured such as cosmetic and some vision corrective surgeries have only declined in cost while enjoying advancement in related technologies. I can picture a marketplace where cash-only clinics spring up, charge less, are less bureaucratic, and run much more efficiently. They could quickly become the standard for the types of scenarios you mention. The problem is in order for such services to flourish, we'll need less regulation, not more.

Unfortunately, this takes a little vision instead of just looking for someone to sock it to which too often plays more nicely at the polls.

[ghporter]

One thing those articles (and the bills) don't break down is the hourly pay almost everyone who provides emergency department services (and all of the people who support and enable those providers) earn. RNs earn a national median wage of about $66k (about $33/hour) while LVNs earn about $44k ($21/hour). Physicians' median wage is about $183k (but they usually hit the street with a huge student debt load from their extensive schooling). Physical and occupational therapists earn median annual wages of about $78k and $73k respectively.

Some of the pay differences come from the amount of education each profession requires as a starting point. RNs can start with an associate degree, and LVNs don't require that much. Entry level for both PT and OT is currently MS level, with PT schools featuring entry level doctorate programs; OT lags this with only masters level entry programs and follow-on doctorates in either clinical positions (the OT doctorate or OTD) or in research (which become essentially PhDs). Physicians' education starts with a BS (usually in biology) followed by medical school and an extensive "hands on" apprenticeship called "residency."

Now let's look at what consumers want. When surveyed here in San Antonio, hospital patients overwhelmingly wanted registered nurses providing their care; there are only a few specific routine tasks that LVNs can't do but RNs can. (Can't bring up these surveys on my iPad - Methodist Hospitals, San Antonio uses a mobile site that borks Google links...) These surveys' results are representative of others done elsewhere; people want all of their hands-on care done by RNs. So instead of using an intelligent mix of professionals, with RNs supervising multiple LVNs who perform the routine tasks and allow the RNs to perform the higher level tasks for more patients, hospitals staff with mostly RNs, which is typically about 50% costlier than using fewer RNs and more LVNs. In other words, "market forces" have led to higher prices for health care, essentially because consumers don't know much (if anything) about what nurses do. It's even worse for other health professions.

[Uncle Skeleton]

It's not "market forces" without an informed consumer who is also paying the actual bill. One of the reasons people don't go for a cheaper nurse is because the associated cost is abstracted through insurance and other paperwork. If it was itemized like the $1 menu at McDs, I guarantee you that the outcome of that survey would be different.

I would want the best of everything too, if I wasn't the one paying the bill. Why shouldn't I?

[andi*pandi]

I don't think that's true everywhere. My mother is an RN, and taught several CNA programs. Hospitals were eager to have these less expensive options, and RNs were eager to not do the menial tasks (bedpans, blood pressure, etc). However, my mother was appalled at the quality of some of her students... who could not read at a 5th grade level, but yet managed to pass the course. I would not want someone like that at the forefront of my care.

[pooka]

Out of control costs aside, I'm still trying to figure out why I, a small business owner, am being tasked with figuring out insurance shit for employees. It's hard enough figuring out what managed email service to go with.

[climber]

Originally Posted by pooka 

Out of control costs aside, I'm still trying to figure out why I, a small business owner, am being tasked with figuring out insurance shit for employees. It's hard enough figuring out what managed email service to go with.

Welcome to the new reality of liberal responsibility; Where everyone except me is responsible for my needs except myself.

[ebuddy]

Originally Posted by Uncle Skeleton 

It's not "market forces" without an informed consumer who is also paying the actual bill. One of the reasons people don't go for a cheaper nurse is because the associated cost is abstracted through insurance and other paperwork. If it was itemized like the $1 menu at McDs, I guarantee you that the outcome of that survey would be different.

Bingo. And maybe we'd learn to be a little more self-sufficient overall. I mean, the two examples were three stitches and skin glue.

[ghporter]

It is "market forces" when the suits that run health care corporations can say "our customers demand..." And it is these suits that determine the professional mix their HR departments hire. And the suits are responsible for the staffing ratios that overwork nurses (one does not need to go to nursing school to be able to restock supplies, run blood samples to the lab, etc. but many nurses have these tasks and others) while under-serving patients.

Remember, "market" is not a health care concept, it's a business concept.

[ebuddy]

Originally Posted by ghporter 

It is "market forces" when the suits that run health care corporations can say "our customers demand..." And it is these suits that determine the professional mix their HR departments hire. And the suits are responsible for the staffing ratios that overwork nurses (one does not need to go to nursing school to be able to restock supplies, run blood samples to the lab, etc. but many nurses have these tasks and others) while under-serving patients.

Remember, "market" is not a health care concept, it's a business concept.

First of all, we can be fairly certain that Obama's Demcare changes none of this. I also don't think there is anything to substantiate the claim that customers care who's stocking supplies and running blood samples to the lab. You can bet the government would care however as the health services industry is easily among the most heavily regulated "markets" in the country, costing the average US household $1500 per year or exceeding $169 billion nationally.

[Uncle Skeleton]

Originally Posted by ghporter 

It is "market forces" when the suits that run health care corporations can say "our customers demand..."

No it's not. They can say anything they want. It's "market forces" when the customers actually do demand this or that, not when entrepreneurs inflate their margins by claiming it's so.

"Market forces" doesn't just mean anything that's not government. Market forces can also be disrupted from the private sector by fraud, collusion, or force. Armed robbery is not "market forces," for example.

[ghporter]

The Affordable Care Act's biggest impacts for most people will be to provide them with the ability to do an actual apples-to-apples comparison of various insurance plans. It won't change how suits react to what they think their market wants. Even before ACA, a lot of hospital corporations were still focusing on customer satisfaction surveys to measure their performance, instead of the medical outcome of the hospital stay. Medicare rules have changed, and outcomes are becoming the key metric for how hospitals are compensated. Whether the suits like it or not, it is the actual medical activities that they need to pay attention to, not whether or not Mrs. Jones felt slighted when the nurse didn't answer her call light while her finger was still on the button.

Uncle Skeleton, my point was not that the term "market forces" was accurate, but that people who can't figure out a band aid are the ones who decide how many nurses are allowed to work for a given number of patients. Acuity, which is the seriousness of each patient's issues and which drives the workload of all the care providers involved in that patient's care, is hardly even mentioned in staffing plans. It is all about minimizing the personnel costs so that share holders get the most return on their money. Nurses, who do the vast majority of actual hands-on patient care in hospitals, are obviously the largest HR cost in any hospital, and when you cut corners on the folks who can watch over sick people minute to minute, you put those sick people at risk for "poor outcomes," which is ALWAYS more expensive to the hospital and is often cause for lawsuits. But you can't teach suits that sort of thing, because it doesn't come from a shareholders' meeting.

[ebuddy]

Originally Posted by ghporter 

Uncle Skeleton, my point was not that the term "market forces" was accurate, but that people who can't figure out a band aid are the ones who decide how many nurses are allowed to work for a given number of patients. Acuity, which is the seriousness of each patient's issues and which drives the workload of all the care providers involved in that patient's care, is hardly even mentioned in staffing plans. It is all about minimizing the personnel costs so that share holders get the most return on their money. Nurses, who do the vast majority of actual hands-on patient care in hospitals, are obviously the largest HR cost in any hospital, and when you cut corners on the folks who can watch over sick people minute to minute, you put those sick people at risk for "poor outcomes," which is ALWAYS more expensive to the hospital and is often cause for lawsuits. But you can't teach suits that sort of thing, because it doesn't come from a shareholders' meeting.

And of course, the only entity less knowledgable and more destructive than a suit is a politician.

[Snow-i]

ObamaCare exchanges limit access to top hospitals, medical centers | Fox News

Great! More money for shittier care. That'll sure solve the nation's healthcare expense problem. Only the 1%ers can afford the best care now? Where the hell is occupy Washington on this one?

Honest question though - how long before we run these bastards out of town for screwing up a sixth of our economy? Surely the kool-aid isn't that strong.

Is there anyone on these boards that still supports this abomination, and if so: on what basis?

[besson3c]

Originally Posted by Snow-i 

ObamaCare exchanges limit access to top hospitals, medical centers | Fox News

Great! More money for shittier care. That'll sure solve the nation's healthcare expense problem. Only the 1%ers can afford the best care now? Where the hell is occupy Washington on this one?

Honest question though - how long before we run these bastards out of town for screwing up a sixth of our economy? Surely the kool-aid isn't that strong.

Is there anyone on these boards that still supports this abomination, and if so: on what basis?

My basis: it is the beginning of a new generation of health care, assuming that this won't be abandoned for the status quo we have now.

That isn't to defend this transition though, if this story and similar stories are true. My support isn't specific to this specific implementation (or "abomination", as you call it) and how it has been carried out, although speaking purely from a selfish vantage point I can't complain about my $0 monthly premiums starting when my coverage starts in January. However, since I'm leaving the US about halfway into the year I probably won't have to actually use my new insurance policy to have that experience with it.

[ebuddy]

Originally Posted by besson3c 

My basis: it is the beginning of a new generation of health care, assuming that this won't be abandoned for the status quo we have now.

That isn't to defend this transition though, if this story and similar stories are true. My support isn't specific to this specific implementation (or "abomination", as you call it) and how it has been carried out, although speaking purely from a selfish vantage point I can't complain about my $0 monthly premiums starting when my coverage starts in January. However, since I'm leaving the US about halfway into the year I probably won't have to actually use my new insurance policy to have that experience with it.

Assuming you have enrolled and leaving numbers out of it, does it seem sensible, right or even just that you would be on Medicare? I mean, unless there's something important I've missed here in which case just tell me it's none of my business.

I didn't think I could complain either, but my premium increased 63% upon this year's open enrollment. It's still a fantastic plan, but it's the same plan I had before. Fine... whatever... but I don't see how it ends any time soon and too many are in much, much worse shape with their increases.

We absolutely needed a more targeted approach to the issue.

[besson3c]

Originally Posted by ebuddy 

Assuming you have enrolled and leaving numbers out of it, does it seem sensible, right or even just that you would be on Medicare? I mean, unless there's something important I've missed here in which case just tell me it's none of my business.

I answered this question before. We are not eligible for Medicare, we make substantially more than the $26k or whatever the number is.

I honestly don't understand why our tax credit is as big as it is, but I assure you I'm not lying or stretching the truth in any way. It might be because we are both young (< 40) freelancers with registered tax paying businesses, I don't know.

I didn't think I could complain either, but my premium increased 63% upon this year's open enrollment. It's still a fantastic plan, but it's the same plan I had before. Fine... whatever... but I don't see how it ends any time soon and too many are in much, much worse shape with their increases.

We absolutely needed a more targeted approach to the issue.

I think we also need more than anecdotes like this. The "who benefits, who doesn't" is based on the person's state, income, what kind of insurance they require, smoking history, etc. We need more data. I don't know how this breaks down, but it would seem like a good starting place with a targeted approach is compiling this data.

[BadKosh]

I wonder if they(Obama Admin) had not pissed the 600+ million away on the disfunctional, bug ridden web site and just used it to fund the advertised 35 million without insurance (possibly making the bucks a health savings account sort of thing) if they would be hated less? It sure wouldn't have caused the Democrats to be caught en mass lying for three years.

[ebuddy]

Originally Posted by besson3c 

I answered this question before. We are not eligible for Medicare, we make substantially more than the $26k or whatever the number is.

Okay, I'll ask you another way. Leaving Medicare and numbers out of this, there are families at and below poverty level paying either a penalty for not having insurance or a monthly premium to have insurance; does it seem sensible, right or even just that your family's healthcare is 100% subsidized?

I honestly don't understand why our tax credit is as big as it is, but I assure you I'm not lying or stretching the truth in any way. It might be because we are both young (< 40) freelancers with registered tax paying businesses, I don't know.

If you don't know how it is that your healthcare is 100% government-subsidized, yet you are in the very pool with the highest premiums by design and not on Medicare, brace for sticker shock. A grievous mathematical error has been made.

I think we also need more than anecdotes like this. The "who benefits, who doesn't" is based on the person's state, income, what kind of insurance they require, smoking history, etc. We need more data. I don't know how this breaks down, but it would seem like a good starting place with a targeted approach is compiling this data.

Insurance companies have been compiling this data since insurance companies were conceived. That's what they do. The only problem with the data at this point is that it does not say what ACA proponents want it to say.

[besson3c]

Originally Posted by ebuddy 

Okay, I'll ask you another way. Leaving Medicare and numbers out of this, there are families at and below poverty level paying either a penalty for not having insurance or a monthly premium to have insurance; does it seem sensible, right or even just that your family's healthcare is 100% subsidized?

That assumes that in my state people making less than me would have monthly premiums for a family of two. Unless there is an error in the web app that came up with this, I don't think this is a logical assumption.

If you don't know how it is that your healthcare is 100% government-subsidized, yet you are in the very pool with the highest premiums by design and not on Medicare, brace for sticker shock. A grievous mathematical error has been made.

It's hard to fathom an error that would take us from $0 to $270+, but we'll see. We are eligible for the tax credit, I just wasn't expecting it to be for this amount. I was expecting my monthly premium to something between, say, $50-270.

Insurance companies have been compiling this data since insurance companies were conceived. That's what they do. The only problem with the data at this point is that it does not say what ACA proponents want it to say.

You are just caught up in your own ideology.

Long before October 1st there were independent calculators that showed that some people will benefit from the tax credits, it is ridiculous to believe that *nobody* will benefit from them.

[Snow-i]

Originally Posted by besson3c 

My basis: it is the beginning of a new generation of health care, assuming that this won't be abandoned for the status quo we have now.

That isn't to defend this transition though, if this story and similar stories are true. My support isn't specific to this specific implementation (or "abomination", as you call it) and how it has been carried out, although speaking purely from a selfish vantage point I can't complain about my $0 monthly premiums starting when my coverage starts in January. However, since I'm leaving the US about halfway into the year I probably won't have to actually use my new insurance policy to have that experience with it.

I absolutely can complain about your $0 premium, because I'm paying for it. I am literally paying for your healthcare, besson, and its utter horse shit because I can't even afford it for myself at the moment (thanks to the ACA).

Aside from being different then the status quo, are there any aspects of this law that demonstrate improvement in any area of health services? Any at all?

I mean, you keep bringing up how things are gonna be, but aside from the promises of a man who breaks them each chance he gets, on what are you basing the idea that improvements are going to be realized?

[besson3c]

Originally Posted by Snow-i 

I absolutely can complain about your $0 premium, because I'm paying for it. I am literally paying for your healthcare, besson, and its utter horse fence because I can't even afford it for myself at the moment (thanks to the ACA).

Aside from being different then the status quo, are there any aspects of this law that demonstrate improvement in any area of health services? Any at all?

I think you know my answer there too: I don't know yet.

[ebuddy]

Originally Posted by besson3c 

That assumes that in my state people making less than me would have monthly premiums for a family of two. Unless there is an error in the web app that came up with this, I don't think this is a logical assumption.

You mean, healthcare.gov right?

It's hard to fathom an error that would take us from $0 to $270+, but we'll see. We are eligible for the tax credit, I just wasn't expecting it to be for this amount. I was expecting my monthly premium to something between, say, $50-270.

You thought it was going to be somewhere between $50-270, you're the demographic of higher rates by design regardless of State market, and you're paying $0. - 0

I'm not sure my assumptions are illogical.

You are just caught up in your own ideology.

If common sense is an ideology to you, sure. guilty.

Long before October 1st there were independent calculators that showed that some people will benefit from the tax credits, it is ridiculous to believe that *nobody* will benefit from them.

When did I claim that nobody would benefit from them? I generally don't take issue with that aspect of the law, it is how much will be squandered and wasted to meet the very real needs of some 20 million people.

I asked you if it seemed sensible or fair that you would pay 0.

[besson3c]

Originally Posted by ebuddy 

You mean, healthcare.gov right?

Yes. I have been pretty clear and consistent in saying that I'm surprised at what it came up with, and that I wouldn't be surprised if there was an error.

You thought it was going to be somewhere between $50-270, you're the demographic of higher rates by design regardless of State market, and you're paying $0. - 0

I'm not sure my assumptions are illogical.

They are, because I've said that I qualify for some amount of tax credit, so I would expect my monthly premiums to be less than what they are now due to the tax credit.

If common sense is an ideology to you, sure. guilty.

When did I claim that nobody would benefit from them? I generally don't take issue with that aspect of the law, it is how much will be squandered and wasted to meet the very real needs of some 20 million people.

There are far more than 20 million people that are without health insurance, I'm pretty certain.

I asked you if it seemed sensible or fair that you would pay 0.

And I've said that I don't understand how or why it worked out that way for us. Your question seems predicated around the notion that people that make less than me won't be eligible for the same tax credit, that was my point, but no, it doesn't seem sensible nor fair since we can obviously afford to pay something.

Since I've been very forthcoming with you, I'd like to know at what point you start to question your party's lack of ability/success in putting forth something better? Even if you think that this will be possible without repeal, why aren't they trying to gain traction by promoting better, concrete ideas? Your frustration seems one-sided.

[Chongo]

From CBS News via News Busters:

NORAH O'DONNELL: The Wall Street Journal says health insurance customers are finding another problem under ObamaCare. The new generation of policies have higher deductibles. Consumers have to pay more of their own money before insurance kicks in. The average deductible for the lowest level of insurance on HealthCare.gov is more than $5,000.

Read more: CBS Notices &#039;Another Problem&#039; With ObamaCare – Higher Deductibles; ABC, NBC Omit | NewsBusters

In other news:
Oklahoma Lawsuit Could Derail Obamacare

OKLAHOMA CITY, Okla. — As the enrollment period for Obamacare experiences a rocky start, Oklahoma Attorney General Scott Pruitt says his state’s “very consequential” lawsuit against the mandates in the health insurance law could lead to a fiscal nightmare in 34 states.

Oklahoma’s lawsuit claims the federal law limits the collection of tax penalties from large employers that do not provide health coverage for their employees to those states that created their own health-care exchanges. Those taxes are the main source of subsidies that will reduce premium costs for insurance bought on the health exchanges.

Companies in states such as North Carolina and Oklahoma, which are using the federal exchanges, cannot be taxed if they do not provide employee health policies, the lawsuit says. Residents of those states could not receive subsidies for purchasing health insurance on the individual market.

[Shaddim]

Originally Posted by BadKosh 

I wonder if they(Obama Admin) had not pissed the 600+ million away on the disfunctional, bug ridden web site and just used it to fund the advertised 35 million without insurance (possibly making the bucks a health savings account sort of thing) if they would be hated less? It sure wouldn't have caused the Democrats to be caught en mass lying for three years.

You mean those no-bid contracts that went to the company his wife's college buddy works for? That's all 100% above board, I can assure you. **** me, I'm not sure how it could look worse, it makes other Presidential money scandals seem completely insignificant. Anyone want to place bets on whether Obama will face criminal charges when he leaves office? I have a crisp $10 bill saying he'll be charged within 18 months of leaving office.

[Shaddim]

Originally Posted by Chongo 

From CBS News via News Busters:

In other news:
Oklahoma Lawsuit Could Derail Obamacare

Seems to me that it's entirely pointless, a young person paying that much for what amounts to catastrophic coverage only?

[Shaddim]

Originally Posted by besson3c 

There are far more than 20 million people that are without health insurance, I'm pretty certain.

But only 20M are going to benefit, there are still a very large number who still won't have coverage. As he said, that's a lot to pay for shitty service for 20M people.

[Chongo]

Originally Posted by Shaddim 

Seems to me that it's entirely pointless, a young person paying that much for what amounts to catastrophic coverage only?

That is what is killing Obamacare at this point. It requires all those youngsters/Obama voters to pay large for small benefits or pay the "tax" if they don't. It's cheeper to pay the "tax" and sign up later after you need insurance.

[Chongo]

They're at it again over at MSNBC:

Melissa Harris-Perry Suggests ObamaCare Is The New N-Word - YouTube