This is topic Obamacare Predictions for May 2015 in forum General Comments at The Ornery American Forum.


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Posted by Greg Davidson (Member # 3377) on :
 
Let's all go on the record now with our predictions for how Obamacare will be working 18 months from today. You can go on the record with any prediction, from complete collapse and repeal all the way to tens of millions more covered by medicare and healthcare insurance off of the exchanges.

I predict it will still be the law of the land, no death spirals, some boring fixes will be put in place to address parts of the law that were not working, and the minority of the population directly affected by the exchanges (ie; those without health insurance from their employer) will generally be satisfied. The annual rate of healthcare cost growth will continue close to 50 year lows. Polling will indicate that more Americans will favor continuing the law than repealing it. And Republicans will still be benghazi'ing some weird aspect of Obamacare that motivates their base but that the majority of Americans just don't care about.
 
Posted by cherrypoptart (Member # 3942) on :
 
I had thought that the insurance companies were about to learn a lesson the hard way as they start to go bankrupt because not enough people can possibly afford to make these monthly payments on premiums this high no matter how many more payday loan stores open up in the neighborhood but I recently heard of another little known provision in Obamacare that actually covers this contingency with massive and unlimited taxpayer bailouts and support to the insurance companies so basically Obama played a deep game and saw all of this coming. So that bailout/takeover will be necessary to keep Obamacare from bankrupting insurance companies especially when the young and healthy don't fall for the scam.


On another note, though I'm not for salary caps for private companies, once the government starts paying the insurance companies and also now that the government says we have to pay them or we are criminals I don't see how anyone can justify their million dollar salaries and benefits anymore. So you can expect that to come next. If it's a free market that's one thing and that's great that people can make as much as others are willing to pay for their product but this isn't a free market anymore and in fact it's not even a free country anymore either. So another prediction is that there will be serious talk about salary caps for insurance executives and broad support from Americans especially if the insurance companies get a bailout but even if they don't because why should we be forced by law to pay for some big wig insurance company executive's multimillion dollar salary?
 
Posted by Pete at Home (Member # 429) on :
 
What to you believe will prevent the death spiral resulting from the shutdown of small oncology clinics due to the April 2013 rule change re medicaid reimbursement for basic cancer drugs?
 
Posted by Greg Davidson (Member # 3377) on :
 
Pete, for this thread, let's just go out on a limb and make our predictions about what will actually occur. After all, G3 says I am running away from the topic of Obamacare. Instead, I'd like to face right up to the ultimate measure - despite initial problems, will it work and will it be sustained.

All of those 100% critics (of which you are not one, Pete) probably believe that Obamacare will do grievous harm and/or be repealed (I don't think that they would be so critical if they truly believed that the system work work, and bring net benefits in terms of providing better coverage and bending the cost curve). So they should feel confident about predicting the disaster that they believe will occur by the randomly-chosen date of May 2015. And on that day, we can go back and look at this thread, and determine who was right.
 
Posted by Pete at Home (Member # 429) on :
 
Fair enough. The problem I describe isn't all Obamacare but a previous problem agravated by O.

I don't think you are running away.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
1 web portal will still be scaling badly despite now being hosted by HP enterprise division.

2 advertisement for healthcare by third party groups closely associated with democrat interests will have increased dramatically.

3. Security concerns will improve to a "d" level.

4. Small business wil still be unable to utilize portal for employee insurance.

5. Carve outs/set asides for democrat leaning groups and industries will increase. Resulting in unions getting favorable tax and regulatory treatment. While industries with political alliances with Democrats such as GM or unionized teachers will see passes made on regulatory and tax application of self insured policies.

6. Medicare and Medicaid annual funding will be further cut.

7. States that took the Medicare Medicaid prebate funds will beg Washington to make federal direct funding permanent.

8. Medical device manufacturing will see continued offshore flight.

9. Medical staff directly related to patient contact and care will continue to see cuts. Paper pushers associated with medical staffing will increase.

10. Youth purchase of policies will lagg 25% behind expected adoption of coverage for people aged 26- 35.

11. Insurance pools will have fewer insurer options as companies cannot acheive sustainable profit margins. Single provider will increase across additional medical care regions.

12. Medical savings accounts will be sunset.

13. IRS will accept fraudulent self reporting.

14. Emergency room access will increase as the primary access point.

15. Fraudulent or non paid healthcare access by illegal aliens will show no change.

16. Doctor shortages will speed up and calls for H1B visa carve outs will be required .

17. New classification of nurses created with far less traing ing compared to RN or PA levels, yet wil have pharmacy rights.

18. Wait times to see primary care physician for scheduled appointments will increase by three days and acctual examination time will drop by four minutes.

19. Physician consultation time will decrease by 4%.

20. Medicaid and Medicare acceptance rates for new patients will decline 1%. Payouts on reimbursements will suffer a real decline of coverage by 1%.

21 coverage rates among the uninsured will still have 40,000,000 uncovered.

22. Private insurance with private closed health systems will see an increase in market share of 3%. Trend towards concierge doctor access for wealthy individuals increase.

23. Obamacare remains law.

24. Co-pays increase 4% on average.

25. Deductibles increase 2% on average.

26. Bed access and availibility issues force delays in elective surgery.

27. Pharmaceutical spectrum of availible and approved by insurer drugs will shrink for most people. Out of pocket costs to individuals will increase as wellness programs are dropped for fiscal reasons.

28. Insurer maximums on dollar allocations will prove to be disasterous. Only the largest companies will be able to comply with the artificial horizon resulting in many regions having only 1 insurer availible in the pool.

29. Private insurance existing outside of the public pools will see an abandonment of the standard plan levels and show a strong migration towards private high premium low deductible Cadillac plans. Result forces most people into the public pools.

30. State sponsored pools of last resort collapse due to the expected elimination of most of the funds that provide states with budget shortfall coverage.

31. Health outcome and care issues either show slowed improvement, or a cessation of improvement.

32. Life expectancies slow.

33. Infant mortality increases.

34. Prescription rate per capita increases.

35. Surgery hours increase while surgerys per capita decrease.

36. Recovery days will be reduced.

37. Healthcare as a budget outlay at the federal level will increase 3%.

38. Healthcare as a component of GNP will increase 1%.

I'm stopping here simply because I could go on for literally hours. It's ruining my day thinking about this.

I pray I don't actually get sick next year because my health care is unaffordable to actually use. I'm hoping obamacare causes so much pain to the rest of the country that it collapses on its own.
 
Posted by G3 (Member # 6723) on :
 
With a law that is currently being changed on a, literally, weekly basis, I find it impossible to make any predictions. A law that is illegally rewritten by executive fiat so frequently to meet the demands of political expediency could be anything a month from now much less more than a year.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
I find it impossible to make any predictions
Such courage of your convictions... You mean to say that you are lack the confidence in your own judgment to say whether or not Obamacare will turn into the most beneficial government program in history? You cannot make any predictions?
 
Posted by RedVW on a Laptop (Member # 615) on :
 
LOL the most beneficial?

Please.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Greg Davidson:
quote:
I find it impossible to make any predictions
Such courage of your convictions... You mean to say that you are lack the confidence in your own judgment to say whether or not Obamacare will turn into the most beneficial government program in history? You cannot make any predictions?
Mumm.no. I mean that since the law changes on a near weekly basis that we cannot know what the law will be next week much less more than a year from now. Making predictions about a law that is changed at the whim of a weak and ineffective president seeking short term politcal gain has nothing to do with the courage of convictions. When laws get made up as we go, how can we predict their ultimate impact? Your predictions are nothing more than blind ideological wishes.
 
Posted by Greg Davidson (Member # 3377) on :
 
Red, I was being sarcastic.

G3 has been venting about Obamacare for ages, and yet now he is unwilling to even go out on a limb and say that he predicts that it will bring adverse consequences. In fact, he is not even confident disagreeing with the assertion that tens of millions of Americans will now get health care, that the overall rate of growth of health care costs will be reduced, and then tens of thousands of lives will be saved. He lacks confidence in his own judgments to make any comment whatsoever on what is likely to result from Obamacare.

Needless to say, I am surprised
 
Posted by Greg Davidson (Member # 3377) on :
 
Slightly off-topic; evidence of Obamacare's success that has already been demonstrated

quote:
Still, the facts are striking. Since 2010, when the act was passed, real health spending per capita — that is, total spending adjusted for overall inflation and population growth — has risen less than a third as rapidly as its long-term average. Real spending per Medicare recipient hasn’t risen at all; real spending per Medicaid beneficiary has actually fallen slightly.

What could account for this good news? One obvious answer is the still-depressed economy, which might be causing people to forgo expensive medical care. But this explanation turns out to be problematic in multiple ways. For one thing, the economy had stabilized by 2010, even if the recovery was fairly weak, yet health costs continued to slow. For another, it’s hard to see why a weak economy would have more effect in reducing the prices of health services than it has on overall inflation. Finally, Medicare spending shouldn’t be affected by the weak economy, yet it has slowed even more dramatically than private spending.

A better story focuses on what appears to be a decline in some kinds of medical innovation — in particular, an absence of expensive new blockbuster drugs, even as existing drugs go off-patent and can be replaced with cheaper generic brands. This is a real phenomenon; it is, in fact, the main reason the Medicare drug program has ended up costing less than originally projected. But since drugs are only about 10 percent of health spending, it can only explain so much.

So what aspects of Obamacare might be causing health costs to slow? One clear answer is the act’s reduction in Medicare “overpayments” — mainly a reduction in the subsidies to private insurers offering Medicare Advantage Plans, but also cuts in some provider payments. A less certain but likely source of savings involves changes in the way Medicare pays for services. The program now penalizes hospitals if many of their patients end up being readmitted soon after being released — an indicator of poor care — and readmission rates have, in fact, fallen substantially. Medicare is also encouraging a shift from fee-for-service, in which doctors and hospitals get paid by the procedure, to “accountable care,” in which health organizations get rewarded for overall success in improving care while controlling costs.

]link
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Greg Davidson:
Red, I was being sarcastic.

G3 has been venting about Obamacare for ages, and yet now he is unwilling to even go out on a limb and say that he predicts that it will bring adverse consequences. In fact, he is not even confident disagreeing with the assertion that tens of millions of Americans will now get health care, that the overall rate of growth of health care costs will be reduced, and then tens of thousands of lives will be saved. He lacks confidence in his own judgments to make any comment whatsoever on what is likely to result from Obamacare.

Needless to say, I am surprised

Needless to say, I am not. You're in a full court press here aren't you? You must be really panicked. Can't say I blame you either.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Greg

You realize why Medicare/caid spending has dropped don't you?

It has everything to do with the ACA - and it's designed to gut both of them funding and outlay wise.

Medicare and caid funding was preloaded with a bribe to the states that were foolish enough to accept the cash. Federal spending as a result will go down while state share will go way up. It's a ballance sheet transfer but not a real reduction since the states now cover the reduction. See 30 & 20.

I mean come on, you are citing one of the most serious flaws of this law as evidence that it's working? It's like earlier statements about how it's working because it's already collecting funds for future outlays- it's lowing the debt so it's working went the argument.

The reality is it's collecting a tax before the funds must be spent, yet the funds. Collected are not enough to cover the expected outlays. Ie shortly after the 2014 election when the funds will then start being spent, we will either have to print money or raise taxes to make the ACA revenue neutral.

It's just an utter disAster by any measure.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
So flagrant were Krugman’s distortions, that in May 2005, former Times ombudsman Daniel Okrent was moved to vent his exasperation in a farewell column for the paper. Warning that “Paul Krugman has the disturbing habit of shaping, slicing and selectively citing numbers in a fashion that pleases his acolytes but leaves him open to substantive assaults,” Okrent urged publisher Arthur Sulzberger, Jr. to “hold his columnists to higher standards.”

Not my words. But explains your source accurately.
 
Posted by LetterRip (Member # 310) on :
 
Red,

see Krugmans response which is excerpted on Delongs blog, short version is when Okrent provided specifics, he showed pretty clearly Okrent didn't know what he was talking about - it was a case of Okrent not knowing math and economics, not Krugman making mistakes.

http://delong.typepad.com/sdj/2008/10/why-is-ex-new-y.html

Okrent appears to have damaged his own reputation with the false accusation. You should probably read the response by Krugman since it appears you only got half the story.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
No. I have the full story. The issue is in this case that K has decided to tell half the story. Yes the federal outlays are down but no he hasn't told the full reason why they are down.

It's like saying an army successfully attack. Withou further stating the attack failed.

It's been a pattern of K's for over a decade. He might have been right in the earlier manipulation a of data but his pattern of omission really originated from the earlier incident.
 
Posted by Charles in Charge (Member # 6879) on :
 
The slowdown in the growth of healthcare spending happened in 2008 and 2009, before ACA was implemented. Even the CEA report Krugman links to identifies several other causes to help explain the slowdown. The CMS actually goes further and assigns weights to those causes:

quote:

1) Medicare/Medicaid/other programs “unrelated to the ACA” (50.7% of improvement).
2) Other factors “unrelated to the ACA” (26.1%).
3) Updated data on historical spending growth (21.8%).
4) Updated macroeconomic assumptions (6.1%).

ACA gets -4.7% credit for the slowdown.

And it's likely that overall ACA will continue to put upward pressure on healthcare spending. From the CEA report: "as the ACA’s coverage expansion comes online, health care spending may grow at an elevated rate for a few years."

CEA report: http://www.whitehouse.gov/sites/default/files/docs/healthcostreport_final_noembargo_v2.pdf
CMS memo: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsRevisionAnalysis.pdf

Relevant article reacting to both reports:
http://www.economics21.org/commentary/no-grounds-claim-obamacare-lowers-healthcare-costs
 
Posted by RedVW on a Laptop (Member # 615) on :
 
That would be the facts K left out of his assessment this time.

As I pointed out in my predictions, I did take this into account.

The fact is, every few days regulatory stipulations change or Obama unilaterally changes the implementation time table for political gain. Ie the inability of small corporations to use the pools has now been pushed beyond the mid term election. Net result, those cost impacts to the federal government will occurr after an election thus allowing Obama to maintain his cost lowering fiction until after the voters elect a new congress.

It's just stupid.
 
Posted by Pete at Home (Member # 429) on :
 
From what I hear from people on Medicaid (most of the people I know), and from doctors that used to receive it (I have an oncologist and an opthamologist in my family), there's a general feeling that it's become selectively parsimonious.

That's anecdotal evidence; I'm interested if there's general survey of the doctor and patient ends of things.

I have little trust for people who use terms like "efficiency" ambiguously, especially when you find out that when it boils down, efficiency means less doctor time per patient, and more money going to the corporation/megahospital rather than into the pocket of flesh and blood caregivers.
 
Posted by noel c. (Member # 6699) on :
 
"ObamaCare", whatever that label eventually comes to mean, will do one thing very effectively; It will successfully dismantle the private health-care system beyond recognition, and do serious short term damage to the welfare of individuals being bumped off their plans through 2014.

Republicans will retain control of the House, and pick up a majority in the Senate in the next election cycle, but this will do nothing to put Humpty Dumpty back together again. Barry may not know how to govern/manage, but he has masterfully screwed up the most advanced health-care system in the world. It will take literally years to re-establish the professional networks, and doctor/patient relationships that he is hell-bent on placing under government oversight.

Liberalism will be starkly exposed for its ineptitude at central planning, and will not recover politically from this debacle... but that is not much of a consolation to those who find themselves in need of extensive medical services in the next few years.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Noel I don't think the republicans will win the senate.
 
Posted by noel c. (Member # 6699) on :
 
Red,

...That would explain your prediction. There are seven Democratic senators up for re-election who are beating the bushes at home over this holiday weekend. Monday will be quite telling in reference to the Barry loyalty factor. I am betting that they will attempt to preserve their seats by distancing themselves from any involvement in the cynical ploy that put this obamination on the books... but it is unlikely to work. The tactic will lead to the conclusion that they are either incompetent, liars, or both. All of them are on record.

Republicans only need four more seats to have a majority, and Harry's rule change for judicial appointments is going to come back to haunt the Dems in spades. Republicans will expand the (constitutional) simple majority standard to *all* aspects of Senate business, including legislation.

The backlash to presidential deception will be veto proof.
 
Posted by Greg Davidson (Member # 3377) on :
 
noel, could you please elaborate on what you mean by
quote:
"It will successfully dismantle the private health-care system beyond recognition, and do serious short term damage to the welfare of individuals being bumped off their plans through 2014"
The difficulty I have in understanding this formulation is that "beyond recognition" is totally dependent on the perceptions of the recognizers. Previous discussions here on Ornery have shown that often those on different sides of the issues have entirely different perceptions of what are the facts of a situation. Can you be specific about what specific "dismantling" you are referring to, and what measurable damage that you believe will occur?
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Greg

No offense but if you haven't noticed it has already dismantled and changed healthcare for the worse, further discussion is pointless.

Prime example

My wife's hospital is mandated by law to change the medical coding system to one approved by obamacare. The cost is 1.3 million. This new program of course replaces the one they put in three years ago at a cost of $300k.

To cover this unexpected cost- there have been staffing cuts to bedside care. Specifically senior nursing staff- ie with greater than ten years specialized training- are now being preferentially low censused in favor of new nurses with less than two years general experience.

You want a specialized nurse When you are in a neuro icu. You do not want the best nurses sitting at home due to budget restriction.

The example is just one component of the wholesale changes required by the ACA which are directly impacting a regional medical center. It is directly impacting patient care staffing.

And on a morbid note the icu deaths have gone up. Still in the industry standards- but it's still an increase. When you have a staff that normally has 3 nurses with 10 years experience staffed with every less than five year experienced nurse- you save the unsavable. When you have 1 nurse of ten years experience staffed with 3 nurses with less than five years experience you get more deaths.

But hey that is just one anecdote you can ignore.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
No offense but if you haven't noticed it has already dismantled and changed healthcare for the worse, further discussion is pointless.
Lovely example of epistemic closure - you are so certain of yourself that mere discussion is pointless.

But then you provide a few facts about a single case. You assert that there has been a specific policy change of the hospital to down-grade staff levels in direct response to a $1.3 million expenditure. How do you know that's the root cause? What's the total level of expenditures over the past three years, and is $1.3 million such a large share that they made substantive medical policy decisions due to that cost? Were there any other cost pressures that were even greater? Is this a for-profit hospital (if it is, there's a chance they may have used Obamacare to deflect blame for a change that increases net profitability for the share holders).

At what rate had the level of medical care been suffering cut-backs before the institution of Obamacare? Prior to Obamacare being passed, medical costs had been going up by nearly double-digit percentages per year, and there was declines in medical services prior to institution of Obamacare. Since the rate of annual increases in health care costs has declined, it is both possible that reductions in service continue to be made and the reductions are the same or less than they would have been without Obamacare.

Despite all of those questions, and the example of a single data-point, you are so certain that you are right that "further discussion is pointless". You may be correct, but the root cause of that may be more due to your level of certainty than to your diagnosis
 
Posted by RedVW on a Laptop (Member # 615) on :
 
How do I know?

I'm personal friends with the director of the hospital. If you'd like to come to my annual Christmas party and talk to him directly- you are more than welcome to attend.

While you are at it you can talk to half the directors, doctors, and nursing staff of the hospital. Close to 400 people are invited. About two thirds come every year, with about 100 in attendence each hour between 9-11 pm. After 11 it's usually down to the ICU unit until about 2:am

If you had read correctly you would have noticed I told you they put in an upgraded system three years ago. Y. ou would also have noticed the new system they are paying 1.3 million on is a direct result of the ACA.

If you had read the posts regarding K, you would have realized that costs are not and have not gone down since before the law was passed and also that the expected impact is for it to be even more expensive in 2014 and beyond.

I mean it doesn't get any clearer than that. You can ignore my data point. And you can ignore the federal government data.

You are free to believe whatever you want.

Your level of certainty however you have arrived at your current point of view may be precluding you from acknowledging growing evidence that your view is contraindicated by many factual objective data points.

It's kinda like the arguments made on the personal cost thread regarding the ACA. When I pointed out my cost changes- I was essentially told by some members here that I was telling a lie just to win an argument. Then, other people here started posting their cost increases. Then it began to be national news that essentially only the lowest income earners were seeing reasonable costs. Everyone else was looking at 50% increases at least.

Well in my case my insurance now costs me 104% more than last year, covers far less than last year, and has such high deductibles and copays that I can't even fracking use it next year. Meaning I'm fracking paying double for nothing. You know what my deductible per year is for out of network region coverage is? $27,000. Meaning if I am in Atlanta, and in a serious car accident requiring emergency treatment, I better hope to God I'm able to insist they drive me back to the ONLY in network er availible to me 92 miles away in Athens.

I have health care serfdom. I have to pay a 104% increase in premium, cannot afford to use what I'm paying for, and don't dare leave my local metro area because if I get injured, I'd bankrupt myself if I got treated out of network.

So dismiss this fracking data point as well.

The left's argument supporting this idiotic law is beyond Koolade drinking.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
you would have realized that costs are not and have not gone down since before the law was passed
Red, I totally realize that cost are not and have not gone down. I have written about Obamacare at length and have never made any such claims. I have made assertions about a reduction in the annual rate of increase. On the one hand, that's not as good as a decrease. On the other hand, the Congressional Budget has projected a decrease in future debt by over a trillion dollars due to this change, so it is not a negligible factor.
 
Posted by Greg Davidson (Member # 3377) on :
 
I am skeptical about part of your comment that "my insurance now costs me 104% more than last year, covers far less than last year, and has such high deductibles and copays that I can't even fracking use it next year", only because the policies that were disallowed by the ACA were disallowed because of inadequate coverage, particularly for catastrophic events (for example, one set of insurance that is no longer permitted had an exclusion that did not cover chemotherapy). I understand how policies can cost more and have higher deductibles, but I would have assumed that came with higher levels of coverage for certain contingencies. Now, you may not currently value those contingencies, but they would render inaccurate your statement "covers far less than last year"; a more accurate statement would be that you don't want the extra coverage that is mandated by law.
 
Posted by Greg Davidson (Member # 3377) on :
 
With respect to the trend in medical costs, do you accept that they have gone from an average annual increase of about 8-10% (for decades) to a 4% level since the year the ACA was passed? And we are now just arguing with respect to causality for the change in the rate of growth?

The "relevant article" from the Manhattan Institute pivots on the key phrase
quote:
But no one can rightly claim that CMS has revised their near-term cost projections downward because of the ACA
That's not precisely the question that we are interested in; we are interested in determining what level of the observed savings in health care costs are due to reductions in the rate of growth due to ACA. And if that is our question, the difference between two CMS estimates is not the right measure, particularly as the first CMS measure already had substantial savings assumed in Medicare costs due to the ACA. An earlier CMS estimate stated that the ACA "achieves short term savings of over $200 billion in Medicare through 2016 according to the independent CMS Actuary" link In particular, there are specific real things, such as elimination of an excessive Medicare payments to private insurers who operate in Medicare Advantage, that are in place due to ACA and saving many tens of billions of dollars (and in rebuttal to any argument that savings must come out of patient care, a similar set of savings was achieved (~$60B) when the government eliminated the private "middlemen" from student loan programs.

[ December 01, 2013, 09:40 PM: Message edited by: Greg Davidson ]
 
Posted by noel c. (Member # 6699) on :
 
"... we are interested in determining what level of the observed savings in health care costs are due to reductions in the rate of growth due to ACA."...

This logical construction is identical to Biden's "jobs created or *saved* " mantra.

When unemployment increased, all that our half-whit VP had to say was that, but for the jobs stimulus, things would be worse... never mind the cost to the taxpayer to create these "shovel ready" jobs that evaporated with the completion of any given government contract.

When the baseline is separated from reality, and jumps an ether bound freight, how can any valid measure of success be cited? Repeal the medical device tax if you are interested in isolating the stand-alone viability of ObamaCare "savings".

The fact that administration propaganda extolls gold/silver/bronze "plans" as a "good product", that "people want", offered on the website "marketplace" is some indicator that even these control freaks understand ObamaCare needs to borrow jargon form actual markets to fly in under the radar. It could not be bum-rushed through Congress, much less succeed within a competitive economic environment, on its own merit.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Greg iv covered in detail what my coverage was and what it will be. Matter of fact I went into a lot of detail

If you still can't fracking comprehend facts it's not my concern.

I'm paying double, for less coverage, and with a deductible and copay that makes using the insurance economically responsible.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
I had dental I won't next year.

I had eye care I won't next year.

I had affordable copays of 40 I can't afford 120.

My coverage 1 dollar began afte copay and yearly deductible was $1,000. Next year my dollar 1 coverage does not kick in until $9,000

If I got sick and had to go to an er while away from home I had a nationwide system availible. Next year not so much I gett a 27k deductible

I'm sorry but there is just too much fracking cheap with this law that is wrong that your skepticism is simply a moronic partisan attitude.

Oh wait I have birth control coverage still! Too bad I'm still Catholic.
 
Posted by LetterRip (Member # 310) on :
 
RedVW,

as has been pointed out - your situation appears to be highly anomalous.

This analysis by wallethub suggests most states, businesses, and people will be overall winners with the changes.

http://wallethub.com/edu/obamacare-report-states-benefiting-most-least/1276/

Regarding those who think insurance companies are 'doomed' by ACA - they've typically had their share prices nearly double over the past year, and many are valued at about 6 to 10 fold their historical rate from 2000 and earlier.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
LR

My situation is HARDLY anomalous.

Listen very carefully. If a person is still thinking the ACA is a good deal at this point that person is either mentally challenged, uneducated, or incapable of research.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
Listen very carefully. If a person is still thinking the ACA is a good deal at this point that person is either mentally challenged, uneducated, or incapable of research.
Red, are you literally saying that not a single person has a better deal because of ACA? Because that statement would be as arrogant and incorrect as any statements of any who denied the entire truth of your own experience.

But let me also add that I do appreciate that you did lay out specific predictions - you do have the courage of your convictions, and in 18 months we'll see how accurate our predictions are.
 
Posted by OrneryMod (Member # 977) on :
 
Red: Please see your email.
 
Posted by G3 (Member # 6723) on :
 
I suppose I can make a couple of predictions.

The definition of "anomalous" will change. It will no longer mean something that deviates from the norm. For example, official projections are that in excess of 70 million will lose their insurance. These people will be called "highly anomalous" or "anecdotal" or something like that. Insurance premiums nationwide are expected to increase on average by 41%. This will be called "anomalous" or something similar.

The definition of "success" will also change as there will be no circumstances under which some will accept a failure. There could be bodies piling up in the streets due to lack of healthcare for readily curable diseases and the hyper-partisan ideologues so invested in ObamaCare will call it a unqualified "success".
 
Posted by TomDavidson (Member # 99) on :
 
To nail that prediction down, G3, do you believe that a) there will be bodies piling up in the streets; and b) hyper-partisan ideologues will call the ACA "an unqualified success?"
 
Posted by G3 (Member # 6723) on :
 
Ummm, no.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Greg what I am saying is that it is a bad law. Period. Statistics indicate at least someone must have gotten a benefit. I'm sure people who were in favor of Jim Crow laws could point to people who incidentally benefited.

That doesn't mean its a good law.
 
Posted by TomDavidson (Member # 99) on :
 
G3: I didn't think so, but I just wanted to make sure. In the same vein, do we agree that there could be a wave of utopian good-feeling stemming from all the suddenly healthy people running around, feeling happy, and some hyper-partisan ideologues would still call it an unqualified failure?
 
Posted by G3 (Member # 6723) on :
 
How many suddenly healthy people running around, feeling happy do you expect? A dozen? 150 million?

My prediction is that the hyper-partiscan ideologues here and around the US will tell us ObamaCare is working great and needs to be fixed and is wildly popular and it's the GOP's fault.

Pretty much all in one breath like that.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
How many suddenly healthy people running around, feeling happy do you expect?
It is possible that you failed to understand my point. In fact, given your second paragraph, it is likely.

I asked if you agreed that it is as likely that hyper-partisan ideologues would claim that the ACA was a miserable failure if in fact it was a resounding success as it is that hyper-partisan ideologues (on the other side of the aisle, of course) would claim it as a runaway success if indeed it were a miserable failure.
 
Posted by G3 (Member # 6723) on :
 
It is possible that you failed to understand my point. In fact, given your subsequent post, it is likely.

What would a "resounding success" be?
 
Posted by TomDavidson (Member # 99) on :
 
Perhaps you are still failing to understand. Do we agree that it does not matter what a "resounding success" is, in much the same way that it does not matter that you don't really expect bodies to be piling up in the streets? That, no matter what happens, you and others will call the ACA a failure?
 
Posted by G3 (Member # 6723) on :
 
If we're going to call it a success, then defining what success means matters quite a bit. How can you call it a success if you don't know what a success would be?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
If we're going to call it a success, then defining what success means matters quite a bit.
Except that your own claim -- your claim, mind you -- is that people will call it a success regardless of whether it is or not.

Do you not believe that different people will call it a failure regardless of whether it is or not?
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Greg Davidson:
Red, are you literally saying that not a single person has a better deal because of ACA? Because that statement would be as arrogant and incorrect as any statements of any who denied the entire truth of your own experience.

I think we all acknowledge that there are individuals who will receive better "deals", and generally speaking the rest of us are going to pay higher taxes and premiums to support them.

I predict that no matter what, people will continue to pretend that a post subsidy price is the "cost" of healthcare so they can claim that costs are down. I predict that if you get the fully loaded expenditures, federal, state, and private on healthcare you won't see a decline in costs or savings, absent a reduction in quality of care (personally, I think we'll end up with both a higher cost and a reduction in care). I predict we'll be stuck with the law for a while, and it will serve it's "purpose" by further enshrining a permanent voting bloc to support the Progressives that they can use scare tactics to motivate whenever they like.

And I'm with G3, no matter what the result we'll see partisans declare it a resounding success.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
no matter what the result we'll see partisans declare it a resounding success
And a resounding failure, yes?
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by TomDavidson:
quote:
If we're going to call it a success, then defining what success means matters quite a bit.
Except that your own claim -- your claim, mind you -- is that people will call it a success regardless of whether it is or not.
Your refusal to put even the most minimal definition around a success for this goes to my point. By refusing to define even what a success might look like, you can point to any outcome and claim it was the goal all along and it is, thus, a massive success.

quote:
Originally posted by TomDavidson:
Do you not believe that different people will call it a failure regardless of whether it is or not?

I believe that would be very difficult, if not impossible to do, if there is a actual success with this program. Thus the need to avoid all definitions of success - or if you're Obama, lie about it. Without any idea what a success would be, everything is a success.
 
Posted by JoshuaD (Member # 1420) on :
 
G3: Whether or not the Obama Administration provides the metric for determining whether the ACA is a success is irrelevant. We can determine that for ourselves using our own metrics, and we can compare metrics with one another to see which are fair and which aren't.

Tom's point seems really simple to me: despite the outcome of the law (whether it turns out to be a success or failure) there is always going to be a group of pundits who call it what it's not. If it's a success, a certain group will insist on calling it a failure. If it's a failure, a different group will insist on calling it a success. Do you agree or no?

What's your metric for success for this bill?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
I believe that would be very difficult, if not impossible to do, if there is a actual success with this program.
Why would this be harder than calling it a success if there is no actual success? It seems to me that these are equally difficult.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by TomDavidson:
quote:
no matter what the result we'll see partisans declare it a resounding success
And a resounding failure, yes?
Not sure, probably some of them. I don't think its a resounding failure, just a resoundingly bad policy.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by JoshuaD:
G3: Whether or not the Obama Administration provides the metric for determining whether the ACA is a success is irrelevant. We can determine that for ourselves using our own metrics, and we can compare metrics with one another to see which are fair and which aren't.

It is perhaps one of the most relevant parts of this program. How can we know if it's doing what we intended it to do if we do not have some criteria against which to measure it? Sure, we can compare metrics with one another to see which are fair and which aren't but you know what that will be called? Highly anomalous and/or anecdotal. See upthread for the proof of that.

quote:
Originally posted by JoshuaD:
Tom's point seems really simple to me: despite the outcome of the law (whether it turns out to be a success or failure) there is always going to be a group of pundits who call it what it's not. If it's a success, a certain group will insist on calling it a failure. If it's a failure, a different group will insist on calling it a success. Do you agree or no?

Tom's point is really simple. Some will claim it's a failure no matter what therefore we must not define success criteria. That way it's always, by definition, a success. If a true, measurable success criteria were defined, it could be objectively determined if it succeeded or failed but the supporters of this program would very much like to not have any criteria for it. Ask yourself why that is.

quote:
Originally posted by JoshuaD:
What's your metric for success for this bill?

Wait, are you now saying it's relevant to have a metric for success?

Here's a reasonable first take at a criteria:
quote:
There are at least six ways to possibly judge Obamacare and it is only using the most generous criteria that you can make the case it will succeed.

1) Comparing the ACA to other first world countries – Under this criteria it will be a clear failure. Even the supporters of the law admit after it is implemented the United States will still have the most expensive, complex, and wasteful health care system on earth.

2) Compared to Obama’s original promises – Again by this standard the law is a failure. While the ACA does contain several provisions Obama campaigned on in 2008, such as guaranteed issue and subsidies to buy insurance, the law lacks/broke many of his biggest promises. It does not contain a public option, a national exchange, drug re-importation or Medicare-direct drug price negotiation. It will not save the average family $2,500 a year. Thanks to the Cadillac tax, many people who like their current insurance will not be allowed to keep it, directly contradicting Obama’s promise.

3) Compared to the smaller promises made when the law was signed – Even by this modest benchmark it would be hard to argue that current indicators point to the law being a success. The law will cover significantly fewer people than originally projected, although that is mainly the fault of Supreme Court and Republicans at the state level.

The news about what the law will do to premiums in the individual market is a mixed bag. We still don’t know if a critical mass of people will actually use the exchanges or if they will turn into a dumping ground for the sick. The design of the employer mandate now seems very problematic. On the plus side, there are some signs the law might be helping to bend the cost curve.

Most damaging though is that the law won’t fulfill one of President Obama’s most cited justifications for the law. Evidence from Massachusetts is that the law will not stop people from going bankrupt if they get sick.

4) Compared to the status quo – This is the low criteria by which many supporters of the law use to predict it will be a success. Since the law will significantly expand Medicaid and Medicaid is a good program that helps many people, on that provision alone a decent argument can be made.

That said, there will also be many losers as a result of the law. Rich people will see higher taxes. Some young professionals will see a big increases in their premiums. The poor design of the employer mandate could result in part time workers getting their hours cut. Insufficient subsidies combined with a bad employer mandate could leave some people in a no man’s land where they can’t really afford insurance but are forced to pay the individual mandate. The Cadillac tax will also cause people with good insurance to see their benefits cut and deductibles increased. Most concerning, the law basically locks in place our broken private for-profit insurance system.

5) Compared to the conservative dystopian nightmare – Some conservatives have gone so over the top by claiming that Obamacare will be the beginning of a Stalinist state, that it will be impossible for the actual implementation of the law not to seem mundane by comparison.

6) Will it ever become popular – This is the purely political way to judge the law and no one honestly knows the answer. Opinions about the law have remained remarkably stable since it was first approved, but that could change when the law is implemented.



[ December 02, 2013, 01:30 PM: Message edited by: G3 ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
I predict that no matter what, people will continue to pretend that a post subsidy price is the "cost" of healthcare so they can claim that costs are down. I predict that if you get the fully loaded expenditures, federal, state, and private on healthcare you won't see a decline in costs or savings, absent a reduction in quality of care (personally, I think we'll end up with both a higher cost and a reduction in care).
Is it roughly you opinion, then, that the US population is simply so large that it's effectively impossible to provide everyone with a reasonable level of care? That there's an absolute maximum capacity of care that can be provided that we've already exceeded such that some people have to be denied a basic level in order for others to have it?

If not, then your argument about absolute cost is pure nonsense. Sure given more care will consume more resources (increase the absolute cost) but that' would be the explicit point-0 to actually utilize those resources productively instead of wasting them by leaving them idle when there are people with a clear need for them.

The point is to reduce the sticker price to a point that everyone can afford to fully realize the proper total cost necessary to provide an adequate level of service. The only way that properly adjusting the global cost profile to providing that level of care would be because there's a hard and fast limit to the total amount of care that we can possibly provide and thus, implicitly, that we are unsustainable overpopulated as there aren't enough resources to meet our total needs..
 
Posted by RedVW on a Laptop (Member # 615) on :
 
So it's a wealth transference? And because we have inadequate global resources it can't work until we reduce population demand?

So if we see the needs if the many satisfied by taking from the few with surplus resources and we see a population reduction the ACA is a success?

Is the left even aware of what they are advocating? Small c communisim and eugenics as a basis for measuring the effectiveness of the ACA?
 
Posted by LetterRip (Member # 310) on :
 
G3,

obviously it is likely to succeed on criteria 4, 5, and 6.

It is impossible in the US political climate with such powerful monied interests to succeed on the grounds of 1.

On 2 - it seems absurd to judge it a failure because he couldn't get other politicians to allow those aspects to be part of ACA. Given the severe political opposition and monied interest opposition those goals - while viewed by many as desireable - probably won't change unless we have campaign finace reform.

On 3 - I think it might end up a 'success'. This largely depends on what specific state legislatures and governors do. I think once state populations realize that their governors and legislatures are screwing them over for the purpose of trying to prevent an Obama 'success' you will see a lot of them voted out of office and the medicaid and medicare expansion take place in those states. I suspect this will be a major campaigning stick to be used in those states. Combining this and anger over the shutdown (most red states have a much larger percentage of government employees than blue states) and I think you will see a lot of seats go 'blue' that have historically been 'red' (of course many seats will be saved by gerrymandering).
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by RedVW on a Laptop:
So it's a wealth transference? And because we have inadequate global resources it can't work until we reduce population demand?

Only if you assert that we have inadequate resources. On, the other hand, if you believe that we have, or can easily develop adequate resources, then it's simply a means to provide the financial incentive to utilize them.

quote:
So if we see the needs if the many satisfied by taking from the few with surplus resources and we see a population reduction the ACA is a success?
Perhaps, again, if you're attempting to assert that there is a real, insurmountable limit to the total amount of providable care. If you believe that we are capable of providing sufficient care, then it means success is that the total amount of care that it provided increases in response to the additional demand that it allows to be expressed because the individual price of expressing demand has been sufficiently reduced such that it can be communicated to the market.

quote:
Is the left even aware of what they are advocating? Small c communisim and eugenics as a basis for measuring the effectiveness of the ACA?
Are you asserting that the left's position is that we're unable to provide sufficient care? It was Serati, not anyone advocating a liberal position that made the remarks that only work if you assume a strictly limited potential capacity for medical care.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
quote:
JoshuaD: Whether or not the Obama Administration provides the metric for determining whether the ACA is a success is irrelevant. We can determine that for ourselves using our own metrics, and we can compare metrics with one another to see which are fair and which aren't.
G3:It is perhaps one of the most relevant parts of this program. How can we know if it's doing what we intended it to do if we do not have some criteria against which to measure it? Sure, we can compare metrics with one another to see which are fair and which aren't but you know what that will be called? Highly anomalous and/or anecdotal. See upthread for the proof of that.
I don't agree. The general goal of this law was to improve the quality, availability, and cost of medical care in this country (as opposed to how things would have turned out if we didn't pass the law). It that happens, then I would call the law a success. If it doesn't happen, then I would call the law a failure.

I don't need President Obama to outline the metric of success for me. I use the metric to evaluate this law as I do every single law: did it make the country a better place?

quote:
quote:
JoshuaD:Tom's point seems really simple to me: despite the outcome of the law (whether it turns out to be a success or failure) there is always going to be a group of pundits who call it what it's not. If it's a success, a certain group will insist on calling it a failure. If it's a failure, a different group will insist on calling it a success. Do you agree or no?
G3:Tom's point is really simple. Some will claim it's a failure no matter what therefore we must not define success criteria. That way it's always, by definition, a success. If a true, measurable success criteria were defined, it could be objectively determined if it succeeded or failed but the supporters of this program would very much like to not have any criteria for it. Ask yourself why that is.
I don't see that he has said this so far in this thread. In either case, I'll leave it to him to clarify.


quote:
quote:
JoshuaD:
G3: Wait, are you now saying it's relevant to have a metric for success?
You missed the nuance of my post, it seems. I said it doesn't matter whether this administration provides a metric of success. The law will either be a success or failure, and the metric they provide will mean almost nothing to me when I judge the law for myself.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Some will claim it's a failure no matter what therefore we must not define success criteria.
I fail to see where I've made any argument against defining criteria for success. I have merely pointed out that your observation -- that there are partisans who will call the program a success even if they have to step over bodies on the streets -- would seem to apply equally to the reverse.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Pyrtolin:
[QB]
quote:
I predict that no matter what, people will continue to pretend that a post subsidy price is the "cost" of healthcare so they can claim that costs are down. I predict that if you get the fully loaded expenditures, federal, state, and private on healthcare you won't see a decline in costs or savings, absent a reduction in quality of care (personally, I think we'll end up with both a higher cost and a reduction in care).
Is it roughly you opinion, then, that the US population is simply so large that it's effectively impossible to provide everyone with a reasonable level of care?
What exactly is "reasonable"? I expect that your definition of that will result in a reduction in the quality of care for more than a majority of the population.
quote:
That there's an absolute maximum capacity of care that can be provided that we've already exceeded such that some people have to be denied a basic level in order for others to have it?
There is a current "maximum" capacity. Healthcare isn't a manufactured or a mined resource, it isn't a factory sitting idle. Healthcare is first and foremost a human resource, are doctor's complaining about being underworked? Are hospitals running light?

We can train more doctors, but with lower compensation overall (to get those "cost savings" reimbursements will be cut), what exactly is going to motivate enough top people to take that difficult career path? Do you really think that this is going to incentivise medical school more than the current system (where it can make you rich)? Or is it you plan to just lower the standards and certify more doctors (ie lower quality again)?

I'm not adverse to solving this puzzle, but I get tired of the fake claim that it's going to cost less money and not have impact on quality. So drop the hyperbole that I want people to go without so others can gorge, or that I think we need to push granny into the cold. This is going to be a more expensive lower quality product and that is the trade over for a larger coverage map.
quote:
If not, then your argument about absolute cost is pure nonsense. Sure given more care will consume more resources (increase the absolute cost) but that' would be the explicit point-0 to actually utilize those resources productively instead of wasting them by leaving them idle when there are people with a clear need for them.
Since the "resources" are people and not being under utilized this part of your argument is something that doesn't make any actual sense. Even in the best case where we could train more doctors without a drop in average quality, you'd still need a minimum of about 10 years to ramp up the medical school rates to meet need (and that's assuming that all the doctors who've stated they're ending their practice are actually lieing).
 
Posted by NobleHunter (Member # 2450) on :
 
quote:
Do you really think that this is going to incentivise medical school more than the current system (where it can make you rich)? Or is it you plan to just lower the standards and certify more doctors (ie lower quality again)?
My understanding is that the American Medical Association is currently limiting the supply of doctors to keep prices high, rather than to ensure quality. If you remove artificial (by which I mean non-quality related) constraints on the supply of health care providers you can increase capacity and lower costs without affecting quality. You seem to imply that the options are a Rolls-Royce and a Ford (of the Fix Or Repair Daily years). But in truth, the choice may be between a Rolls and a Toyota. Both fill the core functions equally well, but one is greatly more expensive than the other.

[ December 02, 2013, 05:08 PM: Message edited by: NobleHunter ]
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by LetterRip:
G3,

obviously it is likely to succeed on criteria 4, 5, and 6.
.

Obviously you will claim that no matter what.
 
Posted by PSRT (Member # 6454) on :
 
OUt of curiosity, G3, do you think that anyone here thinks you would ever say that a plan or idea of Obama's had succeeded?
 
Posted by AI Wessex (Member # 6653) on :
 
Maybe. You know how people in romantic comedies say "I hate you" over and over again and end up in bed together at the end of the movie? Ima gonna wait and see how this turns out.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
Compared to the status quo – This is the low criteria by which many supporters of the law use to predict it will be a success.
I love this quote - it somehow manages to imply that it's merely a cheap trick if Obamacare just merely makes things better, because... because... No, it actually makes no sense - the foundational measurement for the worth of a change in policy is the degree to which it generates improvements as compared to what would have happened under the original policy.

I'll be pleased in insurance companies have to re-assign all of their employees who used to work finding post facto pre-existing conditions to deny coverage to people when they need it. I'll be glad when kids with childhood cancer don't have to plan their lives around getting insurance because of the ban on limits due to pre-existing conditions. I'll be pleased when millions of Americans between 23 and 25 who need to can stay on their parent's health insurance. I'll be pleased that in a few years 10's of millions of Americans have health insurance that they would not otherwise have had; this will provide benefits both for more people getting preventative care as well as helping a much smaller percentage of that population from getting help with catastrophic illnesses (both medical and avoiding bankruptcy). I'll be pleased when earlier medical care saves thousands on lives. I'll be pleased when data on outcomes and prices at different hospitals becomes more visible to the public, which can start to emulate some features of a market-type system that have been absolutely moribund in the previous so-called market-based system.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Ok so if the stated goal was for the bill to cover the pre law estimate of insuring the 40,000,000 estimated people without health care, and the post bill estimate is that the law will successfully manage to enroll only 10,000,000 of those people- is that success?

It was suppossed to cut federal budget outlays for gealthcare. They have incteased- is that success?

It was suppossed to lower costs for individuals for nearly all individuals due to the mass expansion of number of insured. Costs on average have increased for individuals by at leasy 50% using the lowest estimate availible- is that success?

It was suppossed to allow people to keep their insurance and their care providers and even expand their care provider options. Instead nearly 2/3 of insured americans are losing their insurance, their care providers, and are seeing a curtailment of provider access and options- is that success?

Im very sorry but almost every statement touting the benefit of the law to consumers and providers has turned out to be false. At what point do its supporters admit the law is a failure?

At what point is the cutoff reached where we state it is fair to judge this law a failure? 2017? Apparently that is the new Democrat party talking point. The system will work by 2017?

Really?

Id like to hear more excuses...

And on a lighter note the administration stated the system could maintain 50,000 users at once. It crashed just above 30,000. And apoarently to make matters worse, the insurers are not getting enrollment information as well as being unsecured.

Right.... Hope, Change. Obama.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
And on a lighter note the administration stated the system could maintain 50,000 users at once. It crashed just above 30,000. And apoarently to make matters worse, the insurers are not getting enrollment information as well as being unsecured.
Just a quibble: in the last week, we've seen a rather dramatic increase in submissions via the online exchange. Either more people are barreling through it despite the problems or the problems are being fixed at a fairly impressive rate.
 
Posted by AI Wessex (Member # 6653) on :
 
Tom: "Just a quibble: in the last week, we've seen a rather dramatic increase in submissions via the online exchange. Either more people are barreling through it despite the problems or the problems are being fixed at a fairly impressive rate."

However, Tom, until every problem is fixed and there are no anecdotal reports from people that have thwarted the system, we can't really call it a success.

Red: "And on a lighter note the administration stated the system could maintain 50,000 users at once. It crashed just above 30,000."

Not perfect, but better, yes?

"And apoarently to make matters worse, the insurers are not getting enrollment information as well as being unsecured."

Not good. This is a separate issue that apparently has its own team working on it. This will have to be addressed in the next few weeks or policies won't be able to go into effect. I don't know where the team stands on current progress.

On a lighter note, I was once at a party with the CTO for the state of Michigan. I had my own consulting company at the time focusing on medical informatics and analytics. She thought I would be interested to hear that the state was so committed to improving these areas for the citizens of the state that she had just committed to a $17M project to revamp the database technology to manage information the state collected and disseminated. I didn't know a thing about the project, but with a drink in my hand and no hesitation in my voice I told her I could get it done for $12M in half the time. She laughed and said she was sure that was true, but it took her two years to get this contract in place and cost her a lot of political capital to get the vendor that was selected (that was a major contributor to the then Governor's campaign, btw). As I recall the project was canceled after another two years having spent close to $25M and producing no results. I can't remember if the program was called a complete success or just a partial success that will fundamentally change and improve the way data is handled in the future.

Bottom line, government is not good at innovation and works increasingly badly with shorter and shorter time frames. It's sad that Obama allowed it on his watch, but not surprising given the nature of bureaucracies everywhere.

I heard that the CEO of SalesForce.com offered to apply his staff to rewrite the whole thing from scratch for cheap and maintain it for 5 years at no cost to the government. His reason for making the offer was that revamping how health care is managed in the marketplace is the defining issue for our age, and that for all of our future's the ACA must succeed.

That sounds like a good plan to me, and given the success SF.com has had over the past several years I'm sure he could back up his words with action. But then it was discovered that the CEO had been a contributor to Obama's campaign and Obama can't touch it because the GOP would attack it as cronyism. No word if Benioff also contributed to Romney's campaign, but he did donate to Boehner.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by TomDavidson:
Just a quibble: in the last week, we've seen a rather dramatic increase in submissions via the online exchange. Either more people are barreling through it despite the problems or the problems are being fixed at a fairly impressive rate.

Yeah, and that was the promise made - that by Nov 1 the problems would be fixed at a fairly impressive rate. This is what I mean when you refuse to define success, you start claiming that anything is a success.

The reality is that problems are being *hidden* at a fairly impressive rate. The difference between a error page and the waiting room page is nothing more than UI changes. A estimated one third of enrollees are not really enrolled, they only think they enrolled. The system cannot process them properly. And then, the thing is a security nightmare.
quote:
It could take a year to secure the risk of "high exposures" of personal information on the federal Obamacare online exchange, a cybersecurity expert told CNBC on Monday.
"When you develop a website, you develop it with security in mind. And it doesn't appear to have happened this time," said David Kennedy, a so-called "white hat" hacker who tests online security by breaching websites. He testified on Capitol Hill about the flaws of HealthCare.gov last week.

"It's really hard to go back and fix the security around it because security wasn't built into it," said Kennedy, chief executive of TrustedSec. "We're talking multiple months to over a year to at least address some of the critical-to-high exposures on the website itself."

<snip>

Another online security expert—who spoke at last week's House hearing and then on CNBC—said the federal Obamacare website needs to be shut down and rebuilt from scratch. Morgan Wright, CEO of Crowd Sourced Investigations said: "There's not a plan to fix this that meets the sniff test of being reasonable."

So if you can access the site, if it stays up and running while you put all your personal information in there and maybe you will be enrolled but who really knows. The one sure thing is that your information will get taken by hackers soon.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
The reality is that problems are being *hidden* at a fairly impressive rate.
When I said "we," I specifically meant my company, the insurance company for which I work. We are seeing much larger numbers coming from the online exchange than in previous weeks, which suggests that either people are more determined now or the site is working better. "Hidden" problems would not be producing more applicants.
 
Posted by G3 (Member # 6723) on :
 
your situation appears to be highly anomalous
 
Posted by TomDavidson (Member # 99) on :
 
That's not what I'm given to understand. I know at least two of our regional competitors are also seeing an upswing in applications, although of course I don't know their numbers. I'm sure the totals are still way off what the government was hoping, but the volume we're seeing now is pretty close to what we had projected.
 
Posted by G3 (Member # 6723) on :
 
your situation appears to be highly anecdotal
 
Posted by TomDavidson (Member # 99) on :
 
Yes, that's why it's an anecdote. It's funny how anecdotal anecdotes are, when you think about it.
 
Posted by G3 (Member # 6723) on :
 
your idea of "funny" appears to be highly anomalous
 
Posted by OrneryMod (Member # 977) on :
 
G3: Please see your email.
 
Posted by Wayward Son (Member # 210) on :
 
You know when Obamacare is going to be a success?

When it is replaced by a system that insures more people than Obamacare, at lower overall rates than Obamacare, and with higher overall care than Obamacare. That would be success in my book.

And the Republicans are working day and night to ensure that never happens. [Razz]
 
Posted by G3 (Member # 6723) on :
 
quote:
“It doesn’t appear that any security fixes were done at all,” David Kennedy, CEO of the online security firm TrustedSec, told the Washington Free Beacon.

Kennedy said fundamental safeguards missing from Healthcare.gov that were identified by his company more than a month ago have yet to be put in place.

“There are a number of security concerns already with the website, and that’s without even actually hacking the site, that’s just a purely passive analysis of [it],” he said. “We found a number of critical exposures that were around sensitive information, the ability to hack into the site, things like that. We reported those issues and none of those appear to have been addressed at all.”

After warning Americans when testifying before Congress on Nov. 19 to stay away from Healthcare.gov, Kennedy now says the situation is even worse.

“They said they implemented over 400 bug fixes,” he said. “When you recode the application to fix these 400 bugs—they were rushing this out of the door to get the site at least so it can work a little bit—you’re introducing more security flaws as you go along with it because you don’t even check that code.”

“I’m a little bit more skeptical now, and I would still definitely advise individuals to not use the website because it’s definitely something that I don’t believe is secure and neither did the four individuals that testified in front of Congress,” Kennedy said. “I think there’s some major security concerns there around privacy and information, and they haven’t even come close to being addressed, and won’t be in the short term.”

The current best advice is advise individuals to not use the website. Sounds likes it done got fixed reel good.

So here's another ObamaCare prediction I will make - healtcare.gov will be hacked (if it hasn't been already) and the personal information of most, if not all, enrollees will be exposed to identify theft and fraud.

quote:
“States are required to notify in the event of a breach, the federal government is not,” he added. “So in the event that Healthcare.gov gets compromised and all their information gets taken out of it they don’t have to notify anybody.”
My next prediction, the hacking will be covered up and not reported. It will come out as some type of leak.

Enrollees that report their identity stolen will, no doubt, be called "highly anomalous" or "anecdotal" cases.
 
Posted by LetterRip (Member # 310) on :
 
The SQL injection attempts don't imply it was actually 'hacked' (he based that opinion on the fact that the search function on the site - entering a ; returned results suggesting that people were entering queries attempting SQL injections. It isn't clear that the site was vulnerable to such injections).

Also he has said that all problems he had reported were fixed before he testified.

His opinion on bug fixing - that really depends on how shallow or deep the bugs were and who was doing the fixing. When their bug fix rate rocketed it appears it was due to bringing in skilled individuals. Skilled individuals rarely introduce new bugs with fixes and can fix even fairly deep bugs quickly; and shallow bugs blazingly fast.
 
Posted by LetterRip (Member # 310) on :
 
Note that it wouldn't surprise me if that site does get hacked - most sites regardless of how much money the organization has do get hacked - that includes banks and the most skilled software firms in the country.

There are a lot of things that concern me about the sites security and there were obviously many 'rookie' security mistakes - that would have been caught with a basic security audit by a skilled practitioner (ie enumeration attacks that potentially can reveal user information).
 
Posted by G3 (Member # 6723) on :
 
He said:
quote:
Kennedy said fundamental safeguards missing from Healthcare.gov that were identified by his company more than a month ago have yet to be put in place.
Yet to be out in place.... Which you interpret to mean:

quote:
Originally posted by LetterRip:
Also he has said that all problems he had reported were fixed before he testified.

He said the exact opposite of your interpretation. I suppose you'd call this a success?
 
Posted by LetterRip (Member # 310) on :
 
G3,

I was reading a blog post he did that said that the issues he talked about were fixed prior to his testimony. He has stated there are other issues that have not yet been fixed that he hasn't provided details on and didn't testify about (one of them was an enumeration attack).
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:

(1) 40,000,000 estimated people without health care... enroll only 10,000,000 of those people

(2) Supposed to cut federal budget outlays for healthcare.

(3) lower costs for individuals for nearly all individuals

(4) allow people to keep their insurance and their care providers and even expand their care provider options.

(1) If 10,000,000 of 40,000,000 uninsured get health insurance, that would be both a very good thing and substantial under-performance.

(2) Obamacare was sold as being budget neutral, not cutting budget outlays, so your number 2 is invalid. And while we are engaged in determining the accuracy of prior claims, it is noteworthy that most Republican political leaders (and most conservatives here on Ornery) made categorical assertions with 100% certainty that Obamacare would have a disastrous impact on the federal budget.

(3) This might be the most debatable. Cost per policy - was the ultimate bill as signed into law really described as "lower costs for individuals for nearly all individuals"? If it were true that "Costs on average have increased for individuals by at least 50% using the lowest estimate available", I would totally agree with you and declare the entire policy a failure. But your assertion is, of course, 100% bogus.

(4) I would also agree that Obamacare would be a total failure is "nearly 2/3 of insured Americans are losing their insurance". But, once again, you are either making stuff up, or
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:

(1) 40,000,000 estimated people without health care... enroll only 10,000,000 of those people

(2) Supposed to cut federal budget outlays for healthcare.

(3) lower costs for individuals for nearly all individuals

(4) allow people to keep their insurance and their care providers and even expand their care provider options.

(1) If 10,000,000 of 40,000,000 uninsured get health insurance, that would be both a very good thing and substantial under-performance.

(2) Obamacare was sold as being budget neutral, not cutting budget outlays, so your number 2 is invalid. And while we are engaged in determining the accuracy of prior claims, it is noteworthy that most Republican political leaders (and most conservatives here on Ornery) made categorical assertions with 100% certainty that Obamacare would have a disastrous impact on the federal budget.

(3) This might be the most debatable. Cost per policy - was the ultimate bill as signed into law really described as "lower costs for individuals for nearly all individuals"? If it were true that "Costs on average have increased for individuals by at least 50% using the lowest estimate available", I would totally agree with you and declare the entire policy a failure. But your assertion is, of course, 100% bogus.

(4) I would also agree that Obamacare would be a total failure if "nearly 2/3 of insured Americans are losing their insurance". But, once again, you are either making stuff up, or quoting those who did.

But if you actually believe these claims, why don't you come back and, in accordance with the question I asked at the beginning of this thread, make a prediction that by May 2015 nearly 2/3rds of Americans will have lost their insurance and insurances costs for individuals have risen an average of 50%? I would respect you for standing behind your position, and then in May 2015 we could see who was closer to be correct, and who was wildly inaccurate.
 
Posted by Seneca (Member # 6790) on :
 
My prediction is that the young and healthy will not sign up in sufficient numbers, premiums will rise and Americans will throw the democrats out in 2016 since that will be their first chance to do so as Obama recently dishonestly & selfishly altered the deadlines for next year so that pricing on the exchanges won't come out until slightly AFTER the 2014 elections.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Greg

I'm sorry but you are unable to understand my comments. The fact you also believe I'm a liar makes rational discourse with you impossible at this time.
 
Posted by AI Wessex (Member # 6653) on :
 
quote:
Originally posted by Seneca:
My prediction is that the young and healthy will not sign up in sufficient numbers, premiums will rise and Americans will throw the democrats out in 2016 since that will be their first chance to do so as Obama recently dishonestly & selfishly altered the deadlines for next year so that pricing on the exchanges won't come out until slightly AFTER the 2014 elections.

This follows the hopeful and confident expectation that the voters were going to throw Obama out in last year's elections. Some of those very same people are right here on Ornery and just as sure they are right this time, too. (Note, those people have never actually been wrong; they just disagree with how real events disagreed with them.)

The same question for you that was given to them, and to which they never responded: How will your thinking change about what other people want if your hopeful prediction above does not become reality?
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
Ai Wessex: This follows the hopeful and confident expectation that the voters were going to throw Obama out in last year's elections
The ACA was structured to roll out in such a way that President Obama didn't have to deal with it, politically, for his second election. If he had, if the stuff that's happening this year happened prior to the election, I believe he would have lost. Do you agree?

The President lied about the ACA during the time when it was being passed and again during his re-election (this has been sustained in that thread last month). He said lots of things that weren't true about the ACA to get elected. If he had told the truth about the ACA, I think he would not have been re-elected. Do you agree?

We weren't wrong about the ACA and people's reactions to it. This is an unpopular bill that is growing less and less popular as people are discovering exactly what's in it and how it is going to affect their lives directly.

The only thing we were wrong about was that we thought people would have enough foresight to see this coming. Many of us did see that the ACA would be what it's turning out to be*, and that's why we voted against President Obama. We thought enough people would see that as well. Instead, President Obama's political trick of having all of the fallout of the ACA happen after his second term election worked.

But please don't act like that's a failure on the part of those of us who opposed it from the beginning. This is the failure of all those people who voted for President Obama in 2012 and are now regretting their decision as a result of seeing actually what the ACA is.


*(Unpopular and much more intrusive than it was sold to be).

[ December 04, 2013, 09:34 AM: Message edited by: JoshuaD ]
 
Posted by JoshuaD (Member # 1420) on :
 
For what it's worth, I also think it's a failure of the Republican Congress and Governor Romney's campaign. They failed to articulate clearly and convincingly what would happen. They failed to paint the picture that we are all now living. If they hadn't failed; if they had shown people "this is what its going to be like" and painted a clear and convincing picture of today, then I also think President Obama would have lost.
 
Posted by Greg Davidson (Member # 3377) on :
 
Red, I can't tell if you are being serious, I am being really specific and questioning your assertions. Do you actually believe either of the following statements:

"Costs on average have increased for individuals by at least 50% using the lowest estimate available"

"nearly 2/3 of insured Americans are losing their insurance"

If you think I am calling you a liar by calling those assertions into question, then I am left with the implication that you are actually staking your reputation on the premise that those statements are true. Therefore, in May 2015 we will check. If those statements are true at that time, I will fully apologize for my errors. And if your assertions here turn out to be grossly false, we will see your character and integrity by whether you acknowledge your errors or not.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
The President lied about the ACA during the time when it was being passed and again during his re-election (this has been sustained in that thread last month). He said lots of things that weren't true about the ACA to get elected. If he had told the truth about the ACA, I think he would not have been re-elected.
I would argue that there is no comparison between the depth and extent of lying between President Obama and the Republicans, with the latter having lied to a much greater degree about ACA. If Republicans had told the truth about the policy and then law that they opposed, the Democrats would have won even higher percentages of the vote than they did in the 2012 election.
 
Posted by JoshuaD (Member # 1420) on :
 
I don't follow what you just said.
 
Posted by Greg Davidson (Member # 3377) on :
 
JoshuaD, if that's referring to my last comment, let me try to be clearer. Some of what Obama said about the ACA was false (for example, the assertion that you can keep your same doctor was not true for some fraction of the population). It would have been politically damaging if Obama had said that some fraction of the roughly 5%-10% served by the exchanges would no longer be able to purchase cheap policies that did not have minimum levels of coverage, and thus would lose their current doctor.

However, if we hold all sides accountable to the same standards of honesty, than Republicans should be similarly judged for the much more significant and substantial statements they have made that are false. Death panels is an obvious example, and there are others that are patently false to all but those who live in a bubble where average health insurance costs have gone up 50% and 2/3rds of Americans are losing their health insurance coverage. My point is that if both Democrats and Republicans were held to the same standards of honesty, the Republicans would have received an even smaller minority of votes in the 2012 elections than they actually did.
 
Posted by AI Wessex (Member # 6653) on :
 
"The ACA was structured to roll out in such a way that President Obama didn't have to deal with it, politically, for his second election. If he had, if the stuff that's happening this year happened prior to the election, I believe he would have lost. Do you agree?"

Possibly, but things don't happen in a vacuum. What if the budget fiasco we just had had also occurred a year ago. Do you think the miserable record the Republicans had compiled up to that point would have have allowed them to overcome the ACA problems that Obama is dealing with?

"For what it's worth, I also think it's a failure of the Republican Congress and Governor Romney's campaign. They failed to articulate clearly and convincingly what would happen. They failed to paint the picture that we are all now living. If they hadn't failed; if they had shown people "this is what its going to be like" and painted a clear and convincing picture of today, then I also think President Obama would have lost."

Was that supposed to be objective? I mean, I hope you're not talking about death panels [Wink] . *If* Romney had lied less about many of the things he said, then *maybe* he could have scraped together enough credibility to damage Obama's election chances. But, he didn't.

You're engaging in the worst sort of partisan cherry picking by pretending Obama's failings can be isolated and treated as if they are the only issue that matters. Let's do it the other way. What if Romney had admitted from the start that what he said about the 47% was actually what he meant to say? Do you think he'd be sitting in the White House today? After all, there are a lot of right-wingers who were mad at him for saying it and then running away from it.

Romney lost; get over it; the ACA will eventually succeed. I hope you don't join the list of people who insist they are always right about Obama's shortcomings, in that case.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:

You're engaging in the worst sort of partisan cherry picking by pretending Obama's failings can be isolated and treated as if they are the only issue that matters.

I don't see that I'm doing that. I criticize the Republicans all the time.

But this is a thread about the ACA. Accordingly, I'm talking about the series of events which led to the ACA becoming law, despite the fact that now that people know what it does, it is not popular enough to be passed as a law.

The President lied to pass a huge bill which is the topic of this thread. He continued to lie about that bill for his re-election campaign. So when you say:

quote:
Ai: This follows the hopeful and confident expectation that the voters were going to throw Obama out in last year's elections. Some of those very same people are right here on Ornery and just as sure they are right this time, too. (Note, those people have never actually been wrong; they just disagree with how real events disagreed with them.)
You are being quite unfair to my position. President Obama was re-elected in a large part because he lied about the ACA. He told us things that he knew weren't true in order to get re-elected. Now we are discovering that he lied, and many people are regretting their decision to vote for him.

I'm not "disagreeing with how real events disagree with me". I have had the same narrative before and after the election, and it continues to be true. Despite the fact that I was right, President Obama was re-elected. The two aren't mutually exclusive.

The fact that he convinced the nation to re-elect him with his lies about the ACA doesn't mean that somehow I was wrong about the ACA. This entire chain of reasoning makes no sense at all.
 
Posted by Greg Davidson (Member # 3377) on :
 
Do you have any substantiation for these assertions?

quote:
President Obama was re-elected in a large part because he lied about the ACA
quote:
now that people know what it does, it is not popular enough to be passed as a law
Actually, as proven by Red's comments above, some people believe that Obamacare increases average premiums by 50% and that 2/3rds of all Americans are losing their insurance coverage. Do you include people like that in the category of "people know what it does"?
 
Posted by G3 (Member # 6723) on :
 
An estimated 50 to 80 million will lose their insurance according to the administration. That sound like about two thirds.
 
Posted by Greg Davidson (Member # 3377) on :
 
Okay, G3, do you also want to go on the record as believing that 50 to 80 million people will lose their insurance by May 2015?

Or are you still so unsure of yourself that you are unwilling to make any predictions?
 
Posted by JoshuaD (Member # 1420) on :
 
Greg: No. If you think I'm wrong you're welcome to disagree. I think it's abundantly clear when you read the polls or watch the news, but you're welcome to draw your own conclusions.

quote:
Greg: Actually, as proven by Red's comments above, some people believe that Obamacare increases average premiums by 50% and that 2/3rds of all Americans are losing their insurance coverage. Do you include people like that in the category of "people know what it does"?
I definitely believe it happened to Red. I also believe that next year I'm going to be about half a grand poorer and have no benefit to show for it.

I don't know if two-thirds of the country are losing their insurance as a result of the ACA. I know that a lot of people are. I know that the President told me that no one would. I know that that line was a big plank in the platform he stood on to pass this bill and to get re-elected.

My reasoning tells me that if he told people "some of you are going to lose your health insurance and some of you are going to see your rates rise, but it will be better for all of us I promise" he wouldn't have been re-elected. I can't prove this (how could I prove this?). But I think it's obviously true. If you disagree you're welcome to articulate why.

[ December 04, 2013, 10:51 AM: Message edited by: JoshuaD ]
 
Posted by AI Wessex (Member # 6653) on :
 
IMO, 47% of the population is only interested in government handouts and their minds can't be changed to see things differently. That's a huge head start to getting to 50%. Let's make sure we include that sort of hyperbole when we make unambiguously critical statements about how people would have handled new information a year ago.

I still say you're game playing if you isolate the ACA in your fictive scenario. You can't just wave away that I said nothing happens in a vacuum. Our recent political history is a hopeless mess of misdirection and dishonest attacks, mostly (but not entirely) by the GOP and media conservatives.

Or should we talk about what would have happened if people knew how untrue Bush's statements about Iraq were leading up to the war?
 
Posted by LetterRip (Member # 310) on :
 
JoshuaD,

quote:
I also believe that next year I'm going to be about half a grand poorer and have no benefit to show for it.
Unfortunately insurance is like that - if you could perfectly predict your illness timing you would only buy insurance exactly when the major illness struck, and if insurance companies knew when you would get ill they would drop your coverage immediately before a major illness struck. What 'benefit' you are getting is mitigation of risk of ruin, death, and major disability. It isn't as significant because due to law (hospitals must accept uninsured emergencys) and custom the downside risk is heavily mitigated. Risk mitigation isn't very tangible, so you feel you have got 'nothing of benefit'.

quote:
I don't know if two-thirds of the country are losing their insurance as a result of the ACA. I know that a lot of people are. I know that the President told me that no one would. I know that that line was a big plank in the platform he stood on to pass this bill and to get re-elected.
People are generally losing their insurance due to employer choices, not the ACA. The ACA grandfather clauses mean that your employer can maintain ones existing insurance - which is what 'you can keep your existing insurance' meant - there is no clause in the ACA that would prevent individuals from keeping their current policies that were provided by their employers. If people are upset they should complain to their employer, not about the ACA. Of course many employers used peoples ignorance to make changes to plans while using the ACA as scapegoat.

What the ACA says is that if your employer wishes to provide different insurance than what they previously provided that any new policy must conform to the ACA.
 
Posted by noel c. (Member # 6699) on :
 
"Romney lost; get over it; the ACA will eventually succeed. I hope you don't join the list of people who insist they are always right about Obama's shortcomings, in that case."...

"Succeed"? In precisely what?

This whole discussion from the left reminds me of a class of sixth graders at an art museum who stand 12" from a 4'x8' canvas to appreciate an abstract composition... just stupid. As a technician, something might me learned about methods with this approach, but it is otherwise useless.

Look at the larger picture; Everyone was promised more for less, through the auspices of a "community organizer" who never ran so much as a hotdog stand. The 47% jumped on it, because they are always for "more", believing actual cost will appear on someone else's tab. The magical "plan" is rolled out for all to "see" per Pelosi and... Gasp!... a significant portion of the 47% get shafted on cost while actually receiving less. "How could this be?" they ask themselves.

Well, it happens whenever despots enter the wealth redistribution game. The logic of this particular scam ends in universal coverage for degraded, or unavailable, healthcare... but it could really be any cause de jour. The ACA has always been about federal control of 1/5 of the economy, not medical insurance. Spreading poverty to ensure equality is the siren song of third-world politics... Barry's only brand. Lie, steal, and cheat... just don't get caught, or at least don't get caught before the next election cycle, assuming elections still happen where this variety of statecraft takes root.

Barry executed the ACA coupe masterfully from a sales standpoint, and it might have worked if the curtain had not been pulled back prematurely. He needed the 47% to be fully dependent prior to a full appreciation of ObamaCare setting in, and it was only administrative incompetence (on a grand scale) that screwed up Junior's game plan.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
LetterRipUnfortunately insurance is like that - if you could perfectly predict your illness timing you would only buy insurance exactly when the major illness struck, and if insurance companies knew when you would get ill they would drop your coverage immediately before a major illness struck. What 'benefit' you are getting is mitigation of risk of ruin, death, and major disability. It isn't as significant because due to law (hospitals must accept uninsured emergencys) and custom the downside risk is heavily mitigated. Risk mitigation isn't very tangible, so you feel you have got 'nothing of benefit'.
I'm going to opt to pay the penalty rather than buy insurance. I can't afford insurance. I can't afford the penalty, either, but it's the less expensive choice.

I get nothing in return for paying the penalty (except maybe scorn).

quote:
LR:People are generally losing their insurance due to employer choices, not the ACA. The ACA grandfather clauses mean that your employer can maintain ones existing insurance - which is what 'you can keep your existing insurance' meant - there is no clause in the ACA that would prevent individuals from keeping their current policies that were provided by their employers. If people are upset they should complain to their employer, not about the ACA. Of course many employers used peoples ignorance to make changes to plans while using the ACA as scapegoat.

What the ACA says is that if your employer wishes to provide different insurance than what they previously provided that any new policy must conform to the ACA.

You should review the thread where we discussed this in detail.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
Ai: IMO, 47% of the population is only interested in government handouts and their minds can't be changed to see things differently. That's a huge head start to getting to 50%. Let's make sure we include that sort of hyperbole when we make unambiguously critical statements about how people would have handled new information a year ago.
I don't understand what you're saying here.

quote:
Ai:I still say you're game playing if you isolate the ACA in your fictive scenario. You can't just wave away that I said nothing happens in a vacuum. Our recent political history is a hopeless mess of misdirection and dishonest attacks, mostly (but not entirely) by the GOP and media conservatives.
Well, I'm not playing a game and I don't like being accused of that. I'm trying to talk about the topic in as straight forward and as honest of a way as possible. If you think I'm wrong you're welcome to tell me that. Please don't accuse me of political game-playing. It's not at all fair, there's no basis in my posting history to sustain it, and it also happens to be not true.

This is the a thread about the ACA. I have said that the election was very close and if President Obama didn't lie about how the ACA works, he wouldn't have been re-elected (and if he wasn't re-elected, the ACA would have been significantly changed or repealed by the Republicans in power).

It may be the case that Republicans also lied. Start a thread about that and I may or may not participate. But I certainly won't come in there and talk about how it's OK that the Republicans lied because President Obama lied too.

quote:
Ai:Or should we talk about what would have happened if people knew how untrue Bush's statements about Iraq were leading up to the war?
Sure, start a thread about it. You're about 10 years too late, but if you're interested in the topic (and others are too) have the discussion. I won't participate, but I don't think there's anything wrong with having that discussion.

I just don't see any point in having here, in the thread about the ACA.

[ December 04, 2013, 01:01 PM: Message edited by: JoshuaD ]
 
Posted by scifibum (Member # 945) on :
 
Joshua, if you don't want to discuss this I understand, but I'm rather curious: what do you intend to do if you need expensive medical care?

From my point of view, I can't afford NOT to have insurance. Insurance is expensive, but with the subsidies available I think it's more affordable than the risk of financial calamity that comes with not carrying it.
 
Posted by noel c. (Member # 6699) on :
 
Scifibum,

Read G3's linked article in the "opt-out" thread.
 
Posted by LetterRip (Member # 310) on :
 
JoshuaD,

quote:
I'm going to opt to pay the penalty rather than buy insurance. I can't afford insurance. I can't afford the penalty, either, but it's the less expensive choice.

I get nothing in return for paying the penalty (except maybe scorn).

Actually what you are getting is the option to buy insurance with a preexisting condition if/when one develops.

quote:
You should review the thread where we discussed this in detail.
I participated in the thread. What specifically do you want me to read?

My statement is correct. Insurers can continue providing the same plan that the individual is insured under indefinitely. However, they are choosing not to do so. The reasons they choose not to do so are

1) They can't add new customers to the plan - thus as people leave the plan the administrative overhead for the plan increases

2) Many of the preexisting plans are largely the same as their new plans under the ACA - so offering the old plan doesn't make any sense, just adding administrative overhead

3) Cost of the plan must stay the same (only 'medical inflation' cost adjustment is allowed). They have greater pricing flexibility with new plans.

4) Only non trivial changes are allowed.
 
Posted by LetterRip (Member # 310) on :
 
scifibum,

since the insurance can now be purchased with a preexisting condition - he can wait till he 'needs' the insurance to buy it.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
Joshua, if you don't want to discuss this I understand, but I'm rather curious: what do you intend to do if you need expensive medical care?

I'd actually really like to discuss it. Maybe privately over email would be the more appropriate venue? I'm probably being stupid-stubborn by refusing to get health care at this point and I'd like to be talked out of that if I am. [Smile]

NJ has (had?) charity care. If something catastrophic happened, it would cover 85% of my medical bills (at my current level of income). I was willing to take the risk that I'd have to pay the remaining 15%.

I would also be glad to get catastrophic care coverage if the cost is reasonable. I absolutely do not want health insurance which covers routine maintenance, I would prefer pay for that as and when I see fit. Visits to the doctor or dentist can be on me. Anything costing more than around $5000 can be on the insurance company. I think it will keep costs low and create a better relationship between me and my doctor.

I also don't have the energy to do the necessary research to figure out what plans do what and whether the fine print screws me.

The plans I looked at cost $2400, did nothing to reduce my immediate costs, and appeared to have way too much fine print for me to be comfortable signing.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
LR:Actually what you are getting is the option to buy insurance with a preexisting condition if/when one develops.

New Jersey already had that.
 
Posted by LetterRip (Member # 310) on :
 
You are incorrect,

quote:
Specifically, the SEH Program Act does not allow carriers to look back more than 6 months at a person’s medical or treatment history for purposes of limiting coverage, and does not allow a carrier to consider any condition as pre-existing unless the condition was actually diagnosed or treated, or treatment was recommended or prescribed medications were taken for the condition.
http://www.northjersey.com/news/opinions/206224941_Let_s_talk_about_pre-existing_conditions.html
 
Posted by scifibum (Member # 945) on :
 
quote:
Originally posted by LetterRip:
scifibum,

since the insurance can now be purchased with a preexisting condition - he can wait till he 'needs' the insurance to buy it.

This is a good point, but I guess that's why the tax penalties will increase significantly later - there has to be a cost to that option.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
1) They can't add new customers to the plan - thus as people leave the plan the administrative overhead for the plan increases
This isn't quite right, as it implies risk pooling which is one of the critical new features that the ACA brings to the individual market. The biggest flaw with the pre-ACA system was that each private plan was an individual plan. Insurers would sell the same basic plan to multiple people, but that did not add additional people to a plan- it resulted in multiple people having discrete instances of the plan, with pricing set on an individual basis, each with it's own individual overhead for management, in as much as it require any plan-specific management as opposed to company wide agreements with a given set of providers.

That's also where the central abuse of the pre-ACA market came into play. While there were some controls over across the board rate hikes and nominally an insurer had to agree to sell you a plan if you met certain conditions, there was no control on risk adjusted pricing on an individual basis- if you were diagnosed with a chronic condition that would require ongoing care, there was nothing to stop the insurer from changing the price of your plan to effectively exceed the cost of treatment, because, on purely actuarial justifications, that was now the cost of providing the plan. And people in such a situation couldn't effectively switch, because while they could not be denied coverage for the pre-existing condition, there was nothing stopping prospective companies from similarly pricing the plan prohibitively high, making that nominal protection essentially useless. (And, when coupled with coverage limits, this also served to actively make many individual plans scams that charged far more than they ever intended to pay out, and essentially dumped consumers out of coverage as soon as they had a problem serious enough to require the coverage they believed they were paying for.

[ December 04, 2013, 01:58 PM: Message edited by: Pyrtolin ]
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by AI Wessex:
quote:
Originally posted by Seneca:
My prediction is that the young and healthy will not sign up in sufficient numbers, premiums will rise and Americans will throw the democrats out in 2016 since that will be their first chance to do so as Obama recently dishonestly & selfishly altered the deadlines for next year so that pricing on the exchanges won't come out until slightly AFTER the 2014 elections.

This follows the hopeful and confident expectation that the voters were going to throw Obama out in last year's elections. Some of those very same people are right here on Ornery and just as sure they are right this time, too. (Note, those people have never actually been wrong; they just disagree with how real events disagreed with them.)

The same question for you that was given to them, and to which they never responded: How will your thinking change about what other people want if your hopeful prediction above does not become reality?

Since the people will not react to this law until they feel the law's ACTUAL EFFECTS OCCURRING (note: how few people have actually READ the law, including people who voted for it...), it stands to reason that because of all the shady delays, waivers and extensions Obama keeps popping up, he is trying to delay all of the bill's negative effects. With his most recent move, pricing for the first year without any delays group extensions will only occur AFTER the 2014 elections, and just barely.

Do you think that's a coincidence?
 
Posted by JoshuaD (Member # 1420) on :
 
LR: Really? That doesn't sound right to me. If I fall of a cliff and have a $300,000 medical bill, it seems like I'd be stuck with that bill.
 
Posted by LetterRip (Member # 310) on :
 
JoshuaD,

quote:
LR: Really? That doesn't sound right to me. If I fall of a cliff and have a $300,000 medical bill, it seems like I'd be stuck with that bill.
Under New Jersey previous law? Or under ACA?

Under NJ previous law I'm pretty sure that you would be 'stuck'. Under ACA - I think as long as you get the insurance established before you are rushed to the hospital you will be covered. Not sure what happens if you wait till you are actually at the hospital.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
LR

You realize the grandfather clause applied only to plans that already met the bronze mini mums? And that if a plan did pass that step - it then could have no cola change in benefits fees or deductibles?

There was some rediculous $15 per month allowed change.

Obama was told by his chief of staff that upwards of 73% of all insured people would be losing their current plan this year.

It's looking like its a bit over 66% so far.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Greg Davidson:
Okay, G3, do you also want to go on the record as believing that 50 to 80 million people will lose their insurance by May 2015?

Or are you still so unsure of yourself that you are unwilling to make any predictions?

That estimate comes from the Obama administration. Are you accepting their prediction?

I have actually made several predictions on this thread, just not ones you want me to make. If it makes you feel better, I will predict that the current estimate will be accurate and that, under the current "law", more than 50 million will lose their insurance. However, the law can change at any moment and polling data prior to the 2014 elections may drive significant change if the polling data proves inconvenient for Barry and the democrats do my confidence in that prediction is about 50/50. More like a guess than a actual prediction.

What is your prediction on the number of losers in this debacle? Do you think Barry is lying yet again with that estimate or do you think the administration is actually telling the truth this time?
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
JoshuaD: This is the a thread about the ACA. I have said that the election was very close and if President Obama didn't lie about how the ACA works, he wouldn't have been re-elected (and if he wasn't re-elected, the ACA would have been significantly changed or repealed by the Republicans in power).

It may be the case that Republicans also lied. Start a thread about that and I may or may not participate.

Actually, this is a thread where the explicit request is to go on the record with your predictions of what will happen with Obamacare as of May 2015.

Speculation about the 2012 election is off-topic to the exact same degree whether you refer to the actions of Democrats or Republicans.

[ December 04, 2013, 10:02 PM: Message edited by: Greg Davidson ]
 
Posted by Greg Davidson (Member # 3377) on :
 
I predict G3 will redefine "70 million will lose their insurance" to mean that there will be some change in the terms or prices of the insurance of 70 million people (even if they have the same policy with the same company, and the level of changes are similar to those experienced in previous years, or net increases in coverage as defined by actuarial likelihood).
 
Posted by G3 (Member # 6723) on :
 
Gonna word lawyer it are we? I think everyone knows what is meant by "lose their insurance". If you need to start torturing that already then you must be really worried.
 
Posted by AI Wessex (Member # 6653) on :
 
"I also believe that next year I'm going to be about half a grand poorer and have no benefit to show for it."

With the historical growth rate in premiums and reductions in benefits, that would have happened to many people anyway. My premiums went up 5x this year, but it's good coverage. The actual cost of health care isn't driving that climb, but the way insurance companies and health providers and equipment vendors manipulate the market is. The ACA should help to control that phenomenon. That means that you may continue to see some costs go up for some people, but in the long run it will be better for everyone.

But only if the program isn't sabotaged by anecdote and visceral opposition from people like G3, who only see the dark side of the issue.

If the GOP does manage to kill the ACA, what then?
 
Posted by noel c. (Member # 6699) on :
 
"If the GOP does manage to kill the ACA, what then?"...

Conservatives will push a renewed effort to bring genuine "marketplace" reform to an industry historically riddled with government assisted monopoly formation.

Interstate competition for the business of individual, and small business pools, would be an easy place to begin... and Barry has always known this.

How secure are you feeling that your employer provided insurance will be around in 2015 Al?
 
Posted by AI Wessex (Member # 6653) on :
 
"Conservatives will push a renewed effort to bring genuine "marketplace" reform to an industry historically riddled with government assisted monopoly formation."

That is just a tad vague. Describe the key components in enough detail that we can evaluate how practical it would be.

"How secure are you feeling that your employer provided insurance will be around in 2015 Al?"

An odd question. We all know that the country is failing due to the Obama secular socialist dictatorship. People are right now waking up to that fact and collecting arms to overthrow the government and restore the Constitution. At that point the entire economy will have disappeared and the only way you will be able to pay for health care is with bitcoins. Sadly, inflation will overwhelm that currency, so we will be trading body parts for food in 2015.

Are you more hopeful than that?
 
Posted by AI Wessex (Member # 6653) on :
 
quote:
Originally posted by noel c.:
"Romney lost; get over it; the ACA will eventually succeed. I hope you don't join the list of people who insist they are always right about Obama's shortcomings, in that case."...

"Succeed"? In precisely what?

This whole discussion from the left reminds me of a class of sixth graders at an art museum who stand 12" from a 4'x8' canvas to appreciate an abstract composition... just stupid. As a technician, something might me learned about methods with this approach, but it is otherwise useless.

Look at the larger picture; Everyone was promised more for less, through the auspices of a "community organizer" who never ran so much as a hotdog stand. The 47% jumped on it, because they are always for "more", believing actual cost will appear on someone else's tab. The magical "plan" is rolled out for all to "see" per Pelosi and... Gasp!... a significant portion of the 47% get shafted on cost while actually receiving less. "How could this be?" they ask themselves.

Well, it happens whenever despots enter the wealth redistribution game. The logic of this particular scam ends in universal coverage for degraded, or unavailable, healthcare... but it could really be any cause de jour. The ACA has always been about federal control of 1/5 of the economy, not medical insurance. Spreading poverty to ensure equality is the siren song of third-world politics... Barry's only brand. Lie, steal, and cheat... just don't get caught, or at least don't get caught before the next election cycle, assuming elections still happen where this variety of statecraft takes root.

Barry executed the ACA coupe masterfully from a sales standpoint, and it might have worked if the curtain had not been pulled back prematurely. He needed the 47% to be fully dependent prior to a full appreciation of ObamaCare setting in, and it was only administrative incompetence (on a grand scale) that screwed up Junior's game plan.

I confess I find this post so twisted into partisan knots that I have a hard time tracing how you tortured the facts in your mind to come to those conclusions.
 
Posted by noel c. (Member # 6699) on :
 
"That is just a tad vague. Describe the key components in enough detail that we can evaluate how practical it would be."...

You want detailed components of deregulation? I think you are confusing conservatism with liberalism. The "detailed" presentation was incumbent upon Barry when he ram-rodded his 2,600 page manifesto nationalizing 20% of the country's economy through congress.

Permitting interstate sale of insurance plans is pretty straight forward, and not particularly subject to outside planning... "detailed" or otherwise. Allowing small businesses, and individuals to pool their risk is likewise fairly organic in execution, which is probably why you are uncomfortable with it. Risk is inherent in existence, and we all ultimately lose the game. Certainty is for suckers, who end up with neither security, nor certainty.

"How secure are you feeling that your employer provided insurance will be around in 2015 Al?"...

Well, can you answer the question? I am sure you have read the provisions of the ACA impacting your employer's situation, right?

[ December 06, 2013, 03:56 AM: Message edited by: noel c. ]
 
Posted by Funean (Member # 2345) on :
 
I just finished the process of researching and rolling out our benefits plan for 2014. We cover the employee and any children at no cost to the employee. In 2013, we had an okay HMO. In 2014 we will be able to offer a choice between a top of the line HMO and a very good PPO ($1500 deductible 100% covered after it's met). Our expenses will be less than they were this year, so we're also offering an HRA equal to half the cost of the individual deductible (which is the plan we're favoring, only because we want to promote shared responsibility for consumption of the healthcare, and because I personally disapprove of HMOs). Both plans are FAR better than what we have this year. Personally and professionally, I'm delighted with the effects the ACA has had on the coverage available to us as an employer.
 
Posted by G3 (Member # 6723) on :
 
The employer mandate was delayed. The impact will not be felt for another year.
 
Posted by RedVW on a Laptop (Member # 615) on :
 
Funean what state do you live in, I've forgotten.
 
Posted by AI Wessex (Member # 6653) on :
 
quote:
"How secure are you feeling that your employer provided insurance will be around in 2015 Al?"...

Well, can you answer the question? I am sure you have read the provisions of the ACA impacting your employer's situation, right?

Hmmm, I thought you'd be in complete agreement with the answer I already gave you, but...

The company I now work for improved our coverage for next year. The increase in premiums is because we went to from an HSA to PPO, but when I calculated out my expected costs it comes out about the same because the increase in premiums is offset by the much lower deductible. I can't predict what the changes will be for 2015, especially if people keep trying to derail the ACA out of visceral hatred for our beloved diktator.

Back to my previous post, the post of yours that I commented on makes almost no sense to me. I really don't know how to have a conversation with you.
 
Posted by Wayward Son (Member # 210) on :
 
quote:
Furean wrote:
...I personally disapprove of HMOs.

Out of curiosity, why do you disapprove of HMOs? The one my family is on provides us good care, and is much more convenient, insofar as dealing with PPO or HSA paperwork.
 
Posted by scifibum (Member # 945) on :
 
quote:
Originally posted by Funean:
I just finished the process of researching and rolling out our benefits plan for 2014. We cover the employee and any children at no cost to the employee. In 2013, we had an okay HMO. In 2014 we will be able to offer a choice between a top of the line HMO and a very good PPO ($1500 deductible 100% covered after it's met). Our expenses will be less than they were this year, so we're also offering an HRA equal to half the cost of the individual deductible (which is the plan we're favoring, only because we want to promote shared responsibility for consumption of the healthcare, and because I personally disapprove of HMOs). Both plans are FAR better than what we have this year. Personally and professionally, I'm delighted with the effects the ACA has had on the coverage available to us as an employer.

I'm sad that the people affected lost their old insurance. [Wink]
 
Posted by Funean (Member # 2345) on :
 
G3, the employer mandate will not directly affect us or any employer that already provides their employees with access to decent insurance. Interestingly, I found the "bronze" tier insurance options, which are very cheap yet completely compliant with the ACA, to be not worthy of my attention. Still, for an employer with fewer resources, they are a way to provide their employees with *something.*

I do have very mixed feelings about the mandate. I understand it as an attempt to offset some of the issues with the whole system, but those issues wouldn't have existed if I were Queen. I favor mostly deregulating private insurance (short of allowing actual fraud) and letting them duke it out in the marketplace (the sucky ones will eventually go away), but providing a genuinely workable (unlike Medicaid, which you have to be starving to qualify for) public option for the folks who just can't qualify for any sensible private policy. In other words, let businesses be businesses, but address the public health issue of the uncoverable (such as the elderly).

Red, I'm in PA.

Scifi, I know! The poor souls. [Smile]

Wayward, because I am old and remember traditional indemnity insurance. The idea, while perfectly logical on its face, that you will save all kinds of money down the road if you allow unfettered doctor visits and diagnostics, is one that I believe contributed to the runaway increase in the cost of healthcare over the last 30 years (other reasons are the artificially high cost of medical education and restriction of providers, newly developed and over-used technology that hasn't gotten cheap yet, and malpractice costs). People overuse healthcare in ways that don't necessarily promote improved outcomes, and needless legal exposure to providers increases exponentially with every unnecessary visit. In the indemnity model, wherein individuals take care of the smaller, maintenance costs like checkups and insurance covers the big or catastrophic ones, like surgery and cancer and dialysis. The PPO plan I selected has a nationwide network (Blue) and a $1500 deductible for individuals, after which *everything* is covered 100%. No nitpicking over copays or percentages of whatever the doc's contract amount stipulates. Just covered. My feeling is that most people with the income level of our employees can afford $1500 in a year if they have to, and in fact if their consumption of healthcare crests that threshold, they've got stuff going on such that the 100% coverage thereafter is going to be very useful.

ETA: also, in my experience, PPOs have far less paperwork and foolishness than HMOs, with their various copays, coinsurance, and referrals. But maybe they operate differently in different states.

Also, another problem I have with HMOs is as a provider--the reimbursement rate is much lower, because the notion is that you're "guaranteed" a certain amount of foot traffic, such that your practice's overhead is covered, so you won't mind accepting peanuts per patient visit. This leads to padding encounters with procedures and other things that are separately billable--which jacks up costs and unduly influences the way care is provided.

As I say, the shape the reform effort ended up taking is not one I favored. I don't think it will result in the end of the world, the way some of the more breathlessly hysterical opponents seem to feel, but I do think it will not have all of the outcomes hoped for. What it will do, I hope, is at least help to frame the problem of access to healthcare as a bona fide public issue before it reaches the stage where the whole system collapses under its own weight--which is where we were in fact headed. No industry in which the product can't be afforded without insurance, and in which the insurance is also unattainable by most (and employer-funded group insurance just masked that), can survive. When it is a critical function like farming or healthcare, we then have a public crisis at hand. And make no mistake--we absolutely have been paying for "these people" all along; they've been getting substandard care, of course, which only results in additional costs to the public. It's similar to the situation in which we're all subsidizing the profits of large employers who pay wages below the living level to the majority of their staff, because we have to make up the difference in food stamps and other public underwriting, or risk things like food riots and mass homelessness, while those companies' shareholders pocket the huge false profits out of which sensible wages by rights should have been paid--not the taxes of the middle class.
 
Posted by MattP (Member # 2763) on :
 
quote:
Originally posted by G3:
Gonna word lawyer it are we? I think everyone knows what is meant by "lose their insurance".

Just to be very clear, if my existing policy is cancelled, but I am able to obtain a similarly-priced or less expensive policy with similar or better terms, would this be a case of "[losing] my insurance?"

Note that this is the experience of nearly everyone with an employer-provided group plan every year during open enrollment after the employer and insurance broker negotiate the next year's plan, if that affects your answer.
 
Posted by Funean (Member # 2345) on :
 
I (as benefits admin) got a letter in the fall stating that our current plan would be discontinued 12/31, and providing information about the plans that would be offered that were most analogous. The only PITA part was that we got the rates halfway through November, which only gave us a month to choose plans and share all the information with the staff so they could choose which plan they wanted, but to be honest I don't think we ever get them much earlier. But we notified our employees right away that the plan would be changing, but not for the worse (since we were given enough information to determine that), and that there would be no gap in coverage. I mean, *shrug*. Certainly no crisis for us or probably anyone enrolled in an Independence Blue Cross plan in our area.
 
Posted by Wayward Son (Member # 210) on :
 
quote:
ETA: also, in my experience, PPOs have far less paperwork and foolishness than HMOs, with their various copays, coinsurance, and referrals. But maybe they operate differently in different states.
OK. Yeah, it is different with me.

I'm on with the Kaiser HMO right now, and they are not like the HMOs you described. They have their own facilities, their own doctors, even their own hospitals. You have practically no paperwork. Referrals are handled electronically by them, usually to a doctor within the system itself. If they don't have a specialist, they will find you one and do most of the communication with him themselves.

The downside is that you have a limited choice of doctors--only those in the plan, unless you need a specialist they don't have. The upside, though, is if you need to see a doctor just about anytime, they can make an appointment with any doctor in the area that has an opening. In the last ten or so visits I've had to a primary care physician, I've seen about eight different doctors, since any one could treat the cold I had (or the fainting spell that I last had [Eek!] ).

Personally, having easy access to a doctor hasn't made me abuse it--mainly because I don't have the time. If I'm not really sick, I got too many other things to worry about! [Smile]
 
Posted by Funean (Member # 2345) on :
 
Oh, now you tell me. Kaiser is a whole other kettle of fish. Putting Kaiser in with the average HMO is like calling the Grand Canyon a dried up river bed. Okay, technically, from a certain angle...

That's not how HMOs work most places. Kaiser is more like a health network than an HMO. A shared EHR alone is a huge aid to care. People I know who have moved from the west coast openly grieve for Kaiser. [Smile]
 
Posted by G3 (Member # 6723) on :
 
quote:
G3, the employer mandate will not directly affect us or any employer that already provides their employees with access to decent insurance. Interestingly, I found the "bronze" tier insurance options, which are very cheap yet completely compliant with the ACA, to be not worthy of my attention. Still, for an employer with fewer resources, they are a way to provide their employees with *something.*
Decent. Who defines that?

You think it won't affect you. You know there's no way for you to determine that right now.
 
Posted by Funean (Member # 2345) on :
 
For my employees? I define decent. And you're right; we have been affected--for the better. Our choices increased, the overall quality increased, and the price went down.

Of course no one knows what all the potential sequelae are or will be. Significant portions of the law haven't been implemented yet and some that have been are being fooled with. But employers who already provided non-crappy insurance are probably not in any set that will feel negatively affected immediately.

And while I uphold anyone's right to run a business poorly, if you are an employer large enough to dominate the economy of your region, or to distort the national economy alone, and you're choosing profits over living wages and useful benefits for your employees, you're not being a good corporate citizen, and the community should demand more from you. Whether that's by taxing you into submission, refusing to allow you to operate in the community, or enacting requirements for how you operate within the community, ,that's up to said community. I grew up in a place where a single company could doom an entire town to near starvation if it felt like it, so I don't have a lot of illusions as to the beneficence of corporate human relations decisions made independent of community standards.

[ December 07, 2013, 10:19 AM: Message edited by: Funean ]
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Funean:
For my employees? I define decent.

No, you don't. Not anymore. It is now defined by bureaucrats in Washington who know nothing about you or your situation ... nor do they care. Not only that, their idea of decent will change frequently and you will be forced to comply.

quote:
Originally posted by Funean:
And you're right; we have been affected--for the better. Our choices increased, the overall quality increased, and the price went down.

I find this very hard to believe. I participate in a small business group of about 50 businesses and not a single one has the experience you claim to have.
 
Posted by Funean (Member # 2345) on :
 
*shrug*

I can't help you with that. Maybe your group members have been trying to get by with substandard insurance, and now that they don't have that option anymore, they're having to pay more. Or maybe it's a situation particular to your state, or they don't have a good understanding of how to select insurance. I don't know. I just know about my situation.

And I do decide, as much as anyone ever has, inasmuch as they get what I pick from the choices available in the market at prices I can afford. I do know that without changing carriers (staying with the Blues) I had more than 30 choices, and would have had more if I could stomach Aetna or UHC. Or I could have branched out to other carriers that my broker doesn't deal with, by changing brokers.

As I said, I'm not a fan of this legislation, but this year's enrollment was a very pleasant experience, unlike in years past, where I've been tearing my hair out trying to maintain coverage levels and absorb premium increases of 15%-18%. I'd be happy to mail you the comparative I gave my staff, showing the current coverage alongside the two choices they have now, if the email associated with your Ornery account is still good. I have no reason to lie, nor do I claim that my experience is universal. All I can do is refute any claim of universal doom, even if only by one small business.
 
Posted by LetterRip (Member # 310) on :
 
G3,

quote:
No, you don't. Not anymore. It is now defined by bureaucrats in Washington who know nothing about you or your situation
Actually ACA defines minimum. Insurance companies can offer any combination of benefits that exceeds the minimum, they just can't provide benefits below the minimum. So she absolutely does define decent.

quote:
I find this very hard to believe. I participate in a small business group of about 50 businesses and not a single one has the experience you claim to have.
What states are the small businesses in? Many 'red states' had allowed heavy exclusion of preexisting conditions and had poor quality coverage, and decided against setting up state exchanges - which generally led to few insurers participating - hence ended up with higher rates and few choices. However most blue states saw prices drop and increased choice.
 
Posted by Seneca (Member # 6790) on :
 
Obama unilaterally changes the law again
quote:
The Obama administration, in an 11th-hour change, announced a major ObamaCare exemption that will let people who lost coverage and are struggling to get a new plan sign up for bare-bones policies, drawing immediate criticism from the insurance industry and Republican lawmakers.

The move Thursday to allow potentially hundreds of thousands of people to sign up for "catastrophic" coverage plans was criticized by the insurance industry as a shift that would cause "tremendous instability.”

The administration downplayed the sudden change, saying they expected it to impact fewer than 500,000 people.

Health and Human Services spokeswoman Joanne Peters said, "This is a common sense clarification of the law. For the limited number of consumers whose plans have been cancelled and are seeking coverage, this is one more option."

An administration official confirmed to Fox News that Health and Human Services Secretary Kathleen Sebelius sent a letter to Capitol Hill saying the administration was expanding the definition of catastrophic plans to deal with people who have not been able to get a new plan.

An insurance industry official, speaking not for attribution, told Fox that while the administration was playing down the significance of the move, it could turn out to be a troublesome last minute change and the industry fears far more than the 500,000 people will apply.

Another industry official, Robert Zirkelbach AHIP Spokesman Vice President, Strategic Communications, said, “This type of last-minute change will cause tremendous instability in the marketplace and lead to further confusion and disruption for consumers."

Democrats praised the steps as a common-sense backup in a difficult situation while Republicans panned the administration action as another patch to an unworkable law.

House Energy and Commerce Committee Vice Chairman Marsha Blackburn, R-Tenn., described the move as "another major policy shift" from the Obama administration.

"We asked Secretary Sebelius point blank what would be the next holiday surprise, and she was silent. Yet, here we are with another major policy shift. The sad reality is that when the law takes effect come January 1, more Americans will be without coverage under Obamacare than one year ago," Blackburn said in a statement released Thursday evening.

"Less than two weeks from going live, the White House seems to be in full panic mode. Rather than more White House delays, waivers, and exemptions, the administration should provide all Americans relief from its failed law."

On Thursday, the administration estimated at less than 500,000 those who have not yet found other coverage in the wake of seeing their coverage canceled.

Obama was roundly criticized for reneging on a longstanding promise that if you liked your plan, you would be able to keep it under his health care law. The president apologized, and then said insurers could extend those plans for one more year. Most state regulators followed Obama's lead and gave insurance companies the additional latitude, but it's unclear whether the problem has been fully resolved.

Insurers are concerned that healthy customers who potentially would have bought full coverage may now stay out of the market, leaving the companies with a group of patients in worse health overall.

The "few" people who have been canceled?! Try MILLIONS...

In other news, Obama's honesty ratings have fallen below 50%...

Period.
 
Posted by Pete at Home (Member # 429) on :
 
I have to thank Obamacare for making me employable again. Coming out of rehab with my masters and doctorate, I applied for but could not get so much as a job interview with Wal-Mart, Wall greens, or Circle K. I finally found a law firm a mere 90 minute walk from my house. "We aren't hiring" they said. Then I said the magic words. INDEPENDENT CONTRACTOR. Within 20 minutes they had me set up in the conference room with a file and a laptop.

[ December 20, 2013, 08:36 AM: Message edited by: Pete at Home ]
 
Posted by G3 (Member # 6723) on :
 
This is why I say you can't make predictions on this.the law changes regularly and significantly. The only thing missing from this banana republic is Barry wearing a military uniform with a raft of medals.

quote:
The ability to get an exemption means that the administration is freeing these people from one of the central features of the law: a requirement that most Americans have health insurance as of Jan. 1 or risk a fine. The exemption gives them the choice of having no insurance or of buying skimpy “catastrophic” coverage.
That's right kids! No more individual mandate. Who predicted that? A core feature of Obamacare, completely changed. The scale of this fustercluck is truly hard to verbalize. It's epic.

quote:
It is unclear how many people facing canceled policies will choose no insurance, bare-bones coverage or a plan through the insurance exchanges that meet new federal standards. But the prospect that healthy people with canceled insurance might opt out of the new health plans set off immediate alarm among insurance industry leaders, who already have been worried whether enough people who are inexpensive to cover will sign up.

“This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” said Karen Ignagni, president of America’s Health Insurance Plans, the industry’s main trade group.

The web site is still in epic fail mode so it looks like we'll see a lot of people simply stay with their cancellation - not like they have much choice. The enrollment period ends on .... let's see .... today it ends on the 23rd. This bring Friday and time for the traditional Obama news dump, it could be changed. Who knows?
 
Posted by G3 (Member # 6723) on :
 
Already my predictions are coming true!

quote:
Originally posted by G3 on 12-04-2013 04:38 PM:
However, the law can change at any moment and polling data prior to the 2014 elections may drive significant change if the polling data proves inconvenient for Barry and the democrats ...


 
Posted by Greg Davidson (Member # 3377) on :
 
G3, that prediction is so vague it is a practically a "get-out-of-jail-free" card for being wrong about your other predictions.

Do you still think 70 million people will lose their insurance or not? If not, then the initial primary basis of you complaining was wrong.
 
Posted by TomDavidson (Member # 99) on :
 
*laugh* It is true that predicting "things will change" is not much of a prediction.

That said, I find this a very troubling change. I understand what it's intended to achieve, but it makes me very worried that the people making this decision don't actually understand the insurance industry very well; it's enormously problematic from an actuarial perspective and doesn't actually address the underlying change it's trying to help with.
 
Posted by Pete at Home (Member # 429) on :
 
From my perspective, as one who is and associated with other unemployed and underemployed saps who haven't given up trying to claw our way into non parasitic living, I have little use for the politics of the right or the left. Last thing we needed was a program to make small businesses afraid of hiring us. Public transport would be nice. I really don't think that either party gives a **** about the country or about the poor
 
Posted by G3 (Member # 6723) on :
 
I did not generically predict things would change. I predicted that there would be a significant change in the law itself. The removal of the individual mandate fulfills that prediction. Not only that, it was clearly made for the reasons I predicted - political fallout.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Greg Davidson:
Do you still think 70 million people will lose their insurance or not? If not, then the initial primary basis of you complaining was wrong.

With you, I think we need to be sure we nail down some terms before I can answer. What do you mean by "lose", "70 million" and "insurance"? Those terms seem to be getting awfully slippery with the Obamacare fanboys.

I think I'm gonna need to start putting together primer on terminology ...
 
Posted by Greg Davidson (Member # 3377) on :
 
Ah, G3, Merry Christmas to you!

Millions of men, women and children are about to get better health care than they would have if McCain or Romney would have been elected, or if Republican sabotage would have been more successful in throwing impediments. Your nightmare scenarios won't occur, but on the other hand, neither will there be paradise on Earth where healthcare is as easy as going to the Apple store, and a perfect check-up with no problems is guaranteed.

I am sure that thousands of people will have some adverse consequence due to Obamacare, and with the right-wing media I am sure that those complaints will get as much media time (or more) than the millions who will get better care. Your 70 million assertion will prove to be false.

But pour positions are really clear - let's wait unti;l the set deadline and see who is right.

And then maybe you'll have to rebrand as G4 so you won't have to be held to your predictions as G3.
 
Posted by G3 (Member # 6723) on :
 
Welp, today is the day. At least it is right now. If you want to have insurance on Jan 1, gotta be signed up today. OK, ok, maybe not really. There are good faith clauses and hardship clauses as detailed in the law .... LMAO, not really. Those clauses were legislated by executive order.

The final is really anybody's guess at this point. Obama could decree new changes to the law any second so everything and anything may change at any time. Literally. The law today is not the law tomorrow.

We know that millions have had their insurance cancelled. We know that only a few hundred thousand have go through the process to enroll - exact numbers are being withheld and obfuscated (that should tell you what you need to know about enrollment). We also know that only about 10%-15% of those going through the process actually completed the important step of making their payment - they do not actually have insurance until the first payment is made.

Millions have already lost their insurance. Millions more are set up to lose it once Premier Barry issues the diktat to really begin enforcing the employer mandate.
 
Posted by Greg Davidson (Member # 3377) on :
 
"Millions" having their insurance cancelled is a much smaller claim; are you backing off of 70 million?
 
Posted by Seneca (Member # 6790) on :
 
Millions must be negligible right?

I wonder when Obama's repo squads will start invading funeral homes to pick corpses' pockets.
 
Posted by AI Wessex (Member # 6653) on :
 
Do you think the Oathkeepers could be deployed to guard the corpses to prevent that sort of thing?

Looks like Obama has again extended the sign-up deadline, this time because millions of people are bombarding the web sites trying to sign up and they simply can't keep up with the unexpectedly high volume. Bad news is sometimes good news.
 
Posted by Seneca (Member # 6790) on :
 
Welcome to the New Amerika where Congress doesn't need to pass laws anymore, Obama can legislate for them.

Make sure to have your kids send a thank you card to Obama for removing the estate recovery limits.

Merry Christmas (a VERY merry one for the government).
 
Posted by AI Wessex (Member # 6653) on :
 
Is it unconstitutional?
 
Posted by JoshuaD (Member # 1420) on :
 
Funean: Could you email me or message me the information you gave to your employees? It might help me find the appropriate insurance, and I'd be interested to read it in either case.
 
Posted by Funean (Member # 2345) on :
 
You bet. Is the email attached to Ornery still good?

NM, messaging because I don't think I can send attachments through the Ornery mail link.

[ December 25, 2013, 08:02 PM: Message edited by: Funean ]
 
Posted by JoshuaD (Member # 1420) on :
 
Thanks. [Smile]
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Greg Davidson:
Millions of men, women and children are about to get better health care than they would have if McCain or Romney would have been elected, or if Republican sabotage would have been more successful in throwing impediments.

Out of curiousity why do you believe this? The most likely result even if you sign everyone up on the new plans is not millions of people receiving better health care. The deductibles and costs on these plans mean for practical purposes those who could not afford plans in the old model are still not going to be flocking to doctors, and when they do it'll largely be paid out of pocket. Plus they'll have less money in pocket because of higher premiums, which even for those receiving subsidies will be a concern if they ever increase their income and exist from subsidies.

Out of curiousity, what will be the result if the Dems push through their minimum wage increase? Will it push people working 40 hours off of subsidies?

The only real gains that are oblivious are for catastrophic coverage (where the deductibles are still going to cause pain) and for those who were already sick and have a chance to convert a known crippling cost level into a subsidized payment stream (and that's whether or not they get an official subsidy since all-in they will pay less than the cost of treatment).
 
Posted by AI Wessex (Member # 6653) on :
 
It's unknown what the actual effects will be, but providing the opportunity for better health care to people who sometimes avoided it in the past can't be a bad thing.

It doesn't seem likely that the Congressional push for an increase in the minimum wage will happen. Localities will decide for themselves if they want it. Personally, I don't think it's reasonable for someone working full time to be in poverty.
 
Posted by cherrypoptart (Member # 3942) on :
 
I just saw this on the internet and have no idea if it's true or not:


"Comps of the top ceo's after Obamacare became law of the land in 2012.

Wellpoint ceo salary and bonus---- $48,566,512 This years increase 65.70 %

Tenet ceo salary---- $11,200,000 This years increase 5%

Aetna ceo salary--- $48,000,000 300% increase

Lifepoint hospitals ceo salary--- $23,544,715 21.03% increase

Health South ceo salary---$15,950,223 10.07% increase

HCA ceo salary--- $46.3 million 800% increase in salary"


but if it is true that seems quite excessive considering that we are now being forced to pay their salaries against our will and they get a guaranteed government bailout if they lose money on health insurance.
 
Posted by TomDavidson (Member # 99) on :
 
In general, it is good to be a CEO.
 
Posted by MattP (Member # 2763) on :
 
Just picking one at random:
quote:
"Bertolini received no salary increase in 2012 and his bonus was down 55%," Aetna spokeswoman Cynthia Michener said. "The long-term stock payouts reported in 2012 actually include two years' worth of equity grants from prior years. No long-term equity grants are scheduled to pay out in 2013."
He wasn't given a bunch more money - he just cashed in his chips.
 
Posted by G3 (Member # 6723) on :
 
quote:
(Reuters) - Health insurer Humana Inc said on Thursday that it projected its enrollment mix in private plans through the exchanges created by President Barack Obama's healthcare law will be, "more adverse than previously expected."

Humana attributed the enrollment trend to regulatory changes allowing people to remain in previously existing plans not sold on the exchanges. Obama proposed allowing insurers to keep selling plans that did not comply with the Affordable Care Act after political fallout that he was not keeping his promise that people can keep insurance plans if they like them.

It gonna be glorious!
 
Posted by edgmatt (Member # 6449) on :
 
quote:
but providing the opportunity for better health care to people who sometimes avoided it in the past can't be a bad thing.
- The opportunity was already there for those that were avoiding it.

- It could be real bad depending on the cost of providing such a thing.

It's so easy to shrug one's shoulders and say "well, we tried to do good, that can't be bad".
 
Posted by G3 (Member # 6723) on :
 
quote:
“The Departments’ mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013,” wrote the administration on page 34552. All in all, more than half of employer-sponsored plans will lose their “grandfather status” and get canceled. According to the Congressional Budget Office, 156 million Americans—more than half the population—was covered by employer-sponsored insurance in 2013.

Another 25 million people, according to the CBO, have “nongroup and other” forms of insurance; that is to say, they participate in the market for individually-purchased insurance. In this market, the administration projected that “40 to 67 percent” of individually-purchased plans would lose their Obamacare-sanctioned “grandfather status” and get canceled, solely due to the fact that there is a high turnover of participants and insurance arrangements in this market. (Plans purchased after March 23, 2010 do not benefit from the “grandfather” clause.) The real turnover rate would be higher, because plans can lose their grandfather status for a number of other reasons.

How many people are exposed to these problems? 60 percent of Americans have private-sector health insurance—precisely the number that Jay Carney dismissed. As to the number of people facing cancellations, 51 percent of the employer-based market plus 53.5 percent of the non-group market (the middle of the administration’s range) amounts to 93 million Americans.

Glorious.
 
Posted by Seneca (Member # 6790) on :
 
No wonder King Obama is delaying the employer mandate until after the midterms.

Those are horrifying numbers.
 
Posted by D.W. (Member # 4370) on :
 
Is it not common to change providers or plans every 1-2 years? I assumed most firms shopped around pretty much every year for the best deal.

Is this shock/outrage/panic real or was I just inoculated against it by a frugal employer?
 
Posted by Seneca (Member # 6790) on :
 
Not every year or even 2.
 
Posted by LetterRip (Member # 310) on :
 
DW,

most individuals have their policy cancelled every year, though that doesn't necessarily mean a change in providers. ANY change in policy has always required a cancellation of the old policy and signing up with the new policy - I think there were some sort of administrative notification changes though so people who were previously unaware that that is what happened for each minor change to their policy suddenly believe they are losing their coverage.
 
Posted by G3 (Member # 6723) on :
 
We're having a little word game. Policies were not "cancelled" every year. Insurance policies may expire and require renewal. Most employers keep the same insurance provider from year to year. It's not really a cancellation any more than any other service you contract for over a set time period. Terms remain relatively consistent as do providers.

What is happening now is real cancellations. The policies people wanted to renew are frequently gone. In their place are new, expanded policies (like pregnancy coverage for men) with dramatically higher deductibles and premiums that people don't want and that very often exclude their preferred providers.
 
Posted by Seneca (Member # 6790) on :
 
Semantics, the not-so-new battlefield of the progressives.
 
Posted by D.W. (Member # 4370) on :
 
True I haven't changed provider AS frequently as that. (but possibly more often than normal?) I have had my plan changed or had the plan cease to exist and we adopted something similar to it.

quote:
What is happening now is real cancellations. The policies people wanted to renew are frequently gone. In their place are new, expanded policies (like pregnancy coverage for men) with dramatically higher deductibles and premiums that people don't want and that very often exclude their preferred providers.
This has been my experiance already the last decade of employment. Though typically the trend has been higher deductibles and premiums in exchange for less coverage. [Smile]

[ January 13, 2014, 06:45 PM: Message edited by: D.W. ]
 
Posted by AI Wessex (Member # 6653) on :
 
Obama certainly didn't create the trend toward higher premiums and out of pocket expenses combined with less coverage. The rate of growth in premiums has far outpaced inflation or wage growth every year for decades. What critics fail to acknowledge is that since the passage of the ACA that rate of growth is slowing and more people are getting coverage.

I don't understand why the issue of men having to have pregnancy coverage is being raised. That's not new at all, since I believe there's no such thing as "men only health insurance".
 
Posted by TomDavidson (Member # 99) on :
 
quote:
That's not new at all, since I believe there's no such thing as "men only health insurance".
It is actually new, as women used to -- on some plans -- have to pay extra for riders for "woman-only" medical issues. Interestingly, men did not generally have to carry riders on "man-only" coverage.
 
Posted by G3 (Member # 6723) on :
 
Finally getting a little breakdown on the demographics ... and it's bad. It looks like a onesie clad hipster sipping cocoa on Mom's couch did not inspire enrollments any more than slutty chicks or keg standing drunks. The 18-35 enrollment is a bust at just 24% - Barry needed it to be 39%. If these numbers hold, it's the "death spiral". Of course, what will most likely really happen is a bail out of the insurance companies.

They're counting about 2.1 million people enrolled. But again, we have to have some definition challenges to make that number work. Traditionally "enrolled" meant they'd paid their first premium and actually had insurance. Now it apparently means you just went through the sign up process. This is like Amazon counting something as a sale if you put it in your shopping cart.

How many have enrolled in the traditional sense? Well, that number is, shall we say, obscure. Estimates from insurance industry range as low as 10% and the administration puts it quite a bit higher at 50%. Uh, yeah. It's all about the level of suck on these numbers. Does it epically suck or just really suck?

Of the "enrollees", a full 79% will qualify for subsidies. Great.

55% of "enrollees" are over the age of 45 and a whopping 37% are over 55. I suspect some of you wonder why that's so bad ... take a guess at who requires more medical care and the most expensive medical care. Yeah, that's right, older people.

Add this little factoid in: 80% of the plans selected are the Silver, Gold or Platinum Plans. They took the most expensive plans. Any guesses why they'd do that? Come on, you know. The did it because they plan to get their money back and then some.

This is about as bad as it gets from a demographic perspective.

[ January 14, 2014, 10:03 AM: Message edited by: G3 ]
 
Posted by geraine (Member # 6844) on :
 
quote:
Originally posted by D.W.:
True I haven't changed provider AS frequently as that. (but possibly more often than normal?) I have had my plan changed or had the plan cease to exist and we adopted something similar to it.

quote:
What is happening now is real cancellations. The policies people wanted to renew are frequently gone. In their place are new, expanded policies (like pregnancy coverage for men) with dramatically higher deductibles and premiums that people don't want and that very often exclude their preferred providers.
This has been my experiance already the last decade of employment. Though typically the trend has been higher deductibles and premiums in exchange for less coverage. [Smile]
This generally depends also on the size of the company you work for. The company I work for has utilized Aetna and Blue Cross / Blue Shield for at least 15 years. We also have over 13,000 employees. The previous company I worked for had about 6,000 employees and had also utilized Aetna for over a decade.

Health insurance companies used to have HUNDREDS of different plans available. Health Insurance brokers would only offer a certain amount of plans....usually those that gave them the biggest commission. Those plans were not always the most expensive, they simply paid the broker more.

Over the past 10 years or so many payroll companies started to provide health insurance administration services. The company I work for has Health Insurance benefits that will literally shop the hundreds of plans out there for a client, not just the ones that provide a commission. I have clients that switch health insurance plans and companies on an annual basis, simply because we find a company that provides slightly better rates they had the previous year.

These are NOT forced cancellations, but a choice the employer makes. On the other hand, I had a client that operates in 16 states that planned on keeping their insurance with Aetna from 2013. Many of the plans they were offered in 2013 were cancelled and were no longer offered by Aetna in 2014 due to not meeting the "Minimum requirements." The requirement it didn't meet? The deductible. Everything in the plan complied with the ACA MRB (Minimum Required Benefits) except the deductible, which was $100 more than the maximum set forth in the ACA.

We had to shop around for the client and was able to get them a comparable plan close to the price they were paying. The real kicker is that while they were able to get a comparable plan with a deductible that met the deductible requirement, the employees now pay $400 more a year for employee only coverage.

Their employees are young and healthy, so understandably they were not too pleased.

ETA: I should mention that prior to the cancellation the client was told by Aetna that the premium increase for the plan that was cancelled would have increased $120 for employee only coverage, which was about $10 a month.

[ January 14, 2014, 02:02 PM: Message edited by: geraine ]
 
Posted by D.W. (Member # 4370) on :
 
quote:
These are NOT forced cancellations, but a choice the employer makes.
Fair point. A distinction I hadn't thought about previously. I'm unsure how many of the "changes" were due to the removal of an option as opposed to selecting something else upon a cost change of that option.

Also welcome. Too much information rather than opinion for our traditional greeting. [Razz]
 
Posted by G3 (Member # 6723) on :
 
Staples decided in early December that effective with the week ending January 4, 2014, “part-time associates should not be scheduled to work more than 25 hours per week.” Staples has also informed managers that because of this move, they “may need to hire additional associates to ensure optimal staffing levels.”

Whole Foods is doing the same.

They join 389 other organizations as tracked by Investor's Business Daily who announced decisions to cut part-timers’ hours that can arguably be tied to the employer mandate.

So 2 predictions: 1) this will continue and more people will be forced to work fewer hours or be forced to accept that their full time positions will become part time and 2) this will be called "anecdotal" no matter how many companies do it.
 
Posted by Seneca (Member # 6790) on :
 
Underemployment is Obama's new America.
 
Posted by Seneca (Member # 6790) on :
 
Interesting comparisson between Obamacare and Walmart's health coverage

quote:
New Obamacare health insurance enrollees may feel a pang of envy when they eye the coverage plans offered by Walmart to its employees.

For many years, the giant discount retailer has been the target of unions and liberal activists who have harshly criticized the company's health care plans, calling them “notorious for failing to provide health benefits” and "substandard.”

But a Washington Examiner comparison of the two health insurance programs found that Walmart's plan is more affordable and provides significantly better access to high-quality medical care than Obamacare.


Click here to see an infographic comparing Obamacare's health insurance premiums to Walmart's

Independent insurance agents affiliated with the National Association of Health Underwriters and health policy experts compared the two at the request of the Examiner.

Walmart furnished employee benefit information to the Examiner. Neither Obamacare advocate Families USA nor the United Food and Commercial Workers, which backs anti-Walmart campaigns, responded to Examiner requests for comment.

Walmart offers its employees two standard plans, a Health Reimbursement Account and an alternative it calls "HRA High" that costs more out of employees' pockets but has lower deductibles. Blue Cross Blue Shield manages both plans nationally.

Also offered is a Health Savings Account plan that includes high deductibles but allows tax-free dollars to be used for coverage.


Click here to see an infographic comparing Obamacare's health access to Walmart's

For a monthly premium as low as roughly $40, an individual who is a Walmart HRA plan enrollee can obtain full-service coverage through a Blue Cross Blue Shield preferred provider organization. A family can get coverage for about $160 per month.

Unlike Obamacare, there are no income eligibility requirements. Age and gender do not alter premium rates. The company plan is the same for all of Walmart's 1.1 million enrolled employees and their dependents, from its cashiers to its CEO.

A Journal of the American Medical Association analysis from September showed that unsubsidized Obamacare enrollees will face monthly premiums that are five to nine times higher than Walmart premiums.

JAMA found the unsubsidized premium for a nonsmoking gouple age 60 can cost $1,365 per month versus the Walmart cost of about $134 for the same couple.

The medical journal reported a 30-year-old smoker would pay up to $428 per month, in contrast to roughly $70 each month for a Walmart employee.

A family of four could pay a $962 premium, but the same Walmart family member would pay about $160.

Low premiums are not the only distinguishing feature of the Walmart plan. The retailer's employees can use eight of the country's most prestigious medical facilities, including the Mayo Clinic, Pennsylvania's Geisinger Medical Center and the Cleveland Clinic.

At these institutions, which Walmart calls "Centers of Excellence," Walmart employees and their dependents can get free heart or spinal surgery. They can also get free knee and hip replacements at four hospitals nationwide.

Many top-rated Walmart hospitals — such as the Mayo and Cleveland clinics — are left out of most Obamacare exchange plans.

But the real difference between Obamacare and Walmart can be seen in the levels of day-to-day access to doctors and hospitals.

Robert Slayton, a practicing Chicago independent insurance agent for 11 years and the former president of the Illinois State Association of Health Underwriters, described to the Examiner the differences between Walmart and Obamacare provider networks.

Slayton said the BlueChoice exchange network for President Obama's hometown has very limited hospital participation. “In downtown Chicago, the key is the number of hospitals: 28,” he said.

“Now we’re going to the national network — this is what the Walmart network would most likely be — and you have 54 hospitals. That’s a big difference,” he said.

Former New York Lt. Gov. Betsy McCaughey, a Republican who is now a health care advocate, said Obamacare's lack of first-class hospitals is a big problem.

“It’s not just the number, but who they are. You’ll find under the Obamacare exchanges that the academic hospitals have declined to participate, along with the specialists who practice at those hospitals. The same is true of cancer hospitals,” she said.

“People who are seriously ill need to stay away from these exchange plans,” McCaughey said.

Slayton said the gap between doctor availability in Chicago under the Obamacare and Walmart plans is dramatic.

“You will notice there are 9,837 doctors [under Obamacare]. But the larger network is 24,904 doctors. Huge, huge difference,” he said.

Walmart also offers a free preventive health plan that mirrors the Obamacare plan. Its employees can take advantage of a wide range of free exams and counseling, including screenings for colorectal cancer, cervical cancer, chlamydia, diabetes, depression and special counseling for diet and obesity.

Their children can get more than 20 free preventive services, ranging including screenings for genetic disorders, autism and developmental problems to obesity, lead poisoning exposure and tuberculosis. There are also 12 free vaccinations, and free hearing and vision testing.

Walmart employees pay as little as $4 for a 30-day supply of generic drugs and only $10 for eye exams through a separate vision plan.

“It’s a lot better program than people, I think, might assume without looking, just because Walmart has gotten such a bad reputation by some of the labor groups and other groups for its general activities,” said Gail Wilensky after reviewing the retailer's plan.

Wilensky was head under President George H.W. Bush of the federal Health Care Financing Administration, the predecessor to the the Centers for Medicare and Medicaid Services. CMS is the agency in charge of implementing a large part of the Affordable Care Act, and it oversaw the rollout of the troubled healthcare.gov website.

David Todd, an independent insurance agent based in Little Rock, Ark., also compared the health plans for the Examiner. Walmart’s corporate headquarters is in Bentonville, Ark., and the company has 58,000 workers in the state.

Todd pointed to stark differences between the government plan and Walmart: “If I buy a family plan on the exchange, it’s still $1,000 a month. And I can buy this for ... [$160] on Walmart.”

Walmart also gives cash to its employees for any health care expense. The annual payments run from $250 to $1,000 and are given at the beginning of the enrollment year in an account that can only be used for health care expenses.

Walmart individuals face a $2,750 deductible and families need to pay $5,500 under the HRA plan. Individuals pay $1,750 and families pay $3,500 deductibles under the HRA High plan.

The deductibles are high, but Obamacare deductibles are higher, going up to $6,300, according to Todd.

Todd looked at a 30-year-old woman who could qualify for the government subsidy. “The nonsubsidized premium is $205 a month for this 30-year-old. If they get a subsidy, then the premium is zero. But that person has to come up with $6,300 if something catastrophic happened,” he said.

The Walmart monthly premium for the same 30-year-old woman would be about $40. Her deductible would be $2,750, minus $250 in cash advance, for a total net deductible of $2,500.

Todd said some Obamacare exchange family plan deductibles can go as high as $12,000 before benefits kick in.


 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
A Journal of the American Medical Association analysis from September showed that unsubsidized Obamacare enrollees will face monthly premiums that are five to nine times higher than Walmart premiums.
Why did this article choose a comparison with unsubsidized Obamacare enrollees? Anyone equivalent to a Walmart employee would be making so little money that they would have a substantial subsidy.
 
Posted by Seneca (Member # 6790) on :
 
Evidence?
 
Posted by TomDavidson (Member # 99) on :
 
The majority of Walmart employees earn less than $25K per year. While some of them no doubt have other jobs, that's firmly in subsidy territory.
 
Posted by Seneca (Member # 6790) on :
 
Well, this must be one of those "conservative biased" news sources, right?

http://www.nytimes.com/2014/02/05/us/politics/budget-office-revises-estimates-of-health-care-enrollment.html?_r=0
 
Posted by LetterRip (Member # 310) on :
 
Seneca,

actually that is a reading comprehension fail for the NYT reporter.

What the CBO is projecting is that full time workers will voluntarily reduce the amount of overtime they work due to threshold effects. Ie if you work enough overtime that you cross a subsidy threshold you can lose a substantial amount of federal subsidy for your families health insurance.

Here is an example with numbers for illustration that I just did on facebook for a friend,

quote:
As an example let us assume someone earns 8$ an hour (and works four hours of overtime a week), and gets a subsidy of 600$ per month on health care. The subsidy drops to 300$ if they exceed an income threshold. 4hr * 12 (8$ at time and a half) * 52 = 2496$ But the loss of 300$ is 3600$ - so 2496-3600 = -1104$ Ie the individual is 'paying' to work overtime if they exceed the threshold (note example numbers above are just illustrative but convey the idea). So it is irrational for them to work overtime that exceeds certain thresholds due to the reduction in subsidy.
So the actual effect will likely an increase in total number of people employed as corporations hire people to do the overtime that their existing full time employees are unwilling to accept.

[ February 04, 2014, 09:38 PM: Message edited by: LetterRip ]
 
Posted by Seneca (Member # 6790) on :
 
That's absurd. If anything I'd say it's a reading comprehension fail because half the article is predictable spin and smoke from the NYT, that is always covering for Obama, on how it's not ALL bad news...

This isn't about overtime, this is about the loss of 2.5 million FULL TIME jobs because of the worst effect of socialism: people lose the incentive to work when things are provided for them for free.
 
Posted by NobleHunter (Member # 2450) on :
 
I think the CBO is saying that it's the equivalent of 2.5 million workers, not jobs. The work still needs to be done so the jobs will still exist. Since we're looking at a a long term surplus of workers, isn't fewer workers a good thing?

The unemployment rate is down because so many people are being driven completely out of the labour market; so freeing up jobs for people who want to work is good. Especially since the report doesn't seem to be saying people will stop working, but that they will instead work less. I'll agree with the implication that's it's good for people to have full time jobs; I think hours above fulltime (35 or so) to be value neutral.

It also doesn't say much about what effect the employer mandate will have. It doesn't seem to have had one yet, but it hasn't turned on.
 
Posted by PSRT (Member # 6454) on :
 
Seneca-
THe CBO is saying that many people will CHOOSE not to work because elderly and new parents will not be forced to to work in order to maintain health care coverage.

The only way I can see this as a bad thing is through reading comprehension problems.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
That's absurd. If anything I'd say it's a reading comprehension fail because half the article is predictable spin and smoke from the NYT, that is always covering for Obama, on how it's not ALL bad news...

This isn't about overtime, this is about the loss of 2.5 million FULL TIME jobs because of the worst effect of socialism: people lose the incentive to work when things are provided for them for free.

It's only a "worst" effect if it's a net negative, rather than a net positive. (This also has nothing at all to do with Socialism, which, to remind you, is about public or popular ownership and control of productive property and industry. Public support programs are completely orthogonal to socialism, capitalism, or any other economic designation of public vs private ownership)

In out case this is a highly desirable effect, because it celars the market of a vast oversupply of excess workers, leaving more empoyment opportunities for those who are seeking work and better self sufficiency to those that we do not need or otherwise have more productive uses to put their time to than competing for private sector employment, such as education, child rearing, education and training, arts, entrepreneurship, retirement, etc..
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by PSRT:
Seneca-
THe CBO is saying that many people will CHOOSE not to work because elderly and new parents will not be forced to to work in order to maintain health care coverage.

The only way I can see this as a bad thing is through reading comprehension problems.

How can this possibly make sense to anyone? It's bizarre. People will simply choose not to work and it's gonna be great! They'll have all the "free" health care they need so working is totally optional now? Yeah, just go on welfare, food stamps, etc and now see the doctor any time you want. That's great. Full time job? Go part time! Part time job? Quit or work even less! Everyone can simply work part time because they're gonna just be so damn many part time jobs available!!! Great.

The only way I can see this as a good thing is through economic comprehension problems.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
They'll have all the "free" health care they need so working is totally optional now? Yeah, just go on welfare, food stamps, etc and now see the doctor any time you want.
I know you're being histrionic and tongue-in-cheek about this, but it's actually quite possible that a full dole of this sort would be considerably more efficient and less expensive than the mish-mash of stopgap measures we have now.
 
Posted by JoshuaD (Member # 1420) on :
 
I'm starting to think a dole might not be a bad idea. I think I have to turn in my conservative credentials just for having the thought.
 
Posted by PSRT (Member # 6454) on :
 
Well, I think a lot of conservatives recognize that a dole could simplify the tax code, while providing a solid safety net for everyone. If implemented with actual bipartisan compromise, a dole could meet a lot of the goals of conservatives and liberals, without becoming a political hot potato. I've seen other principled conservatives endorse the idea.
 
Posted by NobleHunter (Member # 2450) on :
 
quote:
How can this possibly make sense to anyone? It's bizarre. People will simply choose not to work and it's gonna be great! They'll have all the "free" health care they need so working is totally optional now? Yeah, just go on welfare, food stamps, etc and now see the doctor any time you want. That's great. Full time job? Go part time! Part time job? Quit or work even less! Everyone can simply work part time because they're gonna just be so damn many part time jobs available!!! Great.
It seems like an awfully pessimistic view of human nature that given a chance not to work, most people will lapse into parasitic idleness. I think despair causes more people to chose not work than laziness. Why take a job if all it does is make most of your waking time more unpleasant without improving the rest?
 
Posted by Seneca (Member # 6790) on :
 
So what happens when too many people see all this great free stuff and not enough want to work to support the economy?

Guess we need a repeat of the USSR and have to destroy our society in order to get people to remember socialism doesn't work. And that's only less than 25 years after their collapse. So much for the generational example it was supposed to provide.
 
Posted by NobleHunter (Member # 2450) on :
 
In 20 years, our problem isn't going to be getting enough people to work, it will be finding ways to distribute resources to all the people who have no work to do. We're already running into a demand problem because wages have not matched increases in productivity; it will only get worse if certain technological trends live up to their potential.
 
Posted by Seneca (Member # 6790) on :
 
I those advocating general welfare for anyone underestimate the laziness of humans in general.

During the soviet union humans clearly had the technology where not everyone had to work or even most people, and yet their economy crumbled and collapsed because they couldn't even get enough people to float their system on basic production.
 
Posted by NobleHunter (Member # 2450) on :
 
Was that because people were lazy or saw no point? I'm under the impression that improving your standard of living was very difficult in the USSR. If I get $200 a day whether I go to work or not, I'm not going to work unless I really like my job. Not a circumstance that often prevailed in the Soviet Union.

[bad Russian accent]In Soviet Russia, job works you![/bad Russian accent]

If I get $200 for staying home or $300 for work it's a different story. I choose to work because that extra $100/day makes a real difference in the options available to me. Again, not something that was true in the USSR.

There's also real value in working just to have something to do. Trying to keep myself occupied for an extra 40 hours a week would be a real chore. A job at least gives me something purposeful to do. If got that $200/day, I probably wouldn't put 40 hours in but I'd at least check in to see if they had anything worth doing. I'd also spend time writing, which would hopefully prove more valuable than my current job.
 
Posted by Seneca (Member # 6790) on :
 
quote:
The head of the nonpartisan Congressional Budget Office delivered a damning assessment Wednesday of the Affordable Care Act, telling lawmakers that ObamaCare creates a "disincentive for people to work," adding fuel to Republican arguments that the law will hurt the economy.

The testimony from CBO Director Douglas Elmendorf comes after his office released a highly controversial report that detailed how millions of workers could cut back their hours or opt out of the job market entirely because of benefits under the health law.

The White House and its Democratic allies accused Republicans, and the media, of mischaracterizing the findings. But Elmendorf backed Republicans' central argument -- fewer people will work because of the law's subsidies.

"The act creates a disincentive for people to work," Elmendorf said, under questioning from House Budget Committee Chairman Paul Ryan, R-Wis.

[/b]"The act creates a disincentive for people to work."[/b]
- Douglas Elmendorf, CBO Director

Ryan clarified that the CBO report found not that employers would lay people off, but that more individuals would choose not to work.

"As a result ... that [lower] labor supply lowers economic growth," Ryan said.

Elmendorf answered: "Yes, that's right."

Ryan fumed that this would mean fewer people would be "joining the middle class."

"It's adding insult to injury," he said. "As the welfare state expands, the incentive to work declines -- meaning grow the government, you shrink the economy."

The CBO report on Tuesday effectively found that more people would opt to keep their income low to stay eligible for federal health care subsidies or Medicaid. The workforce changes would mean nationwide losses equal to 2.3 million full-time jobs by 2021, the report said.

Republican lawmakers seized on the report as major new evidence of what they consider the failures of Obama's overhaul, the huge change in U.S. health coverage that they're trying to overturn and planning to use as a main argument against Democrats in November's midterm elections.

It's the latest indication that "the president's health care law is destroying full-time jobs," said Republican Rep. John Kline of Minnesota, chairman of the House Education and the Workforce Committee. "This fatally flawed health care scheme is wreaking havoc on working families nationwide," he said.



 
Posted by LetterRip (Member # 310) on :
 
Elmedorfs answer was wrong - reduced labor only lowers growth IF labor is close to capacity OR it results in a shortage of a particular labor niche.

We have such a massive oversupply of labor there is no reason to anticipate this will happen.

Also Ryan has pretty big misunderstandings of economics it will likely increase people 'joining the middle class' in that it will provide more employment opportunities for those who want/need to work.

Also Kline misunderstands the report - he talks about it 'destroying full time jobs' - it should create more full time jobs based on this finding - since individuals will reduce overtime hours worked resulting in increased total employment both part time and full time.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
So what happens when too many people see all this great free stuff and not enough want to work to support the economy?


All what great free stuff? There's a small amount of stuff that's barely adequate to get by for those that have other priorities, but the only great stuff comes from income levels that can only be achieved through generating a higher income level than the support programs provide.

quote:
Guess we need a repeat of the USSR and have to destroy our society in order to get people to remember socialism doesn't work.
What socialism? This is welfare/public support, which has nothing to do with socialism. No one is advocating nationalizing industries and trying to replace market allocation of production resources with political direction of production here. Nor is anyone advocating removing the reward of higher income by way of working which is effectively what provided the disincentive to do so in the example that you're trying to put forward.
 
Posted by D.W. (Member # 4370) on :
 
I thought ACA was a disincentive to employers. How exactly does it disincentivize workers from working? Unless you know, they take a pay hit to cover the employer contributions?
 
Posted by scifibum (Member # 945) on :
 
LR - the CBO is saying it will reduce hours worked. There is indeed a disincentive to work if it disqualifies someone for Medicaid or for the healthcare premium subsidies. I don't think there's any reason to dispute this.

Those disincentives could be compensated for in some way, of course.

However, it seems to me to point to the ultimate solution.

We (aside from a somewhat extreme and rather small minority) do not accept a system where indigent people are left to suffer and die from illness because they can't pay for treatment. This is why ERs can't turn anyone away.

It's also true that the pre-ACA status quo was not working very well. The overall costs of our system are way too high relative to our outcomes. So something needed to change.

It's fairly clear that most people aren't going to sign up for a guaranteed minimum income that eliminates the category of "can't pay for treatment."

It's also pretty clear that Medicaid and the subsidies of ACA create a disincentive to work in some situations. I think it's mostly people choosing not to take a second [or nth] household job, rather than choosing not to work at all - I'm not too worried about Seneca's worst nightmares.

If the effective tax on labor supply is unacceptable, and the dying-in-the-streets and do-nothing-and-keep-overspending-relative-to-outcomes options are still unacceptable, then it says to me that the solution is single payer.

As of now, most people seem to consider the ACA with its downsides a better solution that single payer.

I think if we're going to truly stand behind the de facto position that we don't just let people die in the streets because it's their own problem to figure out how to pay for whatever they need, then we either have to suck up the labor supply downside the CBO has just articulated, or we have to eliminate that downside with a more comprehensive overhaul - and the only one that escapes the dilemma, as far as I can tell - is single payer.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by D.W.:
I thought ACA was a disincentive to employers. How exactly does it disincentivize workers from working? Unless you know, they take a pay hit to cover the employer contributions?

If you've been looking to retire, but can't because you've got a medical condition that would have left you dead in the water on the private market, the ACA opens up a way to make that affordable. Similar at the low end if you're a student or parent that has other possible priorities than private employment- improved eligibility for Medicaid now means that you're a little more free to focus on those priorities instead of having to work for health coverage (and, perhaps, daycare costs)

Those are the major groups that are predicted to drop out of the job market, making way for the current unemployed to actually get the jobs that they need and are actually actively interested in working in order to improve their financial situations.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
then we either have to suck up the labor supply downside the CBO has just articulated,
Except that it's not a downside- in our current state, the reduced labor supply is an upside, because we're currently extremely over-supplied with labor, and facing rapidly growing disemployment pressure as technology displaces the need for labor.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by JoshuaD:
I'm starting to think a dole might not be a bad idea. I think I have to turn in my conservative credentials just for having the thought.

Would it make it more palatable to call it a dividend? Because that's basically what it could be boiled down to- a baseline slice of total productivity paid out to each person by virtue of the implicit investment in the US represented by their citizenship.
 
Posted by Seneca (Member # 6790) on :
 
This is absurd.

We are running a budget deficit and will continue to do so, and it will get worse because of this unless economic activity grows a lot, which it won't thanks in part to the ACA.

quote:
However, the budget experts see the long-term federal deficit picture worsening by about $100 billion a year through the end of the decade because of slower growth in the economy than they had previously predicted.
So instead of losing jobs and worked hours from the market we needed more to generate revenues to cover this mass deficit. Instead we are getting less. If we don't get more the only solution will be to raise taxes which will destroy even more jobs and isn't even a solution. Do you see where this spiral is headed?

As for single payer, that is a nightmare from hell. I'd rather take my chances on the open market than have the government tell me whether or not I am approved for care. The IPAB is bad enough, you want to turn over the whole thing to bureaucrats?
 
Posted by LetterRip (Member # 310) on :
 
scifibum,

were you responding to someone else? DW perhaps?

DW,

I explained why it is a disincentive to maximize ones labor output - each threshold for ACA subsidy means that once you cross that threshold it can take numerous hours to compensate for the subsidy lost. Ie a 100$ per month loss in subsidy at a job that pays 20$ an hour for overtime would take more than 5 hours a month in labor to subsitute for the lost subsidy. So if you are on the threshold where doing an extra hour of labor loses the subsidy, there is a strong incentive to not take that extra hour of labor.

So it disincentivizes existing workers to maximize their labor output when they are close to a threshold level.

However, while it disincentivzes close to thresholds, that reduce labor can now be done by the currently unemployed.

So net effect is likely positive to the economy and taxes, unless we are at or close to full employment.
 
Posted by D.W. (Member # 4370) on :
 
Thanks Pyrtolin that make sense. Doesn’t cause me to fret but it is a solid example.
quote:
So if you are on the threshold where doing an extra hour of labor loses the subsidy, there is a strong incentive to not take that extra hour of labor.
So we need better gradation of subsidies? [Smile]
 
Posted by scifibum (Member # 945) on :
 
quote:
Originally posted by LetterRip:
scifibum,

were you responding to someone else? DW perhaps?


No, I was responding you -

"...- it should create more full time jobs based on this finding - since individuals will reduce overtime hours worked resulting in increased total employment both part time and full time...."

It's going to cause a reduction in full time job equivalents, according to the CBO. I read the detailed analysis (appendix c: http://www.cbo.gov/sites/default/files/cbofiles/attachments/45010-Outlook2014.pdf) - they do not expect the labor hours to be picked up by others.
 
Posted by Pyrtolin (Member # 2638) on :
 
To add to it- "retire" above very often actually means "Attempt to start an individual business venture, not "Start collecting a pension/IRA payment" People who do that are considered to have left the labor market because they're not seeking external employment, even though they're still being as productive, if not perhaps more productive than they would have been if employed by someone else. Fears of losing or otherwise not having access to employer provided group health insurance have been a huge disincentive to entrepreneurship which the ACA is more or less directly designed to address.
 
Posted by LetterRip (Member # 310) on :
 
scifibum,

ok thanks. I'm reading appendix C, for specifics - here is a summary - effects are listed in order of expected impact.

Substitution effects are as the marginal utility of your labor decreases (each hour worked is worth less) you substitute lesiure for labor hours. This is partially what I was describing above with threshold effects can reduce the marginal utility of labor.

Income effects are - that some individuals work to achieve a specific baseline consumption thus reducing labor when they can meet that baseline consumption for fewer hours worked.

Here are there claims

1) They anticipate a substitution effect and income effect for some of those already working. This will result in some individuals exiting the work force; some individuals deliberately switching from current full time positions to part time positions; and some individuals forgoing overtime.

This will impact individuals with no preexisting coverage who are below 400% of the poverty threshold; or those who are workers who only work part of a year (seasonal workers, and individuals who work only enough to make what is needed to meet their needs for a year).

2) Impact of medicaid eligibility

This will primarily impact single childless individuals. The will gain coverage, and thus have similar substitution and income effects.

3) Impact on employer labor supply (ie exceeding 50 workers)

The 'penalty' for not providing insurance will be 'passed on' to the employee. Resulting in reduced pay, and thus reduced incentive to work

4) Excise tax on 'gold plated' plans

Will cause plan coverage reductions, but this should shift to increases in other forms of compensation (ie higher take home pay). However, the higher pay will be subject to income taxes - the net effect could be reduced total compensation, and thus reduced incentive to work.

5) Retirement decisions for elderly and disabled

might allow some to retire earlier

6) Effects due to productivity

Some employees might choose jobs better matching their skills since they no longer have to worry about not getting health insurance. This might result in reduced need for training because they are better qualified.

Others might improve their productivty through better health

Some employers might split jobs into part time to avoid paying for insurance reducing productivty.

Etc.

They project that the total demand for goods and services will increase.

So that ends their analysis.

All of this combined (increased demand for goods and services, some individuals exiting or reducing their supply of labor) should have a net increase in total employment (those interested in working being employed).

There doesn't seem to be anything in the report that provides a justification for a claim that total labor demand would decline. If demand for goods and services increases total labor supply has to expand to meet it, all else being equal.

For instance, lets say all small business cap their employment at 50 employees with a constant demand. For total employment it would actually increase. The reason should be obvious. Larger businesses provide economy of scale, so with business capped at 50 employees, we need more total businesses and each of them operating less efficiently than a combined larger business. (Other effects make the analysis slightly more complex - more competitors means lower prices which will increase demand; lack of economy of scale will drive up cost of doing business raising prices and lowering demand; etc.)
 
Posted by LetterRip (Member # 310) on :
 
scifibum,

the reduction in total employment can only happen if there is a supply constraint on labor. With a glut of labor, as is the current case, there is no rational reason to expect a decrease in total labor demand.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
We are running a budget deficit and will continue to do so, and it will get worse because of this unless economic activity grows a lot, which it won't thanks in part to the ACA.
Do you accept as fact that the average reduction in the annual deficit over the past 5 years since Obama took office has been greater in absolute (or inflation adjusted) terms than under any other President in the last 50 years?

How do you explain that?
 
Posted by Seneca (Member # 6790) on :
 
quote:
However, the budget experts see the long-term federal deficit picture worsening by about $100 billion a year through the end of the decade because of slower growth in the economy than they had previously predicted.

 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
quote:
However, the budget experts see the long-term federal deficit picture worsening by about $100 billion a year through the end of the decade because of slower growth in the economy than they had previously predicted.

That's going to keep happening as long as politicians keep pursuing self destruction via deficit cuts instead of focusing on investing in growth.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by LetterRip:
scifibum,

the reduction in total employment can only happen if there is a supply constraint on labor. With a glut of labor, as is the current case, there is no rational reason to expect a decrease in total labor demand.

Yes, there is. ObamaCare drives a decrease in labor demand among businesses.
 
Posted by Wayward Son (Member # 210) on :
 
Would you like to tell us why you believe that, G3? And whether it pertains to this recent report?
 
Posted by G3 (Member # 6723) on :
 
Check it out, one of my prediction came true already.
quote:
Originally posted by G3 on 01-14-2014 05:49 PM:
So 2 predictions: 1) this will continue and more people will be forced to work fewer hours or be forced to accept that their full time positions will become part time and 2) this will be called "anecdotal" no matter how many companies do it.

So on prediction 1, we know from the CBO report that this will be true as 2.5 million full-time workers will become part timer by 2025. Spot on with that prediction.

I was, at least for now, wrong on the anecdotal part but really, who could have predicted that millions being dropped from full time positions into part time work would have been called good news? I say for now because a claim this stupid can't fly for long. We'll see ...
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Wayward Son:
Would you like to tell us why you believe that, G3? And whether it pertains to this recent report?

It has been discussed heavily in many threads. I don't see the need to regurgitate it every time someone tries to deny it. You can google obamacare job losses.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
I was, at least for now, wrong on the anecdotal part
Actaully, what you missed was "unsustainable" on that.

Many companies have loudly announced that they'd be doing that, then quietly retracted those plans, when they realized that they wouldn't be able to operate if they shorted staffing hours and the overhead/turnover from trying to maintain that costed them more than just offering proper compensation up front.
 
Posted by G3 (Member # 6723) on :
 
What companies "quietly retracted those plans"?
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by G3:
quote:
Originally posted by LetterRip:
scifibum,

the reduction in total employment can only happen if there is a supply constraint on labor. With a glut of labor, as is the current case, there is no rational reason to expect a decrease in total labor demand.

Yes, there is. ObamaCare drives a decrease in labor demand among businesses.
TEchnological productivity gains drive a reduction in labor demand. Businesses cannot employ less labor than it takes to meet consumer demand, and won't waste money employing any more than it takes to do so. Obamacare may lead to some small marginal hikes in prices to account for having to pay a less suppressed cost of employment, but it's consumer demand that sets the bar for labor demand, businesses just serve to broker that demand to the people they hire to meet it.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Pyrtolin:
Businesses cannot employ less labor than it takes to meet consumer demand...

Yeah, actually, they can.

Related news:
quote:
AOL is trimming back its employee retirement benefits, a move the media company's chief executive said Thursday was made necessary by new costs incurred by President Barack Obama's health care reform law.

"Obamacare is an additional $7.1 million expense for us as a company, so we have to decide whether or not to pass that expense to employees or whether to cut other benefits," AOL's Chairman and CEO Tim Armstrong told CNBC Thursday morning. AOL is the parent company of The Huffington Post.


 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by G3:
What companies "quietly retracted those plans"?

Darden Restaurants
John Metz (Announced and retraced for his Denny's franchises and Hurricane Grill)
Papa John’s
New York Area Applebees

Some of the big headliners from the initial wave of claims. Other's haven't as explicitly backtracked, but they also haven't actually cut hours, because it's not really possible, otherwise they'd have already cut the hours that they were wasting even without the ACA as an excuse.

(Disney, apparently, has gone the other way, and started looking to promote part time workers to full time status in order to give them better health plan access)
 
Posted by LetterRip (Member # 310) on :
 
G3,

quote:
So 2 predictions: 1) this will continue and more people will be forced to work fewer hours or be forced to accept that their full time positions will become part time and 2) this will be called "anecdotal" no matter how many companies do it.
So on prediction 1, we know from the CBO report that this will be true as 2.5 million full-time workers will become part timer by 2025. Spot on with that prediction.

Reading comprehension fail. They are not being 'forced to work less'. It is people who want to work less doing so because it changes the economics (they can achieve the same equivalent income and benefits that they want with fewer hours). In this case it is people working fewer hours than the hours that the company would allow them to work - thus the complete opposite of your prediction. Also it isn't 2.5 million people shifting to part time - it is 2.5 million FTE hours being reduced. A significant source is earlier retirements of full time workers, another significant source is early retirement of part time workers, another significant source is reduction in voluntary overtime hours, another source is voluntary reduction of part time hours, only a modest part will be voluntary switching from full time to part time.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by LetterRip:
G3,

quote:
So 2 predictions: 1) this will continue and more people will be forced to work fewer hours or be forced to accept that their full time positions will become part time and 2) this will be called "anecdotal" no matter how many companies do it.
So on prediction 1, we know from the CBO report that this will be true as 2.5 million full-time workers will become part timer by 2025. Spot on with that prediction.

Reading comprehension fail. They are not being 'forced to work less'. It is people who want to work less doing so because it changes the economics (they can achieve the same equivalent income and benefits that they want with fewer hours). In this case it is people working fewer hours than the hours that the company would allow them to work - thus the complete opposite of your prediction. Also it isn't 2.5 million people shifting to part time - it is 2.5 million FTE hours being reduced. A significant source is earlier retirements of full time workers, another significant source is early retirement of part time workers, another significant source is reduction in voluntary overtime hours, another source is voluntary reduction of part time hours, only a modest part will be voluntary switching from full time to part time.
This may be some of the best spin of the Obama era.
 
Posted by Wayward Son (Member # 210) on :
 
I agree, G3. The Conservatives you quoted have spun the report way out into the stratosphere. [Big Grin]
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by G3:
What companies "quietly retracted those plans"?

Darden Restaurants
John Metz (Announced and retraced for his Denny's franchises and Hurricane Grill)
Papa John’s
New York Area Applebees

Some of the big headliners from the initial wave of claims. Other's haven't as explicitly backtracked, but they also haven't actually cut hours, because it's not really possible, otherwise they'd have already cut the hours that they were wasting even without the ACA as an excuse.

(Disney, apparently, has gone the other way, and started looking to promote part time workers to full time status in order to give them better health plan access)

I'll look at some of the others but let's start with Papa John's. John "Papa" Schnatter wrote a article about this:
quote:
Reading what has been written about statements I made on the effect of the Affordable Care Act on our franchisees reminds me of a quote from Lewis H. Lapham, former editor of Harper's magazine: "People may expect too much of journalism. Not only do they expect it to be entertaining, they expect it to be true."

Many in the media reported that I said Papa John's is going to close stores and cut jobs because of Obamacare. I never said that. The fact is we are going to open over hundreds of stores this year and next and increase employment by over 5,000 jobs worldwide. And, we have no plans to cut team hours as a result of the Affordable Care Act.

Clearly there was some misunderstanding somewhere.

So it really does look like he's walking back on this right? But let's go a little further in the story:
quote:
Here is the part of the interchange that was the genesis of the news:

Reporter: "Do you think your -- you know -- franchise owners... are going to cut people hours back to make them part time instead of full time?"

Me: "Well, in Hawaii there is a form of the same kind of health insurance and that's what you do, you find loopholes to get around it. That's what they're going to do."

Reporter: "My understanding is that if you're a full time employee, which is 35 hours or over, you'd be covered. Or if you're part time then you wouldn't be. So wouldn't some business owners just cut people down like 34 hours a week so they wouldn't have to pay for health insurance?"

Me: "It's common sense. It's what I call lose-lose."

The reporter asked what I believed Papa John's franchisees would do in response to Obamacare, not what Papa John's would do. In fact, her question was "wouldn't some business owners just cut people down like 34 hours a week so they wouldn't have to pay for health insurance?"

My answer: "It's common sense."

So is it going to be the "common sense" outcome or not? I think we all know.

He finishes:
quote:
Papa John's, like most businesses, is still researching what the Affordable Care Act means to our operations. Regardless of the conclusion of our analysis, we will honor this law, as we do all laws, and continue to offer 100% of Papa John's corporate employees and workers in company-owned stores health insurance as we have since the company was founded in 1984.
And how "common sense" will his future conclusions be you think? Sure, we all know.

The real question for Schnatter is why the, let's call it, clarification? Why the need to talk about how something so "common sense" does not mean for him what it means for his franchisees? Why does he need everyone to know that he will honor the law no matter what his analysis concludes?

Think this through, what is the message and who is the intended recipient here? The average consumer is not even aware of ObamaCare (hard to believe there it is) so Schnatter is not trying to talk to them. Schnatter's shareholders know he has to do the "common sense" things, they don't need to be told in the pages of Huffington Post. His own employees would be addressed via internal communications. So who's he trying to placate with this? Here's a hint: audit.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Wayward Son:
I agree, G3. The Conservatives you quoted have spun the report way out into the stratosphere. [Big Grin]

I always picture Peewee Herman with these kinds of responses ...

However, the spin is how great it's gonna be that all these people get to "choose" not to work. They'll have all this leisure time now to finally write that symphony, solve those pesky scientific questions that have plagued mankind for months, solve pressing world issues, create great works of art, etc, etc. It's the most ridiculous spin I've ever heard.
 
Posted by LetterRip (Member # 310) on :
 
G3,

again reading comprehension fail.

What the report says is that people who are working to achieve a target income rate, or target amount of consumption often work the minimum to reach that target.

If you subsidise insurance at 700$/month. Then that is 12*700$ = 8400$ less they need to earn to achieve the same consumption. So if they, for instance, are earning 10$ an hour then 8400/10 = 840 hours less they need to work each year to achieve the same consumption pattern/income equivalent.

A classic example of this behaviour is surfbums/skibums. There are plenty of people who hate their jobs and work only enough to meet their expenses.
 
Posted by Wayward Son (Member # 210) on :
 
quote:
I always picture Peewee Herman with these kinds of responses ...
As the old Finnish saying goes, "What you shout into the forest, the forest will echo." Just think of me as the forest. [Smile]

quote:
However, the spin is how great it's gonna be that all these people get to "choose" not to work. They'll have all this leisure time now to finally write that symphony, solve those pesky scientific questions that have plagued mankind for months, solve pressing world issues, create great works of art, etc, etc. It's the most ridiculous spin I've ever heard.
The problem is the "spin" is what the CBO used to make its estimate. It's what's in the report. It didn't come from the pundits or the spinmasters, like
Boehner's "President Obama's [health care reform] law expected to destroy 2.3 million jobs...

If you disagree with people "choosing" not to work, then you have to discount the conclusions of the report, too. If the basis is "spin," the conclusions therefore must be "spin," too.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
the spin is how great it's gonna be that all these people get to "choose" not to work
I'm not sure why that's in quotes. Are you saying that the CBO was not specifically speaking of people who, in fact, choose not to work?
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by LetterRip:
G3,

again reading comprehension fail.

What the report says is that people who are working to achieve a target income rate, or target amount of consumption often work the minimum to reach that target.

If you subsidise insurance at 700$/month. Then that is 12*700$ = 8400$ less they need to earn to achieve the same consumption. So if they, for instance, are earning 10$ an hour then 8400/10 = 840 hours less they need to work each year to achieve the same consumption pattern/income equivalent.

A classic example of this behaviour is surfbums/skibums. There are plenty of people who hate their jobs and work only enough to meet their expenses.

How is that a good thing? Don't you see that this ratcheting down to work the bare minimum while the government will have to increase deficit spending and probably raise taxes to pay for fewer working people will destroy our economy? The problem with socialism is that people are lazy.
 
Posted by MattP (Member # 2763) on :
 
A significant number of the hours I currently work are discretionary. If my expenses were much less I would (probably) work fewer hours. I suppose I might decide to keep working those hours to further boost my savings, but lower costs would be a strong incentive toward working fewer hours.

I doubt I'd be composing music or solving the great questions of our time, but I do have a backlog of video games I've been wanting to get to.
 
Posted by Seneca (Member # 6790) on :
 
quote:
I doubt I'd be composing music or solving the great questions of our time, but I do have a backlog of video games I've been wanting to get to.
I think that statement sums up the "freed-up productivity" that society will gain by subsidizing people's lifestyles and letting them off from covering their expenses...
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Don't you see that this ratcheting down to work the bare minimum while the government will have to increase deficit spending and probably raise taxes to pay for fewer working people will destroy our economy?
While this is understandably a matter of faith for you, I think it's probably far from the truth.
 
Posted by Seneca (Member # 6790) on :
 
quote:
It is the common error of Socialists to overlook the natural indolence of mankind; their tendency to be passive, to be the slaves of habit, to persist indefinitely in a course once chosen. Let them once attain any state of existence which they consider tolerable, and the danger to be apprehended is that they will thenceforth stagnate; will not exert themselves to improve, and by letting their faculties rust, will lose even the energy required to preserve them from deterioration. Competition may not be the best conceivable stimulus, but it is at present a necessary one, and no one can foresee the time when it will not be indispensable to progress.

 
Posted by LetterRip (Member # 310) on :
 
Seneca,

quote:
How is that a good thing?
If we have substantial unemployment, then it should result in net increase in total employed. Ie if Billy, Joe, Bob, and Fred are working 50 hours a week and cut back to 40 hours a week. Then Jimmy can now get a job at 40 hours a week. Then Jimmy is now paying taxes and needs less (or even no) welfare.

The issue you are concerned about only arises if we are at or close to maximum employment.
 
Posted by Seneca (Member # 6790) on :
 
That would be fine if we had unemployment that wasn't directly related to welfare. As it stands now, I submit that a huge portion of those unemployed are unemployed because their welfare benefits pay more and give them better overall resources than trying to work. So no, this is a terrible thing.
 
Posted by MattP (Member # 2763) on :
 
What percentage would you say is "huge" in this case? 50%? 75%?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
It is the common error of Socialists to overlook the natural indolence of mankind...
How lazy are you, Seneca?

If you need me to lay into Skousen and his "Natural Law" for you, let me know. He's a particularly amusing target, since he was so transparently awful.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
I submit that a huge portion of those unemployed are unemployed because their welfare benefits pay more and give them better overall resources than trying to work.
If you were wrong, would you change your mind? Or change the subject?
 
Posted by Seneca (Member # 6790) on :
 
When collective welfare benefits that pay more than minimum wage in most states, and more than $15 an hour in some states, I can understand this. And the way welfare is structured, a vast plurality of people are more eligible than not for most or all of those benefits the way they are bundled. IE: you sign up for food stamps so you get contacted about free phone service and housing vouchers, etc.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
And the way welfare is structured, a vast plurality of people are more eligible than not for most or all of those benefits the way they are bundled.
I think you'll find upon further investigation that this is not true.
 
Posted by Seneca (Member # 6790) on :
 
Putting in very little info besides trying to emulate that of a slothful individual with no dependents and virtually no accomplishments who was simply unemployed for 6 months returned over 130 benefits on this website: http://www.benefits.gov/
 
Posted by MattP (Member # 2763) on :
 
quote:
When collective welfare benefits that pay more than minimum wage in most states, and more than $15 an hour in some states, I can understand this.
This was explained when you brought it up a few days ago, but those numbers assume that you qualify for all of the benefits, regardless of the fact that very few people actually qualify for all of them. It also ignores the fact that some of those benefits are only available over a fixed period of time. Further it ignores that many of those benefits pay out even if you get a job. Also, it ignores the fact that most people who receive welfare are in fact already employed. Finally, it ignores the fact that the majority of unemployed people receiving welfare were employed the year prior or will be employed the year after. Do you really think no one has taken the effort to actually measure this stuff?

The data available do not support your claim that welfare is a substantial disincentive to work or that there is a substantial able-bodied population who perpetually receives welfare rather than working.

Whether it's theoretically possible to assemble a package on benefits.gov with a large number of benefits (what's the monetary value? which are exclusive of others? are any of them time-limited? are you counting things like "counseling services" and "job training" as benefits that people are consuming rather than getting a job?) is rather beside the point if there aren't actually substantial numbers of people doing so.

So, I'll ask again - what portion of the unemployed are not working because they are receiving welfare benefits that exceed what a job would bring in? Ballpark. More or less than 50%?
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by MattP:
quote:
When collective welfare benefits that pay more than minimum wage in most states, and more than $15 an hour in some states, I can understand this.
This was explained when you brought it up a few days ago, but those numbers assume that you qualify for all of the benefits, regardless of the fact that very few people actually qualify for all of them. It also ignores the fact that some of those benefits are only available over a fixed period of time. Further it ignores that many of those benefits pay out even if you get a job. Also, it ignores the fact that most people who receive welfare are in fact already employed. Finally, it ignores the fact that the majority of unemployed people receiving welfare were employed the year prior or will be employed the year after. Do you really think no one has taken the effort to actually measure this stuff?

The data available do not support your claim that welfare is a substantial disincentive to work or that there is a substantial able-bodied population who perpetually receives welfare rather than working.

Whether it's theoretically possible to assemble a package on benefits.gov with a large number of benefits (what's the monetary value? which are exclusive of others? are any of them time-limited? are you counting things like "counseling services" and "job training" as benefits that people are consuming rather than getting a job?) is rather beside the point if there aren't actually substantial numbers of people doing so.

So, I'll ask again - what portion of the unemployed are not working because they are receiving welfare benefits that exceed what a job would bring in? Ballpark. More or less than 50%?

On the contrary, public assistance is set up and bundled in a way so that a vast plurality of people ARE eligible for most or all benefits. Check that website I linked.
 
Posted by MattP (Member # 2763) on :
 
The vast majority of the program that I see are not cash or cash equivalents. A typical "Housing benefit", for instance:
quote:
Fair Housing Initiatives Program (FHIP) Private Enforcement Initiative
The purpose of the program is to develop, implement, carry out, or coordinate programs or activities designed to obtain enforcement of the rights granted by the Fair Housing Act or by substantially equivalent state and local fair housing law.

It's not money for rent - it's a program to ensure enforcement of the Fair Housing Act.

So, yes there's a large benefit count of programs that are primarily training, education, counseling, enforcement, etc.

quote:
a vast plurality of people ARE eligible for most or all benefits
A "vast plurality" doesn't make sense here. Plurality refers to when there are more than two groups being counted with one group having more than the other others while still having less than a majority. If we're measuring how many welfare recipients are eligible for most or all benefits vs how many are not it's either a majority or it's not. If it's not a majority that doesn't make it a plurality, vast or otherwise, unless there is a third group that you are measuring against.

I'm not sure why you're trying to make this case - it was already tried in the report you linked earlier and in that case they actually pointed out the cash-equivalent programs and added up the dollars. They just ignored the actual qualification criteria for those programs and the existing data on how they are actually used. Why you think pointing at the larger body of programs that includes those programs and whole bunch of non-cash programs as well would address those flaws is beyond me.

Regardless of all that, are you just not willing to say what you think that huge portion of welfare recipients is who refuses to work because welfare is more profitable?

[ February 08, 2014, 01:53 AM: Message edited by: MattP ]
 
Posted by Greg Davidson (Member # 3377) on :
 
I wonder what happened in September 2008 that suddenly caused such large numbers of Americans to start preferring welfare to working? We had 4.7% unemployment as late as the end to 2007, and then suddenly millions of Americans seemed to prefer welfare over work.
 
Posted by DonaldD (Member # 1052) on :
 
Bah, kids nowadays. Why, when i was young...
 
Posted by edgmatt (Member # 6449) on :
 
Well, welfare is more profitable. I do 0 work and get paid X. That's a better pay rate than any job, as far as the numbers are concerned.
 
Posted by LetterRip (Member # 310) on :
 
Seneca,

I just did a similar methodology, as if I were a 25 year old male, single head of household who was not the child of a veteran, who had been unemployed for six months with a science degree. As you said, there were a huge number of benefits listed. However, almost all of the benefits the individual was actually illegible for, or were benefits than anyone could get.

For instance as a male, he certainly was not going to be eligible for cervical cancer screening

http://www.benefits.gov/benefits/benefit-finder/#results&bid=697

and as someone without children, he wasn't eligble for any of the programs that required children. (Food, medical, and housing benefits).

It also listed things that were competitive applications that anyone who was using the site would almost certainly not qualify for.

For instance the 'Life Sciences Award'

http://www.benefits.gov/benefits/benefit-finder/#results&bid=4778

Other things were mentioning standard tax deductions that you would get when filling out your taxes.

It also listed things that were useless to someone without income such as tax filing assistance.

And some things that were available to everyone regardless such as the unemployment office.

So, little or no benefits available, when actually examined, although a cursory examination might lead one to believe a large array of benefits were available.

[ February 08, 2014, 02:56 PM: Message edited by: LetterRip ]
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
Well, welfare is more profitable. I do 0 work and get paid X. That's a better pay rate than any job, as far as the numbers are concerned.
Edgmatt, what you write is plausible. It may or may not be correct, but it is plausible. And given the diverse range of human beings (and their circumstances) in America, I am sure it is true for some. But how many? The economic collapse of 2008 nearly doubled unemployment. Were those job losses due to people performing the calculation you list above?
 
Posted by MattP (Member # 2763) on :
 
It's more profitable per hour, but not in absolute terms. I wouldn't take a job at $500/hour if it only paid me for an hour a month and it meant I could only ever work for that one job. The total benefits vs what a typical job might pay is much more relevant.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by edgmatt:
Well, welfare is more profitable. I do 0 work and get paid X. That's a better pay rate than any job, as far as the numbers are concerned.

It's only a better rate if it's more that you need to live at your desired level of security. If it's less than that, it's worse than anything that brings in more meet income, one the costs of doing the work in question are accounted for. (And unless you have an unusually high tolerance for stagnation, you'll find out pretty quickly that it's much harder to make yourself be content with doing nothing than with trying to find something to do to make yourself feel productive. Even retirees that have managed to secure a reasonable income tend to eventually give up on it and seek out part time or volunteer work to satisfy the natural human tendency toward industriousness. (The garbage Seneca posted about laziness is nonsensical propaganda that doesn't hold up to any examination of more than a few exceptional outliers that would basically be deadweight in any system, so aren't worth the cost of phishing the population at large in hopes of accomplishing the impossible, and that's not even getting into it's misleading attempt to point a finger at socialism when it's taking about public support and charity- things that serve to protect capitalist system against pressure to convert to more socialistic economic models)

Except that's not how welfare is structured. Especially with the EITC factor in, welfare is currently, do 0 work and receive a pittance (X) for 5 years that amounts into a slow slide into perpetual debt to payday lenders and similar scams, and then simply being abandoned to their mercy. If you can find someone willing to hire you, though, you get an extra amount (y) that increases for a while along with your income, then levels off, and finally starts to decline at a slower rate than your income levels.

For most offshore that still need welfare, they pretty much used up their eligibility I'm the first 5 or so years after Clinton gutted it, or I'm the wake of the recession at the end of his term. (But abandoning people to poverty who were still unable to find work did make for good stats in the number of people in the program, just as long as you glossed over the the direction they were headed on the way out)
 
Posted by Pyrtolin (Member # 2638) on :
 
To note, many people can talk a good game about how they'd be able to kick back and do nothing (or at least nothing that others would value enough to pay them to do, which already begins to belie the nominal claim), but like most fantasies, most people can't actually pull it off unless they're coupling it with crippling levels of depression.

Boredom is a powerful fundamental motivator, and it can lead to some very pathological outcomes when it arises with few clearly productive alternatives available. (Impoverished neighborhoods where people have largely given up hope of improving their condition certainly don't have a reputation for being bland, boring places where nothing happens, for example)
 
Posted by Seneca (Member # 6790) on :
 
quote:
(The garbage Seneca posted about laziness is nonsensical propaganda that doesn't hold up to any examination of more than a few exceptional outliers that would basically be deadweight in any system, so aren't worth the cost of phishing the population at large in hopes of accomplishing the impossible, and that's not even getting into it's misleading attempt to point a finger at socialism when it's taking about public support and charity- things that serve to protect capitalist system against pressure to convert to more socialistic economic models)
Ha! This is one of the most humorous things I've read so far. The idea that "public support" is a "buffer" that's supposed to protect capitalism from angry mobs demanding total socialism is funny.

So this is what we're left with, a veiled threat that those who work and produce had BETTER put up with high taxes and giveaways for those who won't work, and be HAPPY about it, or else we'll take EVERYTHING they have.

That's nice. At least it's out in the open. Frankly, I wish the Progressive Statists would be this honest, as the response to them could then be equally honest and equally direct.

And as to the objections to the quote, it is funny to see those endorsing so-called liberal policies abandoning John Stuart Mill...

[ February 09, 2014, 04:34 AM: Message edited by: Seneca ]
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
I wish the Progressive Statists would be this honest, as the response to them could then be equally honest and equally direct.
And I wish you would respond to my earlier question about how your theory explains how levels of personal motivation changed starting in September 2008, resulting in a massive increase in unemployment. Let's see whose wish comes true.
 
Posted by MattP (Member # 2763) on :
 
Or my question about what constitutes the "huge portion" of the unemployed that are collecting welfare because it pays more than a job.
 
Posted by Seneca (Member # 6790) on :
 
It's very simple. The gigantic expansion of our welfare state didn't just magically occur in 2008, it has been expanding for decades. People are simply refusing to work, whereas they'd take lower paying jobs prior to that in order to eat. In a market free of government interference, people would take lower jobs, and wages and cost of living would find balance. That's how the private sector is supposed to work. Unfortunately, through taxation, regulations and crony capitalism, the government has screwed that up massively.

As to fraud, we've heard the absurdly low % fraud number claimed by the federal government. However, given that our current admin. is ideologically married to welfare one can't really trust those numbers. Lets take a look at more local examples where governments simply can't mint whatever they need, and in a large area, say, California...
http://articles.latimes.com/2010/oct/04/local/la-me-welfare-20101004/2
 
Posted by TomDavidson (Member # 99) on :
 
quote:
In a market free of government interference, people would take lower jobs, and wages and cost of living would find balance.
Ah. The simple faith of a simple man.
 
Posted by MattP (Member # 2763) on :
 
Great. So what is the approximate percentage of welfare recipients that are receiving welfare in lieu of working because it pays better than an actual job?
 
Posted by edgmatt (Member # 6449) on :
 
quote:
To note, many people can talk a good game about how they'd be able to kick back and do nothing (or at least nothing that others would value enough to pay them to do, which already begins to belie the nominal claim), but like most fantasies, most people can't actually pull it off unless they're coupling it with crippling levels of depression.
I don't agree. The biggest cost is housing/living space. Some people live with their parents at 0 cost, some are able to room with friends at 0 cost, or at a minimum cost....etc.

It's not crippling for some part of the people who are on unemployment, and of course there are the scammers. The ones who also have a job and are getting paid under the table, or who just don't mind living simply if it means they don't have to work.

To go back to Greg's question:

quote:
But how many? The economic collapse of 2008 nearly doubled unemployment. Were those job losses due to people performing the calculation you list above?
I don't know. Less than all of them, and more than none of them. The sarcasm in the previous posts made it seem necessary, to me at least, to point out that some people have done the math and decided that X pay for 0 work is a pretty good trade off.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
to point out that some people have done the math and decided that X pay for 0 work is a pretty good trade off
Shall we say five people, then? We could even say that two of them live in California.
 
Posted by Seneca (Member # 6790) on :
 
quote:
"If it's a one-time thing in Miami, we would never check that out," said John Haley, commander of the financial crimes division of the San Diego County district attorney's office, who said 24% of all new welfare applications in his jurisdiction contain some form of fraud. "We look for patterns of abuse."
quote:
A state audit last year found that none of California's 58 counties was adequately following up on information that could help root out fraud, including monthly computer matches that list clients who are receiving duplicate aid from other states, those who are ineligible because they're in prison and others who have died.

 
Posted by JoshuaD (Member # 1420) on :
 
quote:
Originally posted by TomDavidson:
quote:
to point out that some people have done the math and decided that X pay for 0 work is a pretty good trade off
Shall we say five people, then? We could even say that two of them live in California.
Really? You think it's something that doesn't happen?

I know a guy who does seasonal work in the summer and decides to play video games through the winter on unemployment. I can't imagine it's terribly uncommon.

He could get a better paying job in the winter, but he's able to get by this way and prefers to have the maximum amount of free time.
 
Posted by MattP (Member # 2763) on :
 
Got it. A "huge portion of those unemployed" are not in fact "unemployed because their welfare benefits pay more and give them better overall resources than trying to work." The real problem is that there are a lot of people filing fraudulent welfare claims.

Though that's a weird argument to bring up in response to the original point - people voluntarily work fewer hours when there is adequate/subsidized healthcare available and those fewer hours don't represent forcing people out of work.

If I'm a single parent with two kids working two jobs to make ends meet and my healthcare costs go down allowing me to quit one of those jobs and spend a few hours a day with my kids is that a good thing or a bad thing?

quote:
24% of all new welfare applications in his jurisdiction contain some form of fraud.
The number of fraudulent tax returns approaches 40%, so 24% with "some form of fraud" strikes me as remarkably restrained. That would indicate that number that are completely or substantially fraudulent are probably a fair bit lower still.
 
Posted by MattP (Member # 2763) on :
 
quote:
Really? You think it's something that doesn't happen?
I think he's saying that the hypothetical problem supported by anecdote is not demonstrated to represent a significant fraction of the welfare load. It's just assumed by people that object to welfare in general.
 
Posted by Seneca (Member # 6790) on :
 
The stats in that article are not anecdotes. They are hard numbers. And quite high.

First off, where do you get that the number of fraudulent tax returns approaches 40%? 2nd, how is something a "little bit of fraud?" That's like saying someone is a "little bit pregnant." If someone is committing welfare fraud, then that is a crime and it means they shouldn't get the welfare. You can't qualify it by degrees.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
The stats in that article are not anecdotes. They are hard numbers. And quite high.
From the article: "The out-of-state spending accounts for less than 1% of the $10.8 billion spent by welfare recipients during the period covered, and advocates note that there are legitimate reasons to spend aid money outside of California."
 
Posted by Seneca (Member # 6790) on :
 
The statewide numbers are misleading and grossly under-reported.
quote:
A state audit last year found that none of California's 58 counties was adequately following up on information that could help root out fraud, including monthly computer matches that list clients who are receiving duplicate aid from other states, those who are ineligible because they're in prison and others who have died.

 
Posted by TomDavidson (Member # 99) on :
 
So, to clarify, you're asserting that they are not hard numbers?
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
So, to clarify, you're asserting that they are not hard numbers?
But, conveniently, they have an error that only some can detect, that goes in exactly the right direction to substantiate their position.
 
Posted by Seneca (Member # 6790) on :
 
The only thing convenient about it is for people pushing welfare policies.

The fraud that they have found absolutely does exist as absolute bare minimums, the flaws in the accountability suggests that the amounts are grossly under-reported.

quote:
A state audit last year found that none of California's 58 counties was adequately following up on information that could help root out fraud, including monthly computer matches that list clients who are receiving duplicate aid from other states, those who are ineligible because they're in prison and others who have died.

 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
quote:
"If it's a one-time thing in Miami, we would never check that out," said John Haley, commander of the financial crimes division of the San Diego County district attorney's office, who said 24% of all new welfare applications in his jurisdiction contain some form of fraud. "We look for patterns of abuse."

Note the word "applications" there. Not recipients. The statement points to pwrt of why the actual system itself has a fairly low fraud rate- they're good at catching it at the application stage and preventing people trying to defraud the system from getting in in the first place.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by edgmatt:
quote:
To note, many people can talk a good game about how they'd be able to kick back and do nothing (or at least nothing that others would value enough to pay them to do, which already begins to belie the nominal claim), but like most fantasies, most people can't actually pull it off unless they're coupling it with crippling levels of depression.
I don't agree. The biggest cost is housing/living space. Some people live with their parents at 0 cost, some are able to room with friends at 0 cost, or at a minimum cost....etc.

And what? It's possible to get your nominal cost of living down very low, sure. That doesn't mean that a person who does so will be content to sit around doing nothing meaningful for month after month. People in that situation tend to become desperate for an outlet or a way to dull the discontent (A century and a half ago you could make money hand over fist selling laudanum as a cure for such ennui where unemployment was high or where people were fairly housebound, such as many women on the frontier)

Industrious is fundamental to human behavior; it takes drugs or other forms of mental brokenness to suppress it, even if a person has no nominal cost of living that they need to work for.

quote:
It's not crippling for some part of the people who are on unemployment, and of course there are the scammers. The ones who also have a job and are getting paid under the table, or who just don't mind living simply if it means they don't have to work.
None of those are effective for overcoming ennui. Some peaople can resist it longer than others, but all will eventually seek out something to do to avoid monotony and the sense of uselessness- and that something can tend toward the destructive if there are few appealing productive outlets available to them.
 
Posted by Seneca (Member # 6790) on :
 
The idea that boredom will save our economy is so far beyond the pale that I don't even know how to address it. It is absurd and hysterically laughable to assume that we should just impart resources to everyone and trust that in their boredom they won't spend time watching TV, going out to eat and playing video games and instead will do the hard work necessary to run our society.
 
Posted by NobleHunter (Member # 2450) on :
 
My perception of the ennui problem may rely overmuch on my own experience. My fiance is on disability and spends most of his time developing games. I don't know if he'll ever actually finish one, but he feels it absolutely necessary to have something productive to do. When people I knew were on medical leave, but the time it ended they were figuratively (thankfully) dying for something to do. I have a standing date with a friend on Sunday night because he's bored out of his mind after two days with nothing to do. I go half mad if there isn't anything useful to do at work.

Maybe my people are just too middle class but the idea that people will just sit around and do nothing is absolutely foreign to my experience.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
quote:
(The garbage Seneca posted about laziness is nonsensical propaganda that doesn't hold up to any examination of more than a few exceptional outliers that would basically be deadweight in any system, so aren't worth the cost of phishing the population at large in hopes of accomplishing the impossible, and that's not even getting into it's misleading attempt to point a finger at socialism when it's taking about public support and charity- things that serve to protect capitalist system against pressure to convert to more socialistic economic models)
Ha! This is one of the most humorous things I've read so far. The idea that "public support" is a "buffer" that's supposed to protect capitalism from angry mobs demanding total socialism is funny.
Something that can only be said in complete ignorance of the nature and direction of the labor movements across the world at the beginning of the 20th century. The mob was there, tired of being exploited and forced to live effectively as serfs of the robber barons of the time. In other countries they did outright revolt, in the US we headed off the problem through progressive reforms to capitalism instead.

quote:
So this is what we're left with, a veiled threat that those who work and produce had BETTER put up with high taxes and giveaways for those who won't work, and be HAPPY about it, or else we'll take EVERYTHING they have.
That's nonsensical. The "threat" here is _from_ those that work, and it's directed at those that do not work- specifically those that collect a heave rent on the work that the first group does and then uses the proceeds to lend them the balance of what they need to survive so that they're effectively enslaved at both ends. And it's from those that are forced to remain unemployed by that same model so that the price of labor can be forced downward to unsustainably low levels out of a delusional faith in the need to maintain a proper NIARU level.

Even more than that, the restes is not to take any real wealth away from the rentiers, but rather just for them to share an equitable portion of the profits they make on labor with the people doing the work so that those workers can afford to buy more of the things they need, which would lead to more net profits overall, even if the short term margins might be a little tighter.

quote:

And as to the objections to the quote, it is funny to see those endorsing so-called liberal policies abandoning John Stuart Mill...

Since that quote has nothing to do with the aspects of his work that have stood up over time and little, even to to with the elements that were lead astray because of their roots in classical economics or association with Malthus, but instead is a statement of the misguided and self destructive social biases of the ear in which it was written, it's hard to say how pointing out that it's nonsense it relevant at all to distance from the areas where he did manage to move economic and social thinking forward.
 
Posted by stilesbn (Member # 6842) on :
 
quote:
Originally posted by NobleHunter:
Maybe my people are just too middle class but the idea that people will just sit around and do nothing is absolutely foreign to my experience.

I'm pretty much the same way, though I am also middle class. I have met people who don't have the same gumption and need to be productive. It seemed completely foreign to me, but I've known some.

Which tells me nothing about the pervasiveness of the attitude, just that it exists somewhere.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
It is absurd and hysterically laughable to assume that we should just impart resources to everyone...
Why?
 
Posted by Seneca (Member # 6790) on :
 
quote:
Something that can only be said in complete ignorance of the nature and direction of the labor movements across the world at the beginning of the 20th century. The mob was there, tired of being exploited and forced to live effectively as serfs of the robber barons of the time. In other countries they did outright revolt, in the US we headed off the problem through progressive reforms to capitalism instead.
Oh please, they weren't close to revolting the US. That's the worst revisionist garbage I've ever heard. Don't confuse pseudo-populist snake oil in the legislature that was pushed by a handful of Progressive Statist Elites for any kind of real movement by the majority of the population. Where were the cities lost, the armies marching on our capitol, the thousands of bodies from a brutal civil war? They didn't exist, not over THIS issue. And since the generation you are discussing arrived at the tail end of an actual civil war and had plenty of context to think about it and compare it to their current situation, if there really was a time they'd revolt because they thought the issues warranted it so much it would have been then. We'd at least have seen a few major battles. Instead we got nothing like that. Such total garbage.

quote:
That's nonsensical. The "threat" here is _from_ those that work, and it's directed at those that do not work- specifically those that collect a heave rent on the work that the first group does and then uses the proceeds to lend them the balance of what they need to survive so that they're effectively enslaved at both ends. And it's from those that are forced to remain unemployed by that same model so that the price of labor can be forced downward to unsustainably low levels out of a delusional faith in the need to maintain a proper NIARU level.

Even more than that, the restes is not to take any real wealth away from the rentiers, but rather just for them to share an equitable portion of the profits they make on labor with the people doing the work so that those workers can afford to buy more of the things they need, which would lead to more net profits overall, even if the short term margins might be a little tighter.

I think you are confused. The reason that the cost of living is going up and wages aren't keeping pace is because of inflation and government interference, not the lack of it.
quote:
Since that quote has nothing to do with the aspects of his work that have stood up over time and little, even to to with the elements that were lead astray because of their roots in classical economics or association with Malthus, but instead is a statement of the misguided and self destructive social biases of the ear in which it was written, it's hard to say how pointing out that it's nonsense it relevant at all to distance from the areas where he did manage to move economic and social thinking forward.
Even funnier! How can you possibly pick and choose which of his writings you support and then write all kinds of motive speculations about why some were because he was "lead astray" or the other subjective qualifications you use to describe it?

[ February 10, 2014, 11:38 AM: Message edited by: Seneca ]
 
Posted by TomDavidson (Member # 99) on :
 
quote:
The reason that the cost of living is going up and wages aren't keeping pace is because of inflation and government interference...
Nope. Want to know one easy way you can tell? Because the wages of the top 5% are outpacing inflation. Businesses aren't underperforming; rather, the wages of the bottom 95% are being suppressed. In fact, if you look at the traditional retailers that are having difficulty versus retailers that are not, what you'll find is that businesses which cater to the middle class are struggling as the middle class is drained of livelihood by the rich -- whose retailers are doing just fine.
 
Posted by edgmatt (Member # 6449) on :
 
quote:
I know a guy who does seasonal work in the summer and decides to play video games through the winter on unemployment. I can't imagine it's terribly uncommon.

He could get a better paying job in the winter, but he's able to get by this way and prefers to have the maximum amount of free time.

....and he's not in an extreme state of poverty. and that was part of my point. My roomate has no job. She's been on and off un-employment, on and off of a job for the past 3-4 years. Her rent is usually $350/month, but she's been living for free for a few months now while she gets back on her feet. She can't even get unemployment right now. She trades watching the kids and helping around the house to be able to live there. She's not in such a state of poverty that shes going to starve, freeze, or die. She has a boyfriend that takes her out to eat once in a while, she has parents that give her a little cash once in a while, and she has my house, which is on the nicer side, to live in. She's going to be just fine, with or without unemployment.

quote:
And what? It's possible to get your nominal cost of living down very low, sure.
So that means that your earlier statement:

quote:
To note, many people can talk a good game about how they'd be able to kick back and do nothing (or at least nothing that others would value enough to pay them to do, which already begins to belie the nominal claim), but like most fantasies, most people can't actually pull it off unless they're coupling it with crippling levels of depression.
is false. Particularly the bold part.

quote:
That doesn't mean that a person who does so will be content to sit around doing nothing meaningful for month after month. People in that situation tend to become desperate for an outlet or a way to dull the discontent
And yet it happens. I wouldn't be satisfied with life living it that way, but there are a lot of people who would.

quote:
I think he's saying that the hypothetical problem supported by anecdote is not demonstrated to represent a significant fraction of the welfare load. It's just assumed by people that object to welfare in general.
It's exactly as hypothetical as saying that every single person on welfare is in such a state of poverty that they are devastated and going to die any second. No one here is making either claim.

Some of you are mocking the ones who point out that *some* people on welfare are doing just fine and are actually scamming the system. You are also dismissing this claim as something "those against welfare" always use to discredit the program. You say- We don't know how many people are on it that don't actually need it, or don't even deserve it, so it's silly to even bring it up.

Well, since you don't know the numbers, it's silly to have the program then. Tom sarcastically said "Shall we say it's five people then?" and my retort shall be, "Shall we say it's only five people on welfare who need it?"

OR we could disregard all that minutia and get to what I have actually been saying:

Yes, welfare does these good things over here. It gets people back on their feet when really bad things happen, etc. But it also does these bad things over here. It also allows people to be less incentivised to get a job. It also sets the precedent that if you can't support yourself, someone else will. The cost of the program in monetary terms is a burden on other people. These aren't good things.

This is not to say the program doesn't have value, but it would be naive at best and idiocy at worst to ignore the downside. And it wouldn't be prudent to mock or dismiss the people who try to point it out.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
People are simply refusing to work, whereas they'd take lower paying jobs prior to that in order to eat.
Only if either an alternate form of support or income is available forced to under a level of duress strong enough to indicate that other social and psychological damage it likely being done to them in the process. There's a reason that economists describe wages as "sticky"; people are very attached to the nominal numbers and are very reluctant to allow them to go down, even if there's a potential real gain in the offing.

quote:
In a market free of government interference, people would take lower jobs, and wages and cost of living would find balance.
Which is to say that the standard of living would drop through the floor as unemployment shot up since only the needs off a slect few would be represented on the market, while most people would only survive because of their debts to those select few, perhaps even generational debts to them. Eventually those few formalize their position as the aristocracy/de facto government because there's little need to pretend otherwise once the clear class division has been thoroughly cemented.

We've already done that for most of human history; it works very poorly.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Her rent is usually $350/month, but she's been living for free for a few months now while she gets back on her feet. She can't even get unemployment right now. She trades watching the kids and helping around the house to be able to live there. She's not in such a state of poverty that shes going to starve, freeze, or die. She has a boyfriend that takes her out to eat once in a while, she has parents that give her a little cash once in a while, and she has my house...
You recognize that your anecdotal roommate -- who benefits from not having to pay rent, from not having to buy all her own food, and from regular cash infusions from private parties -- is not exactly doing well, right? That if she became unable to trade childcare for rent, or if she lost her boyfriend, or if her parents cut her off, she would in fact be in a dire situation?

quote:
I wouldn't be satisfied with life living it that way, but there are a lot of people who would.
We're up to "a lot," now? Okay, fine. I'll generously say ten people.
 
Posted by NobleHunter (Member # 2450) on :
 
quote:
Yes, welfare does these good things over here. It gets people back on their feet when really bad things happen, etc. But it also does these bad things over here. It also allows people to be less incentivised to get a job. It also sets the precedent that if you can't support yourself, someone else will. The cost of the program in monetary terms is a burden on other people. These aren't good things.

This is not to say the program doesn't have value, but it would be naive at best and idiocy at worst to ignore the downside. And it wouldn't be prudent to mock or dismiss the people who try to point it out.

It seems that most people who point out it the ill effects of welfare want to either destroy it or implement "reforms" which would make the problems worse. They seem less interested in making things better and more interested in moralistic social engineering.

Also, why should having someone else to support you be restricted to the middle and upper classes? Unless you mean to suggest that someone from a middle class or richer background doesn't get any help from their family or (usually) can't rely on them to mitigate events that exceed their own resourcse.

One of the biggest reasons why I'm just broke and not poor is that I have people who are willing to support me if something goes wrong. I could borrow money from my parents when my car broke down instead of being forced to rely on public transit and the accompanying stresses and inefficiencies. Kinship and friendship networks are all about having other people to support you. One of the markers of poverty is the absence of those networks.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by edgmatt:
quote:
And what? It's possible to get your nominal cost of living down very low, sure.
So that means that your earlier statement:

quote:
To note, many people can talk a good game about how they'd be able to kick back and do nothing (or at least nothing that others would value enough to pay them to do, which already begins to belie the nominal claim), but like most fantasies, most people can't actually pull it off unless they're coupling it with crippling levels of depression.
is false. Particularly the bold part.

How- even in the example of the room mate you gave, she is finding things of value to do with her time, despite the fact that she's not explicitly being paid for them.

My point wasn't that they couldn't afford to live that way, but rather that ennui would set in before long and they would be unable to be as content as they imagined that they would be living that way.

For your room mate- is she happy with her situation? Or does she want to try to improve her lot, but simply finds herself frustrated by the lack of opportunities to do better that she keeps getting dragged down by?
 
Posted by edgmatt (Member # 6449) on :
 
The level of obtuseness on this forum makes me dread posting anymore. I take time and make a thoughtful post, and I used to get excited about seeing responses. Now it's just dread. 'How are they going to twist/ignore what I said.' I'm done here for a while.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Yes, welfare does these good things over here. It gets people back on their feet when really bad things happen, etc. But it also does these bad things over here. It also allows people to be less incentivised to get a job.
To the extent that that happens in our currently oversupplied labor market, you need to make a case for that being bad. Why should we expect people to go out and get a job if no one needs additional labor from them? The only purpose that serves is to make it possible to push wage prices down due to extra competition for what work is available.

quote:
It also sets the precedent that if you can't support yourself, someone else will.
That precedent was set way back when our race found a survival advantage in living as tribes and families. It's a core characteristic of civilization and an active survival advantage we have over solitary species. People that do not have a network of support to protect them generally end up dead because we cannot survive individually, only by collective effort. Even the worst off of our homeless end up leaning on the incidental protection provided by buildings built by other people and the trash discarded by other people- those surviving on the wilderness rely on generations of knowledge of how to do so contributed by other people, even if they manage to do everything else from there on their own. There is nothing bad about being more fully aware of the level of interdependence that we all have.

quote:
The cost of the program in monetary terms is a burden on other people.
The "cost" of the program is more people buying things from other people, and thus more opportunities for employment and growth. It's the fundamental route (that doesn't involve borrowing on private credit) by which we create money for people to earn in the first place. If we were taking the resource themselves to give to those in need, there would be some validity to that, but we support these programs by issuing public credit to those in need, which they in turn can use to reward the producers of the things they need with additional revenue, there's no burden at all involved in the process, except that willingly taken on by those that want to work to capture a share of that credit for their own use above and beyond subsisting as the societal baseline.
 
Posted by Seneca (Member # 6790) on :
 
quote:
The "cost" of the program is more people buying things from other people, and thus more opportunities for employment and growth. It's the fundamental route (that doesn't involve borrowing on private credit) by which we create money for people to earn in the first place. If we were taking the resource themselves to give to those in need, there would be some validity to that, but we support these programs by issuing public credit to those in need, which they in turn can use to reward the producers of the things they need with additional revenue, there's no burden at all involved in the process, except that willingly taken on by those that want to work to capture a share of that credit for their own use above and beyond subsisting as the societal baseline.
If that were true then why tax anyone for welfare at all? Why not just print the money and hand it out?
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by edgmatt:
The level of obtuseness on this forum makes me dread posting anymore. I take time and make a thoughtful post, and I used to get excited about seeing responses. Now it's just dread. 'How are they going to twist/ignore what I said.' I'm done here for a while.

I would hope you'd consider just walking away from this thread instead. This has been the most massive exercise in retconning I've ever seen on this Board.

The CBO says the economy is going to lose productive work hours as people make rational decisions to work less to achieve increased benefits. We get to hear how this "really" means that more people will be working more hours, or that its a good thing cause people will feel secure in retiring (at everyone else's additional expense and burden), or once again how apparently no one ever makes a rational and completely selfish decision to abuse the system.

Notwithstanding having to suffer through an enormous thread about how having welfare benefits greater than the minimum wage, contra-logically increases people's willingness to work, or otherwise results in greater economic productivity (when one might think - apparenly irrationally - that it causes people to go on the Dole rather than work), we now get explained to us, that a CBO finding that exactly that will occur somehow is a misinterpretation on our parts, and in fact will again magically result in more work being done.

And couple that with patronizing "nonsense" comments or assertions of opinion pretending to be fact, and it's easy to see how frustration could set in. But instead of walking away, just realize that for some, the idea of a welfare state being harmfull to the poor is so incompatible with their identity that anything that would demonstrate it can not be allowed to stand. There can be no bad effects, honestly 5 people might be abusing the system?, there can be no tradeoffs considered, heck there can be no evaluation of effectiveness or even if we get our money's worth. Instead as the bus gets ready to plunge over the cliff, we get confident assertions that we need to step on the gas, not the brakes, as it's clear that only more speed will allow us to avoid doom.
 
Posted by LetterRip (Member # 310) on :
 
Seneca and edgmatt,

one of the nordic nations has a policy that the government will contact you with employment opportuntities and if you turn down the job offer then your unemployment benefits are cut off.

This seems like it would address edgmatts concerns.

If you have large scale structural unemployment than edgmatts seasonally employed friend is actually rational for society to support. If society can only support 90% employment rate, then forcing job searching on the marginally employable does two things

1) Increases the costs of hiring (as the volume of applicants go up, if the majority of those additional applicants are of the less skilled, then more time is wasted by the employer to filter them out)

2) Forces down wages (as competition increases for the marginal quality jobs it drives down cost of labor towards the minimum).
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
If that were true then why tax anyone for welfare at all? Why not just print the money and hand it out?

We don't tax anyone for welfare. There is no earmark at all on what general income taxes are for. The only things that are specifically taxed for are things covered under FICA, and even that's ridiculous to do.

Taxing removes money from the economy- the only thing we tax "for" in the general case, is the shredder, virtual or real, that the money paid goes into. Every expenditure made my the Federal Government uses new money created ("printed", if you will) at the moment it's spent and credited to a private account for all of its transactions.
 
Posted by LetterRip (Member # 310) on :
 
Seriati,

quote:
The CBO says the economy is going to lose productive work hours as people make rational decisions to work less to achieve increased benefits. We get to hear how this "really" means that more people will be working more hours
You misunderstood my argument - I said that if there is a constant demand, requiring a supply of labor X. Then any voluntary reduction in supplying that labor has to result in additional labor being hired so that the total labor remains constant. Feel free to offer an explanation why that logic is wrong. I suspect that you can't find a flaw in the reasoning - so rather than admit it is correct, and thus your conclusion is wrong, you offer up attacks and ignore the logic (if the facts are on your side pound the facts; so apparently you are going for pound the table).

quote:
or once again how apparently no one ever makes a rational and completely selfish decision to abuse the system.
I agree that there will be some 'abuses' but doubt it has any economic impact - labor substitutes for labor. So as long as the supply of labor greatly exceeds the demand for labor the economic impact will be non existant. The reason is that these individuals are

1) likely the least productive employees

2) doing reproductive labor that the economy doesn't properly account for (ie childcare, housecleaning, etc. that are only compensated for under special circumstances, but are a significant part of economic activity)

3) productive in a delayed manner that our system currently treats as unproductive (ie the garage startup/inventor/researcher/student)

If labor becomes constrained then it would be worthwhile to hire 1. As a society we could choose to create 'make work' so that their labor doesn't sit idle. I'm all for public works employment to make use of idle labor - doing road repair, park clean up, city rehabilition, etc.

For 2 they are already part of the economy and contributing to it etc. That labor should be recognized economically, but that doesn't make them unproductive or lazy.

For 3 the labor is likely more productive than it would be under traditional employment, likely by many orders of magnitude.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seriati:

The CBO says the economy is going to lose productive work hours as people make rational decisions to work less to achieve increased benefits.

_Potential_ productive work hours. Specifically, the CBO says that people will drop out of the labor pool.

quote:
We get to hear how this "really" means that more people will be working more hours,
More people that want to work will be working more hours, because they will need to be hired to replace those that have left the labor pool. Because again- the CBO is projecting a decline in hours of labor being provided to the pool, not in jobs looking for workers.

quote:
or that its a good thing cause people will feel secure in retiring (at everyone else's additional expense and burden),
Not the burden of those that can take the jobs that they leave behind. Not the burden of those that provide them the goods and services they need. Not the burden that many may be existing to provide proper care for. Not the burden of those that see their wages rise because a smaller labor pool means less suppression due to over-supply.

In particular, to the extent that any burden exists, they're certainly no less burden than the unemployed people that are currently being supported on their behalf, with the only difference being that those that are currently unemployed want to be working and are suffering from that lack, while they have better things to do with their time.

quote:
or once again how apparently no one ever makes a rational and completely selfish decision to abuse the system.
That claim has been made by exactly no one. Rather it's been said that, at the current rate, the cost of a moralistic crusade to try to stomp out such background noise costs more than it saves, and does more significant collateral damage to ernest participants that it prevents.

quote:
Notwithstanding having to suffer through an enormous thread about how having welfare benefits greater than the minimum wage, contra-logically increases people's willingness to work,
They increase their ability to afford to work, bridging the gap between what suppressed wages people can manage to get and what it actually costs to afford to productively participate in society. (I note you lean on the false implication that welfare is an alternative to work here, and not an augmentation to it as it actually is)

quote:
or otherwise results in greater economic productivity
More people buying things means more people needed to produce and provide things. WIthout welfare there would be fewer people buying things, and thus fewer employment opportunities available to produce things. SPending leads production, procedures don't produce in hopes that they pay people enough to buy things.

quote:
(when one might think - apparenly irrationally - that it causes people to go on the Dole rather than work),
And now you explicitly assert the falsehood. It's not "rather than", it's "in addition to".

quote:
we now get explained to us, that a CBO finding that exactly that will occur somehow is a misinterpretation on our parts, and in fact will again magically result in more work being done.
There is less work that needs to be done than there are people looking to do it. The CBO tells us that we'll see a little bit of a normalization of that situation, allowing those that don't want to be ding it to drop out in favor of those that want to do it. (Which will lead in and of itself to a productivity gain, because the direct desire that an individual has to do a given job is a very active and large factor in their total productivity. So, even at a one for one swap, as people retire and are replaced by the currently unemployed, you have a large gain just on the basis of enthusiasm alone.

Note, again, that the CBO report was not that the demand to employ labor would decrease- it said the total supply of labor would decrease. And currently out total supply of labor vastly higher than the amount of demand that we can muster for it.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
There can be no bad effects, honestly 5 people might be abusing the system?...
No, not honestly. Don't be an idiot.
What I'm interested in is data that suggests there is a statistically significant number of people abusing the system.
 
Posted by G3 (Member # 6723) on :
 
This throws off any May 2015 predictions:
quote:
The federal government announced yet another delay in Obamacare's rules for employers on Monday, and also weakened requirements for complying with the law.

The government will now exempt companies employing between 50 and 100 full-time workers from complying with the mandate that they offer employees affordable health insurance by another year, until 2016.

Companies that have 100 or more full-time workers, defined as employees who work more than 30 hours per week, still will have to begin complying with the mandate to offer such coverage in 2015 or face financial penalties of up to $3,000 per worker.

Let's revisit a brief part of this discussion from way back on page 1:
quote:
quote:
Originally posted by G3:
quote:
Originally posted by Greg Davidson:
quote:
I find it impossible to make any predictions
Such courage of your convictions... You mean to say that you are lack the confidence in your own judgment to say whether or not Obamacare will turn into the most beneficial government program in history? You cannot make any predictions?
Mumm.no. I mean that since the law changes on a near weekly basis that we cannot know what the law will be next week much less more than a year from now. Making predictions about a law that is changed at the whim of a weak and ineffective president seeking short term politcal gain has nothing to do with the courage of convictions. When laws get made up as we go, how can we predict their ultimate impact? Your predictions are nothing more than blind ideological wishes.

Exactly.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Seneca:
If that were true then why tax anyone for welfare at all? Why not just print the money and hand it out?

We don't tax anyone for welfare. There is no earmark at all on what general income taxes are for. The only things that are specifically taxed for are things covered under FICA, and even that's ridiculous to do.

Taxing removes money from the economy- the only thing we tax "for" in the general case, is the shredder, virtual or real, that the money paid goes into. Every expenditure made my the Federal Government uses new money created ("printed", if you will) at the moment it's spent and credited to a private account for all of its transactions.

So why should we tax people for anything? And no, i don't buy that no one is taxed for welfare benefits, it comes from the government's general revenue on income tax I'm sure.

But if the government only needs to print money and hand it out, why not do that and avoid taxing people for ANY expenditure, especially welfare ones?
 
Posted by DonaldD (Member # 1052) on :
 
You could do that, but you would need some other way to remove the excess money from circulation in order to avoid runaway inflation.
 
Posted by TomDavidson (Member # 99) on :
 
And when you realize that the best group to remove the excess money from is the group that circulates that money the least efficiently, and has the least dire need for that money, you wind up with something close to the status quo.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
This throws off any May 2015 predictions
Uh, no it doesn't. If you believed that the Obama Administration could take actions that would improve the implementation of the policy, you were free to predict that occurrence.

Or, admit that you are clueless, and it's possible that Obamacare could turn into a very good policy by May 2015.
 
Posted by D.W. (Member # 4370) on :
 
Or say he couldn't make predictions for the exact reasons that have been happening since the question was posed... Almost as if he predicted it.

The administration has taken what I thought was a good idea, fought a long hard and politically costly battle for it, fought even harder to keep it from being dismantled or defunded. Then they poop all over it themselves. Almost thought they had some principles but those are only allowed in brief windows between elections.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Greg Davidson:
quote:
This throws off any May 2015 predictions
Uh, no it doesn't. If you believed that the Obama Administration could take actions that would improve the implementation of the policy, you were free to predict that occurrence.
I actually did make the prediction that it would change significantly and for political reasons:
quote:
Originally posted by G3 on 12-04-2013 04:38 PM:
However, the law can change at any moment and polling data prior to the 2014 elections may drive significant change if the polling data proves inconvenient for Barry and the democrats ...

Man, I am nailing it on these predictions!

quote:
Originally posted by Greg Davidson:
Or, admit that you are clueless, and it's possible that Obamacare could turn into a very good policy by May 2015.

Well, here's the really clueless part of it all. How can it "turn into a very good policy by May 2015" when major parts of it are getting delayed for up to a year after that? You can't predict what it will be by May 2015 since it changes so much. But:
quote:
Originally posted by G3 12-02-2013 10:01 AM:
My prediction is that the hyper-partiscan ideologues here and around the US will tell us ObamaCare is working great and needs to be fixed and is wildly popular and it's the GOP's fault.

Pretty much all in one breath like that.

Yep, nailing it.

[ February 11, 2014, 12:14 PM: Message edited by: G3 ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
I actually did make the prediction that it would change significantly and for political reasons:
There have been changes, however "significant" is subjective, and political is pure assertion. Wht positive evidence do you have that this is political and not logistical as it is being reasonably presented as? (The fact that there might be a political upside isn't evidence for anything in and of itself, since one would rationally except any reasonable and appropriate policy to have a political upside. In fact, in the general case, one would expect a political upside to be evidence of an action that enjoys popular support)
 
Posted by D.W. (Member # 4370) on :
 
It's a fluke the next set of delays are not until after the election?
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by D.W.:
It's a fluke the next set of delays are not until after the election?

What are the odds that a given one year delay in something will push something out past an election?
 
Posted by Seneca (Member # 6790) on :
 
Given that most of a calendar year occurs before elections quite low.
 
Posted by NobleHunter (Member # 2450) on :
 
It'd be pretty hard to get a meaningful delay and still have it before the election. Assuming the delay is to mitigate problems with the bill and not to avoid fall-out right before the election.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
Given that most of a calendar year occurs before elections quite low.

Time doesn't end at the end of an election year. Even so, that's exactly why a one year delay would have a very good chance of moving something past an election- about 50/50 really, when you think about it.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Pyrtolin:
Wht positive evidence do you have that this is political and not logistical as it is being reasonably presented as?

The disparity in treatment between the individual mandate and the employer one would be substantial evidence. Particularly given that delaying the employer while leaving the individual causes a bizarre siutation where individuals who should be entitled to employer coverage are forced to buy individual. The political consequences of the opposite treatment are both pointed in the same direction.
quote:
In fact, in the general case, one would expect a political upside to be evidence of an action that enjoys popular support)
Or like in this case, the avoidance of an event that would prove incredibly unpopular, like massive upswing in cancelled coverages and costs, costing the President's party a substantial amount of its current political power.
 
Posted by G3 (Member # 6723) on :
 
quote:
...Treasury officials said Monday that businesses will be told to “certify” that they are not shedding full-time workers simply to avoid the mandate. Officials said employers will be told to sign a “self-attestation” on their tax forms affirming this, under penalty of perjury.
So people are now going to be forced to sign documentation that says they are behaving "properly" and maintaining the correct relationship of part to full time workers. This is real thought police kind of stuff where the state will decide if you're doing something for the "correct" reasons.

Here's a new prediction, the left will see nothing wrong with this.
 
Posted by Seneca (Member # 6790) on :
 
82% of the fiscal year ends before elections. That means that the % chance that this would randomly occur is 18%...
 
Posted by Wayward Son (Member # 210) on :
 
quote:
Here's a new prediction, the left will see nothing wrong with this.
Here's another new prediction: the right will think such a statement is new and outrageous. [Big Grin]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
82% of the fiscal year ends before elections. That means that the % chance that this would randomly occur is 18%...

No, using that as a baseline, that means that there was an 82% chance that a one year delay moved something past the election. But by that baseline, there was an 18% chance that it already happened after an election- at that point you have a 100% chance that the event will come after the election in question.
 
Posted by Greg Davidson (Member # 3377) on :
 
I stand by my original seven specific predictions - and yes, these are actual predictions including a prediction that changes ("fixes") will be made. And 145 months from now we will see if all six of these predictions are valid:

quote:
I predict (1) it will still be the law of the land, (2) no death spirals, (3) some boring fixes will be put in place to address parts of the law that were not working, and (4) the minority of the population directly affected by the exchanges (ie; those without health insurance from their employer) will generally be satisfied. (5) The annual rate of healthcare cost growth will continue close to 50 year lows. (6) Polling will indicate that more Americans will favor continuing the law than repealing it. (7) And Republicans will still be benghazi'ing some weird aspect of Obamacare that motivates their base but that the majority of Americans just don't care about.

 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Seneca:
82% of the fiscal year ends before elections. That means that the % chance that this would randomly occur is 18%...

No, using that as a baseline, that means that there was an 82% chance that a one year delay moved something past the election. But by that baseline, there was an 18% chance that it already happened after an election- at that point you have a 100% chance that the event will come after the election in question.
You are missing the point here. Obama institutes these delays and their time periods arbitrarily. He isn't Congress that is used to acting within fiscal years, he is all by himself and he is regularly issuing decrees that go into effect days or weeks from when he makes them. That he choose to push it beyond the elections is an obvious political ploy to anyone.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Greg Davidson:
I stand by my original seven specific predictions - and yes, these are actual predictions including a prediction that changes ("fixes") will be made. And 145 months from now we will see if all six of these predictions are valid:

quote:
I predict (1) it will still be the law of the land, (2) no death spirals, (3) some boring fixes will be put in place to address parts of the law that were not working, and (4) the minority of the population directly affected by the exchanges (ie; those without health insurance from their employer) will generally be satisfied. (5) The annual rate of healthcare cost growth will continue close to 50 year lows. (6) Polling will indicate that more Americans will favor continuing the law than repealing it. (7) And Republicans will still be benghazi'ing some weird aspect of Obamacare that motivates their base but that the majority of Americans just don't care about.

145 months from now? You looking at May 2025 instead of 2015? Probably just a typo and you meant 14 months ... no worries.

But, how do you think when significant parts of the law are postponed for a year after this predictive window have no effect on any predictions? It seems that no change can shake your belief - something I think I predicted.
 
Posted by G3 (Member # 6723) on :
 
By the way, the death spiral ...

They are not reaching near the number of sign ups for this needed to prevent that from happening. Not only that, of those that have signed up, it looks like only about half have actually paid the first premium that mean they actually have insurance - based on actual data from Washington State, Wisconsin and Minnesota and which conforms to previous estimates nationwide.

We are very well positioned to actually see the death spiral occur. Something pretty dramatic is going to have to happen to prevent it - probably a insurance company bailout.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Seneca:
82% of the fiscal year ends before elections. That means that the % chance that this would randomly occur is 18%...

No, using that as a baseline, that means that there was an 82% chance that a one year delay moved something past the election. But by that baseline, there was an 18% chance that it already happened after an election- at that point you have a 100% chance that the event will come after the election in question.
You are missing the point here. Obama institutes these delays and their time periods arbitrarily. He isn't Congress that is used to acting within fiscal years, he is all by himself and he is regularly issuing decrees that go into effect days or weeks from when he makes them. That he choose to push it beyond the elections is an obvious political ploy to anyone.
By himself? And not with input from policy advisors, industry representatives, etc...? The positive evidence that we have so far shows that the industry segment that this applies to has been begging for a more gradual implementation and the ability to phase changes in at a more achievable rate, not that the delay arbitrarily came out of nowhere.

By suggesting that Obama is doing this all by himself, you've really upped the evidence you need to provide to substantiate your claim here.

Can you show any non-speculative evidence that this is not, as it appears on its face, a reaction to such public pressure to improve the logistics of the implementation? Again, just noting that there's a political benefit (or lack of political harm) isn't proof of anything, because our system is specifically supposed to work on the basis of popular pressure providing a political benefit for good policy and political harm for bad policy.

[ February 12, 2014, 11:34 AM: Message edited by: Pyrtolin ]
 
Posted by Seneca (Member # 6790) on :
 
What is with the semantics? It's obvious that when I said Obama was acting alone that I was referring to the executive branch which he represents. But that doesn't matter because it's not as if he's the only one in his administration looking out for the political welfare of the Democrats.

Maybe instead of having a president unilaterally create law we should go back to the constitutionally approved way of having Congress do it?

[ February 12, 2014, 03:45 PM: Message edited by: Seneca ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
What is with the semantics? It's obvious that when I said Obama was acting alone that I was referring to the executive branch which he represents. But that doesn't matter because it's not as if he's the only one in his administration looking out for the political welfare of the Democrats.


I'd hope so- it would be pretty disastrous to have politicians in office that weren't sensitive to popular approval of their actions and they way they reflected on their respective parties.

quote:
Maybe instead of having a president unilaterally create law we should go back to the constitutionally approved way of having Congress do it?
What law has he created now? There's no creation here, just choices in the logistics of implementation, which are fully the defined domain of the Executive Branch, not the Legislative Branch (Heck, then entire modern appropriations process was designed to put some limits on the kind of executive discretion that Obama is employing here by marking funds such that they can only be used for a given purpose and not completely diverted away in favor of letting parts of the law the executive was neglecting languish).
 
Posted by G3 (Member # 6723) on :
 
Actually, he has not merely made logistical choices, he has altered tax laws (as the Supreme Court ruled them). Can the executive branch now decide what tax laws get enforced and which don't? No, of course not. This is as unconstitutional as it gets.
 
Posted by Seneca (Member # 6790) on :
 
Exactly. Good to see you back posting here G3.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
We are very well positioned to actually see the death spiral occur. Something pretty dramatic is going to have to happen to prevent it - probably a insurance company bailout.
So is that a prediction? That a death spiral will occur? Because the data I saw suggested that if even the unfavorable early demographics emerged when the enrollment was complete, the risk of premium increase was less than the average annual percentage of health care cost increases in the years prior to 2008.

And by "insurance company bailout", do you mean a massive, Detroit-style bailout, or merely some of the provisions of the law already in place to provide coverage if the risk pool is not precisely as predicted?
 
Posted by G3 (Member # 6723) on :
 
I can't really make a prediction about the death spiral or bailout and the factors relating to them being provisions of the law. The provisions of the law change so often that we simply cannot know.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Wayward Son:
quote:
Here's a new prediction, the left will see nothing wrong with this.
Here's another new prediction: the right will think such a statement is new and outrageous. [Big Grin]
For continuity from a page change, the "this" is:
quote:
Treasury officials said Monday that businesses will be told to “certify” that they are not shedding full-time workers simply to avoid the mandate. Officials said employers will be told to sign a “self-attestation” on their tax forms affirming this, under penalty of perjury.
This is new. Obama wants businesses to swear to this, under penalty of perjury, because he would like to use these statements -- whether true or false -- to argue that Obamacare is not causing reductions in hiring.

There is significant coercion to this. A businessman, being asked by the Treasury to swear he's not reducing staff to avoid Obamacare, understands exactly what Treasury wants: Treasury wants him to claim this. If the businessman claims this, even if falsely, Treasury will leave him alone. If he decides to to tell the truth and say, "Why, actually, I am reducing staff to avoid Obamacare, as is my right," he can expect that Treasury will take an interest in him. An auditing interest. It is thus in businessman's interest to perjure themselves, and Treasury would like them to perjure themselves.

Obama is using the power of the IRS to compel private citizens to commit perjury in order to use those deliberately-elicited perjurious statements as part of his political campaign.

This *is* new and it is outrageous.
 
Posted by Seneca (Member # 6790) on :
 
Looks like all is not well in a liberal state that embraced Obamacare...

quote:
Despite receiving $160 million in taxpayer money, Oregon's ObamaCare website has yet to properly sign up a single person for health care.

And there could be consequences. An Oregon legislator has gone to the FBI. Top officials have resigned. The state is investigating. And there could be a federal probe as soon as Thursday.


It wasn't supposed to be like this. With a strong high-tech community in Portland and a progressive reputation, Oregon was an early, enthusiastic adopter of the Affordable Care Act. The state has been working toward a health care exchange since 2002 and was one of the first states to pass a law creating one.

More than $300 million in federal dollars have come to Oregon from taxpayers all over the country, in the form of grants with names like the "Early Innovator Grant." Oregon ranks third among all states in grants to implement the ACA, despite being near the middle in population.

Still, the website doesn't work.


"It's like a car that has no tires, no engine, no steering wheel -- the doors are locked and you can't get in," said Rep. Greg Walden R-Ore., who has scheduled a press conference in his home state on Thursday to make a "major announcement about Cover Oregon."

Sixteen states created their own health insurance exchanges, including websites where residents can go to shop for health insurance. The federal government runs the exchange for the remaining states at HealthCare.gov.

Oregon is still enrolling residents in health care plans, but using a disjointed process with parts of the website that work. Over 100,000 Oregonians have enrolled, the state claims, including 35,247 in private plans,

"While we are making progress on the website, we will continue to use the hybrid process until we have a fully functioning website," Ariane Holm, a spokeswoman for Cover Oregon, said in a statement. Cover Oregon refused an interview request.

At a press conference on Jan. 30, Gov. John Kitzhaber, a Democrat, said 25 percent more Oregonians now have health insurance.

"It's a remarkable story, and it's a story worth telling," he said, according to The Oregonian newspaper.

State Republicans dispute those numbers, however, arguing tens of thousands of enrollees were in the state's Medicaid plan before Oct. 1, when the website was scheduled to be operational. The state says they don't know how many Cover Oregon enrollees didn't have health insurance before Oct. 1.

Kitzhaber has ordered a state review of Cover Oregon to determine what went wrong.

The state was one of the first nine states to create an exchange by law in 2011, and received national attention with a $10 million ad campaign including the folksy "Live Long in Oregon."

But the ad campaign masked problems from the start, said Patrick Sheehan, a former Oregon state legislator who sat on the state's Legislative Audit, Information Management and Technology Committee. The state didn't hire the right people, were too ambitious trying to build a national model and didn't use proven, existing software, he said.

"The website was where everyone was supposed to go to compare plans, to bring costs down," he said.

Sheehan said he went to the FBI in 2012 and passed on information he received that state officials lied to the feds about the website's progress in order to keep the grant money flowing. The FBI, citing Department of Justice protocol, refused to comment.

The failure is surprising because there was oversight built into the system. There were managers at Cover Oregon and the Oregon Health Authority, and experts at the Oregon Department of Administrative Services and the state's Legislative Fiscal Office. The state hired a Virginia company to provide additional oversight. There were also federal officials supposedly looking on.

Sheehan said Carolyn Lawson, who oversaw much of the development of the health insurance exchange and resigned in December, controlled the flow of information and suppressed those who raised red flags. Lawson could not be reached for comment.

Another top official, Rocky King, resigned Jan. 1.


 
Posted by Seneca (Member # 6790) on :
 
And it looks like the numbers that Obama keeps throwing around are inflated lies...

quote:
The Obama administration’s latest rosy scenario about 3.3 million consumers signing up for health care plans is facing skepticism from top insurance industry officials, who estimate that somewhere in the range of 10 to 25 percent of those “enrollees” actually have not yet paid their premiums and are not fully enrolled.

“The numbers are not as high as 3.3 million -- it’s lower,” one senior insurance industry source told Fox News. “Those numbers are inflated. The question is how much.”

Industry officials tell Fox that some insurance companies have privately reported up to 30 percent of enrollees have not paid up, while other companies believe a higher percentage of customers have taken care of their premiums. The senior insurance industry source suggested it averages out to roughly 10 to 25 percent of enrollees not yet paying into the system, and thus those individuals do not really have insurance.

Scenarios for not paying include people who went through the struggles of logging on to HealthCare.gov and eventually decided it was not worth it to go through the final steps of payment, and others who may simply not be able to afford the premiums. Industry officials believe others have gone through the process of choosing a plan and simply have not gotten around to writing a check, but eventually may make the payment to complete the process and wind up being a success story.

It’s hard to pinpoint precisely how many people have paid their premiums, since companies like Humana and United have not yet disclosed numbers. Aetna has said that 70 percent of their enrollees paid premiums in January, and of those who signed up before January, 90 percent paid their premiums. WellPoint has reported that a majority of its 500,000 enrollees have paid premiums but not a “vast majority” as of yet.

Insurance industry officials are also raising questions about whether the White House really does not know how many people have paid into the system, as White House Press Secretary Jay Carney has suggested.

Pressed by Fox on Wednesday about how many of the 3.3 million enrollees have paid premiums, Carney said the data rests with the industry. “It is a contract between an individual or – well an individual even representing his or her family – and a private insurance provider,” he said. “So insurance companies obviously have data about when those payments were made, but this would be no different from any other insurance contract that you would – you would purchase.”

A senior insurance industry source said the administration actually does have at least a rough idea of how many people have paid into the system because that determines who gets government subsidies, so the administration has to eventually know who’s paying into the system in order to make sure subsidies are going to the right people.

As a rough example, an industry source said if a consumer has to pay a $100 monthly premium for coverage and the government subsidy is worth $80, the consumer only pays the $20 difference to the insurance company. The $80 subsidy is later paid by the government directly to the insurance company, so the insurance companies have to show the administration who is paying into the system in order to get that reimbursement.

An administration official confirmed that the key federal agency involved does get some payment data, but stressed the administration is more focused on getting the payment system completed over the long term.

“CMS receives aggregate-level enrollment data on a monthly basis from issuers that are owed payments of marketplace financial assistance,” said the official. “However, enrollments on the individual level for all issuers will be measured in the long term” using documents known as 834 forms.

The official added that some health plans have already begun providing those forms, “which will eventually be the mechanism for making payment and reporting enrollment data as part of our automated system.” Once that system is fully operational, the official said, “we will determine the most appropriate way to make detailed payment information available.”


 
Posted by Greg Davidson (Member # 3377) on :
 
Looks like millions of people will get health care, and thus thousands will not die because of this law.

My predictions are still on track for May 2015.
 
Posted by Seneca (Member # 6790) on :
 
And many millions will lose their healthcare, lose their doctor and struggle to hit the reset button, start over and in some cases not sufficiently replace it in time or ever. I think I've already read one case where Obamacare killed a woman who needed specific cancer treatments and she lost her specific doctor and coverage at a crucial time and the break in her care until she was able to re-establish it killed her, let me see if I can find it.

Here is a cancer patient who hasn't yet died and has lost her coverage and excellent care and specialized medical team due to Obamacare: http://www.nydailynews.com/life-style/health/obama-affordable-health-care-act-dooms-die-patient-article-1.1506639

[ February 14, 2014, 01:04 AM: Message edited by: Seneca ]
 
Posted by Pyrtolin (Member # 2638) on :
 
I can see how Obamacare is making her lose coverage rather that her insurance company deciding to discontinue her plan. Her company easily could have continued to offer the exact same plan without any modifications under the grandfather provisions, even is they chose not to participate in the CA exchanges. (Also at play, apparently, even though the article completely neglects to actually explain this, the apparent decision of her doctors to stop accept any other insurance provider).
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Pyrtolin:
I can see how Obamacare is making her lose coverage rather that her insurance company deciding to discontinue her plan. Her company easily could have continued to offer the exact same plan without any modifications under the grandfather provisions, even is they chose not to participate in the CA exchanges. (Also at play, apparently, even though the article completely neglects to actually explain this, the apparent decision of her doctors to stop accept any other insurance provider).

That isn't the only product they offer. Do you have any idea how complicated it is to run a huge insurance company and balance all the products with their pools, budgets, taxes and government regulations? When the government overhauls an industry the way the ACA did, you cannot blame this on the insurance company.
 
Posted by NobleHunter (Member # 2450) on :
 
I think it's terrible how big a role insurance companies play in determining people's medical care.
 
Posted by Wayward Son (Member # 210) on :
 
quote:
quote:
--------------------------------------------------------------------------------
...Treasury officials said Monday that businesses will be told to “certify” that they are not shedding full-time workers simply to avoid the mandate. Officials said employers will be told to sign a “self-attestation” on their tax forms affirming this, under penalty of perjury.
--------------------------------------------------------------------------------

So people are now going to be forced to sign documentation that says they are behaving "properly" and maintaining the correct relationship of part to full time workers. This is real thought police kind of stuff where the state will decide if you're doing something for the "correct" reasons.

Here's a new prediction, the left will see nothing wrong with this.

Here's something I didn't catch when this was first posted--what "avoid the mandate" means.

This rule does not apply to every business that is not providing insurance. It does even apply to every business between 50 - 99 workers. [/i]It only applies to businesses that want to delay implementation of the mandate for 1 year.[/i]

quote:
In the new rules released Feb. 12, a company qualifies for the year delay if it:

o Employed 50 to 99 full-time workers in 2014.

o Did not cut workers in order to get under the 99-worker bar. Cutting the workforce for bona fide business reasons is fine, including if sales dip or an employee isn’t up to snuff.

o Did not eliminate or "materially reduce" the health coverage it offered as of February 2014.

If a company meets those conditions, it has to tell the government, formally, under the rules of something called Section 6056.

So, if you want to have a special (some have said illegal) delay in implementing the law, you will need to attest that you are not doing it to simply skirt the law.

In fact, the law does not stipulate that lying on the form constitutes perjury, according to the linked article.

quote:
We’re just concerned with reporting to the government so we looked at the law for 6721. That law makes no mention of perjury. In fact, Klinger found it took a lighter approach.

"It doesn’t look like it comes with huge penalties," Klinger said.

The reality is that the IRS has yet to release the rule that lays out what will happen if a company tells the government it didn’t lay workers off because of Obamacare when in fact it did. In a press release, the agency said final regulations will be out shortly.

Most likely, if the company lied, they will probably lose their special delay and be subject to the normal fines for not complying with the law.

So this requirement only applies to the small number of businesses that want to take Obama offer of a delay, and is only used to certify that they have a real need for the delay and are not just "manufacturing" the need. Yep, real "thought police" kind of stuff. [Big Grin]
 
Posted by Wayward Son (Member # 210) on :
 
quote:
quote:
--------------------------------------------------------------------------------
Originally posted by Wayward Son:

quote:
--------------------------------------------------------------------------------
Here's a new prediction, the left will see nothing wrong with this.
--------------------------------------------------------------------------------

Here's another new prediction: the right will think such a statement is new and outrageous.
--------------------------------------------------------------------------------
...

This *is* new and it is outrageous.

See. I'm right again! [LOL]

(Hey, G3, now I know why you like making posts like this. This is fun! [Big Grin] )
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Did not eliminate or "materially reduce" the health coverage it offered as of February 2014.
This is probably a key factor- looks like the exemption is targeted at companies that have a current contract and need the time to reach the end of it so that a new one can be put in place without facing penalties for breaking from their existing plan.
 
Posted by Seneca (Member # 6790) on :
 
quote:
People with serious pre-existing diseases, precisely those the president aimed to help with ObamaCare, could find themselves paying for expensive drug treatments with no help from the health care exchanges.

Those with expensive diseases such as lupus or multiple sclerosis face something called a "closed drug formulary."

Dr. Scott Gottlieb of the American Enterprise Institute explains,"if the medicine that you need isn't on that list, it's not covered at all. You have to pay completely out of pocket to get that medicine, and the money you spend doesn't count against your deductible, and it doesn't count against your out of pocket limits, so you're basically on your own."

The plan had claimed it would rescue those with serious pre-existing conditions.

"So it could be that a MS patient could be expected to pay $62,000 just for one medication," says Dr. Daniel Kantor, who treats MS patients and others with neurological conditions near Jacksonville, Florida. "That’s a possiblity under the new ObamaCare going on right now."

In fact, one conservative group, Americans for Prosperity, is running an ad on exactly this subject, featuring a woman with lupus, an auto-immune disease.

She starts by saying, "I voted for Barack Obama for president. I thought ObamaCare was going to be a good thing."

But Emilie Lamb says she later got a letter saying her insurance was canceled because of ObamaCare, pushing her premiums from $52 to $373 a month.

"I'm having to work a second job, to pay for ObamaCare,” she adds. “For somebody with lupus, that's not an easy thing. If I can't afford to continue to pay for ObamaCare, I don't get my medicine. I don't get to see my doctors."

One of the problems is that drugs for some diseases such as MS do not have generic versions. So without cheaper alternatives and no help from ObamaCare, patients could face huge personal out-of-pocket bills, forcing some to skimp on their medications.

Kantor worries that "this may drive more patients" to not buy their medicines, "which we know is dangerous," he says. "We know MS can be a bad disease when you’re not treating it. When you’re treating it, for most people they handle it pretty well, but we know when you don’t treat (it), it’s the kind of disease where people end up in wheel chairs potentially."

In the commercial market, of course, drugs not on a preferred list would also be more expensive, but with a major difference, according to Gottlieb.

"You go outside that list, you have to pay out of pocket for it, but you do get some co-insurance, meaning the plans will pay some of the cost of that."

Some say ObamaCare hoped to do better on that problem but ran out of time. Matthew Eyles of Avalare Health, a consulting firm, says although officials wanted "to be able to make sure that all the systems were operational in 2014, they realized that they needed to give an extra year to get those systems changes in place."

Officials intend to try again next year.

Additional benefits cost more, though, meaning premiums would have to rise, or the networks of providers would shrink even further.

Guess these people are the "necessary casualties" right?
 
Posted by Greg Davidson (Member # 3377) on :
 
If I really had to guess, my guess would be that this story is fake. Just like the fake story told about Obamacare in the Republican response to the State of the Union speech.

quote:
McMorris Rodgers described Bette as someone “who hoped the president’s health care law would save her money — but found out instead that her premiums were going up nearly $700 a month.”

Actually, Bette Grenier, 58, was never forced to pay a higher premium, according to an interview with the Spokane Spokesman-Review. In fact, she knew there were other, less-expensive health care options being offered through the exchanges on HealthCare.gov, but she wasn’t interested pursuing them.

Since many opponents of Obamacare have repeatedly demonstrated a willingness to assert false things and then have not had the integrity to admit that they were lying, my guess would be that this is just a continuation of such behavior.

In the case of the Americans for Prosperity commercial, the campaign of the target of the attack ad has asserted that the person with is actually an actor reading a script.

quote:
“Hiring professional actors to impersonate Louisiana families is low even for the billionaire Koch brothers”
And here are a few bonus examples of false assertions

quote:
The Texas Horror Story: In late November Yamil Berard at the Fort Worth Star-Telegram wrote a piece on Obamacare's losers, people whose plans had been cancelled and who were having a hard time finding new plans. Whitney Johnson, a 26-year-old with multiple sclerosis, claimed she was being quoted $1,000 a month for her new premium. Robert Kecseg, 61, said his deductible was "double" the $10,000 he paid previously. Shari Lusk, 57, refused a subsidy.

Mahar found that Johnson, Kecseg and Lusk are all active Tea Party members. Meanwhile, it's extremely unlikely for a 26-year-old to pay $1,000 monthly premium, and anyone following the health care law would know that it limits deductibles for families at $12,700 and $6,350 for individuals. Unfortunately, Berard hadn't been following the Obamacare news. “I haven’t written about healthcare in a long time. We don’t have a healthcare writer," she told Mahar. "I cover about 15 other topics."

The Lesson: Google your sources, or someone else will do it for you. Also, someone who thinks "We as a nation need to stand with the likes of Senator Ted Cruz and Senator Mike Lee who are committed to stopping ObamaCare,” as Johnson wrote in a letter to a pro-life organization, probably has a bias against Obamacare that should be mentioned.

The Los Angeles Horror Story: In October, Deborah Cavallaro of Los Angeles was quoted $478 a month by her insurance broker, nearly $200 more than her current plan. "Please explain to me," she told Maria Bartiromo on CNBC Wednesday, "how my plan is a 'substandard' plan when ... I'd be paying more for the exchange plans than I am currently paying by a wide margin?" She also said, "for the first time in my whole life, I will be without insurance." But, as Michael Hiltzik at the Los Angeles Times found, her current plan kind of sucks:

Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.

A silver plan with a $2,000 deductible would cost her $333 a month after the subsidy that the Times confirmed she was eligible for. Cavallaro, 60, also worried that her income would fluctuate, reducing her subsidy, and that her network would shrink.

See also: 56-year-old Dianne Barrette, whose $54 a month plan hardly covered anything.
Cavallaro on CNBC.

The Lesson: No one benefits when journalists don't dig deeper. CNBC failed to explain to Cavallaro why her plan was substandard — the super low cap on doctors visits, the high out-of-pocket costs (now capped at $6,350 for individuals) — so someone else had to. The network also didn't dig deeper to see if she had better options. Maybe telling people they're screwed gets more viewers.

And that goes both ways. As Cavallaro said later, she didn't research Covered CA plans, but she was reluctant to choose a cheaper plan with fewer doctor options (which Hiltzik glossed over) and was worried there were security risks associated with Covered CA (a somewhat valid concern Hiltzik didn't mention).

The Michigan Horror Story: Twenty-six year old Ashley "Obamacare raped my future" Dionne's story was told on several conservative media outlets, including Campus Reform, American Thinker, the Drudge Report, Red Alert Politics, The Blaze, and Mediaite. She claimed her premium was skyrocketing from $75 a month to $319, which was more than she could afford working 32 hours a week at $8 an hour.
Mike Huckabee covered Dionne for Fox News.

This is probably the most debunkable story of all debunked stories. No one can say what Dionne can afford, but that $319 premium ignored the subsidies she was eligible for (based on the income she gave) and the fact that's she'll likely be eligible for Medicaid now that her state expanded the program.

The Lesson: Just because someone (Dionne) agrees with you (a conservative news outlet) doesn't mean she knows what she's talking about. It's not a journalist's job to determine what someone can afford, but her story didn't check out.
Greta Van Susteren covers Sanford for Fox News.

The Washington Horror Story: Jessica Sanford started out as an Obamacare success story. She wrote a letter to President Obama stating that the law allowed her to get insurance for herself and her son for $169 a month, after years of not having insurance. Obama read that letter to the entire country at a press conference.

But then! It turned out that the exchange in Sanford's home state, Washington, had screwed up her subsidy calculation. As in, she wasn't getting a subsidy and insurance suddenly became too expensive for her again.

But then again! As The Seattle Times reported, Sanford's son is eligible for Medicaid, and her own insurance would be much less than what she'd been quoted in the past. As Danny Westneat at the Times put it:

So here’s a family that was totally uninsured for 15 years because it had always cost at least $500 to $600 a month for skimpy policies to cover them both. And what they can get now is full coverage for $30 a month for the son and scantier coverage in the $250 to $300 a month range for the mom.

If $250-$300 a month is too much for Sanford that's her call. But her son could have cheap insurance and his $250-a-month ADHD medication would be free thanks to the Medicaid expansion.

The Lesson: Stop ignoring Medicaid. There are problems with the Medicaid expansion, but for a lot of people it's a solution. About 3.9 million people have enrolled in expanded Medicaid, while five million have been left out in states that haven't expanded, according to Businessweek. But that's often overlooked.


 
Posted by Seneca (Member # 6790) on :
 
So that's where we're out now, that stories about Obamacare hurting people are false...

Wow.
 
Posted by Greg Davidson (Member # 3377) on :
 
Seneca,

My claim was quite specific - a number of stories told by Republicans about Obamacare have been false, and so if I had to take a "guess" about the latest story you had told, that would be mine.

Either disprove that the Republican response to the State of the Union speech used a false story about Obamacare, or concede the point. Or remain silent, which from you amounts to consent.

[ February 16, 2014, 09:34 PM: Message edited by: Greg Davidson ]
 
Posted by Seneca (Member # 6790) on :
 
Why does MY silence "amount to consent?"
 
Posted by Pyrtolin (Member # 2638) on :
 
The formulary bit isn't false per ser, it's just hyped to to spook people that haven't had insurance before and are unfamiliar with the concept of formularies, which every plan has had long before the ACA. It also glosses over medical necessity waivers that doctors can apply for in specific cases where there isn't an alternate, more cost effective medicine available for a certain individual who has proven unresponsive o the standard treatments (note, not generic, which the article misdirects people toward. It's true that there are new medicine that do not yet have generic forms, but if they're not on the formulary, there will be other medicines that the insurance company has better evidence about overall efficacy to use to determine whether it should be covered.

For people changing plans, that does sometimes involve changing formularies, but for the vast majority of people affected, they're going from paying completely out of pocket to having some degree of coverage, and the small handful that are experiencing such a change that can't be helped equivalently by switching to a cheaper, perhaps more commonly found to be effective treatment should be filing for expectations based on the evidence that their doctor has that a specific medicine is what they need.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Wayward Son:
quote:
quote:
--------------------------------------------------------------------------------
Originally posted by Wayward Son:

quote:
--------------------------------------------------------------------------------
Here's a new prediction, the left will see nothing wrong with this.
--------------------------------------------------------------------------------

Here's another new prediction: the right will think such a statement is new and outrageous.
--------------------------------------------------------------------------------
...

This *is* new and it is outrageous.

See. I'm right again! [LOL]

(Hey, G3, now I know why you like making posts like this. This is fun! [Big Grin] )

Yeah, it is. But les be fair here...predicting the left would defend and support a highly deceptive propaganda effort to whitewash a failing expansion of government and that the right would object to it is not exactly rocket surgery.
 
Posted by Greg Davidson (Member # 3377) on :
 
Links to all these examplwa in the original article, which is here ( link )

quote:
Kevin Drum wonders whether there's a single genuine Obamacare horror story out there, given that virtually every yarn promoted by Republicans or conservatives about people hurt by the Affordable Care Act has deflated like a pricked balloon on the merest examination.

It's a very good question, inspired by the latest horror story bloomer -- the tale of one Julia Boonstra of Michigan, wholesaled by the Koch-founded conservative organization Americans for Prosperity. In a political ad being run by AFP against a Democratic senate candidate in Michigan, Boonstra asserts that "Obamacare" has made her leukemia treatment "unaffordable" and "jeopardized" her health.

But when Glenn Kessler of the Washington Post checked out her story, he found it didn't hold up. The Affordable Care Act provided her with cheaper coverage than she had before, while allowing her to keep her doctor and maintain her treatment. Kessler didn't mention it, but Boonstra plainly benefits from another provision of the ACA: the ban on exclusions for preexisting conditions. Patients living in the pre-ACA world of individual health insurance with conditions like leukemia were constantly in danger of losing their coverage and becoming uninsurable. That's not legal anymore.

Boonstra's case is just the latest of a very long line of deflatable horror stories. We've debunked a passel of them here, from Florida resident Diane Barrette, who didn't realize she'd been empowered by the ACA to move from a costly junk insurance plan to a cheaper real insurance plan; to Los Angeles real estate agent Deborah Cavallaro, whose "unaffordable" premiums turned out to be eminently affordable; to San Diego business owner Edie Sundby, whose cancer coverage was safeguarded by Obamacare after her insurer bailed out on her for financial reasons; to "Bette," the supposed victim trotted out by Rep. Cathy McMorris Rodgers (R-Wash.) in her response to the State of the Union message last month, and who turned out to be an ACA "victim" because she couldn't be bothered actually to investigate her options for affordable care on the Washington state enrollment website.

And there are many more, including the extremely dubious personal narratives of House Speaker John Boehner and Sen. Tom Coburn.

What a lot of these stories have in common are, first of all, a subject largely unaware of his or her options under the ACA or unwilling to determine them; and, second, shockingly uninformed and incurious news reporters, including some big names in the business, who don't bother to look into the facts of the cases they're offering for public consumption. (I'm talking about you, Maria Bartiromo.)

http://www.latimes.com/business/hiltzik/la-fi-mh-obamacare-horror-stories-20140220,0,3801120.story#ixzz2ty43RNMG


 
Posted by Seneca (Member # 6790) on :
 
The "debunking" of Boonstra and others harmed by Obamacare is false.

quote:
Well, that didn't take long at all, less than twenty-four hours, to be precise.

Indeed, right on cue: "How Long Until Democrats Demonize Leukemia Patient Julie Boonstra for Excoriating #ObamaCare?"

It turns out WaPo's Glenn Kessler ran a fact-check on the Americans for Prosperity ad featuring Boonstra, who lost her health insurance under ObamaCare, was terrorized and traumatized by the initial problems with HealthCare.gov, and is now stressed out by the dangerous variability of her out-of-pocket expenses. As noted at the Detroit Free Press a couple of weeks ago:

Boonstra was diagnosed with leukemia five years ago and relies on daily oral chemotherapy. In October, Boonstra was among an estimated 225,000 Michigan residents who received notices the health insurance they purchased on the individual market would be discontinued for not meeting new standards under the law. She said she was covered under a Blue Care Network private plan with a $1,100-a-month premium but low out-of-pocket costs.

Boonstra was dogged by technical difficulties on the federal health care exchange website and panicked she would be unable to keep her University of Michigan doctors and lifesaving treatment. Ultimately, she enrolled in a new Blue Cross Blue Shield plan through an agent where her premiums were cut in half at $571, but she pays higher out of pocket costs. She’s still seeing her U-M oncologist.

“I just want my plan back, I really do,” said Boonstra, 49, a mother of two. “It was extremely expensive and there are things as far as oral chemotherapies that need to be done to reduce the cost. ... But I was covered and I made having a great health plan a priority for me and that was taken away from me.”
Ms. Boonstra liked her existing coverage. She believed the president, who (falsely and repeatedly) said she'd be able to keep her plan. She was lied to. And she was terrorized by the bureaucratic nightmare of the ObamaCare website rollout.

But none of this matters to the despicable Democrat-collectivist healthcare trolls, most prominently the brainless Mother Jones derp Kevin Drum, who uses Kessler's sleazy attack on Boonsta's nightmare experience to blanket-slur Republicans for their opposition to the president's ObamaCare clusterf-k: "Has Anyone in America Actually Been Harmed by Obamacare?" (via Memeorandum):
Boonstra herself is naturally unavailable for comment, and the best an unctuous AFP spokesperson could do to defend this ad is to point out that Boonstra's costs are a little more variable than in the past. Instead of paying a flat $1,100 per month plus low out-of-pocket costs, she sometimes pays more in a single month until she hits her annual out-of-pocket max. That's it.

This ad implies that Boonstra flatly can't afford coverage anymore. It implies that she could no longer see her old doctor. It implies that Obamacare is killing her. None of this is true. Boonstra's care is better and cheaper than it was before. The only downside is that her payments are slightly more erratic than in the past.

So here's my question: if this is the best AFP can do, does that mean that no one is truly being harmed by Obamacare? Hell, I'm a diehard defender of Obamacare, and even I concede that there ought to be at least hundreds of thousands of people who are truly worse off than they were with their old plans. But if that's the case, why is it that every single hard luck story like this falls apart under the barest scrutiny? Why can't AFP find someone whose premiums really have doubled and who really did lose her doctor and who really is having a hard time getting the care she used to get?

If this is happening to a lot of people, finding a dozen or so of them shouldn't be hard. But apparently it is. So maybe it's not actually happening to very many people at all?

This is wrong --- and vicious --- on so many levels. It's not just ridiculous. It's reprehensible.

Forget Kessler's idiotic fact-check. The reality is that Boonstra may well pay so much more in a single month as to make her medications unaffordable, just as the ad indicates; and yet the ghoulish Drum pounces on this woman with the incredulous, "That's it!??" "How dare you Boonstra refuse to sacrifice for the collective?!!"

You see, leftists simply won't tolerate citizens who resist being violently coerced into government programs they don't need, programs that impose hardships and inconvenience, and that take away individual choice and self-sufficiency. We can't have that under the Obama regime. These Democrat collectivists will say, "You will have ObamaCare and you will like it, or else!"

I mean, seriously. The RealClearPolitics polling average for the last month has public support of ObamaCare at 38.4. (Just over half --- a simple majority --- oppose this statist healthcare monstrosity.)

But for radical leftists, you must sacrifice for the social good!

See the idiot tool Ron Chusid's lame defense of this Obamanation, "If Obamacare Is So Bad, Why Can’t The Right Wingers Find Real Losers Under Obamacare?":
While a small minority of us are paying more, a tremendous number of people are now able to obtain coverage who could not obtain it in the past because it was too expensive or insurance companies would not cover them due to per-existing medical conditions. I have patients in this situation who could not obtain coverage in the past but have been covered since January. With all the bogus complaints about people losing their coverage, the significant number is that zero people can now be dropped by their insurance because they become sick, and zero people have to fear losing their insurance should they stop working.

On top of all these benefits, the Affordable Care Act will help the economy. The recent Congressional Budget Office Report, frequently distorted by Republicans, shows that the Affordable Care Act will reduce unemployment, help decrease the deficit, and allow more people to leave large corporations to start small businesses. The effects of this freedom from the “insurance trap” cannot be scored in a CBO report, but should provide a tremendous boost to the economy.

Right.

"Bogus complaints" of millions of Americans ("a small minority") whose existing coverage was ripped out from under them by this disastrous legislation. And look at the pile of lies Chusid heaps on in that second paragraph quoted above: No, the CBO report wasn't "distorted by Republicans"; no, ObamaCare will not "reduce unemployment"; no, more people will not "leave large corporations to start small businesses"; and no, there is no such thing as an "insurance trap." God, this Chusid clown's a shameless liar.

But then again, I predicted that leftists would demonize Ms. Boonstra, especially so since the "evil" Koch brothers are the financial backbone behind AFP's political advertising, and here it comes:
This lady is a liar. The numbers don't add up and her medication is covered. This is a scam This is a disgusting attempt at getting her "10 minutes" of fame all based on a GOP lie. Rep. Walberg, the Koch Brothers, and Ms. Boonstra should be ashamed for this charade. There is enough in the ACA to ridicule without making up lies and stories for sympathy. A liar is a liar. How do you look in the mirror each morning ??
I rest my case.



[ February 21, 2014, 10:46 AM: Message edited by: Seneca ]
 
Posted by Seneca (Member # 6790) on :
 
Looks like someone let Joe out of his kennel again, and his mouth opened up!

quote:
Though officials have confidently claimed enrollment in ObamaCare is surging, Vice President Biden suddenly suggested during a stop in Minneapolis the totals might be lower than projected.

"Initially, we talked about by the end of this period having seven million people lined up," he told a group in a coffee shop on Wednesday. "We may not get to seven but we're gonna get to five or six, and that's a hell of a start with people."

That’s quite a difference from the confident predictions last fall, just before the rollout, from Health and Human Services Secretary Kathleen Sebelius.

"I think success looks like at least 7 million people having signed up by the end of March 2014," she told NBC last September.

The nonpartisan Congressional Budget Office stuck with that estimate for the exchanges until just recently, when it lowered its projection from 7 million to 6 million. But the vice president is the first to mention a number as low as 5 million, suggesting doubts in the administration.

In its report on signups through the end of January, the administration claimed 9.6 million total had gotten health insurance -- 3.3 million in the federal and state exchanges, and another 6.3 million in Medicaid, the health care program for low-income Americans.

But a nonpartisan health care firm says the number of new signups in Medicaid from ObamaCare is much lower than 6.3 million.

"It's about 1.3 to 1.8 million people who are new to the program The rest are part of the regular churn that are in and out," Matthew Eyeles, of the firm Avalere Health, said.

And those in the regular churn -- those who come and go all the time – wouldn’t count as part of ObamaCare because they were already eligible before the health care law.

For those new to Medicaid under the expansion encouraged by ObamaCare, the administration pays 100 percent of the cost for the first three years. But it pays no additional funds for those already eligible, which is often one of the top three items in state budgets:

"The state pays that bill," said former CBO Director Doug Holtz-Eakin. "If it's the expansion, the federal government pays the bill. So it matters a lot whether it's newly eligible or existing eligible who are signing up."

Meanwhile, the vice president might have also irritated other officials by giving the wrong date for the end of enrollment.

"There's a drop-dead date for the first round -- in the beginning of March," he told the coffee-shop gathering.

Actually, open enrollment goes to the end of March, not the beginning.

If the vice president is right on the numbers, though, and only 5 million sign up in private exchanges -- and fewer than 2 million newly eligible enrollees enter Medicaid – then the administration would be hard-pressed to hit half the original projection of 16 million total by next month.


 
Posted by Wayward Son (Member # 210) on :
 
Thanks for rebutal, Seneca. It is actually those kinds of disputations that I come to Ornery for.

That said, I find the debunking to be rather weak. [Frown]

The key part, to me, in the Mother Jones article was:

quote:
Let's recap: Boonstra kept her doctor. Her new plan is, on net, less expensive than her old plan. And presumably she's no longer required to compromise on the type of chemotherapy she receives. In other words, it appears to be superior on virtually every metric.

... Instead of paying a flat $1,100 per month plus low out-of-pocket costs, she sometimes pays more in a single month until she hits her annual out-of-pocket max. That's it.

This ad implies that Boonstra flatly can't afford coverage anymore. It implies that she could no longer see her old doctor. It implies that Obamacare is killing her. None of this is true. Boonstra's care is better and cheaper than it was before. The only downside is that her payments are slightly more erratic than in the past.

When I saw you posted a rebutal, I expected someone to show that the out-of-pocket expenses with the premiums cost more than the premiums of the old plan. That the new plan actually cost more than the old one. That Kevin Drum at Mother Jones was pulling a fast one.

Instead, this is what your "debunking" wrote:

quote:
The reality is that Boonstra may well pay so much more in a single month as to make her medications unaffordable, just as the ad indicates...
Everything else was emotional, name-calling garbage ("idiotic," "violently coerced," "collectivists," etc.) devoid of facts. That appears to be the author's only actual dispute with Drum's analysis.

Now which would you prefer? A plan that costs more, but allows even payments, or one that costs less (probably significantly less) but has a much more even payment schedule.

I would take the cheaper plan. I may lose a lot of money in the first few months of the year, but I would earn back all of it, and then some, by the end of the year in my monthly savings of the premiums. And, assuming her treatment will last a few years, I would put aside the money I was saving each year in a bank account until it was sufficient to cover the deductable for any given year. Then I would pocket the rest of the saving for every year thereafter. [Smile]

Now, admittedly, Boonstra may not have the funds to cover the deductable for the first few months in a bank account, which could cause a hardship. But if she could find someone to give her a loan to cover the deductable until the end of the year, she will be better off.

This is not to say that Boonstra is not in a dire situation. It is not to say that she may have been better off with her old plan. What it does say is that most people (IMHO), in the same situation would be better off with Obamacare than with her old plan. In the long term, most people would save money with equal or superior care.

Which bring us back to what Kevin Drum was saying: Why is this the worst case that the ACP can find?? [Eek!]

If my back-of-an-envelope analysis shows that most people would be better off, we can assume that most people will be better off with Obamacare. Your debunking article actually seems to agree with the orginal article.

[ February 21, 2014, 12:02 PM: Message edited by: Wayward Son ]
 
Posted by Seneca (Member # 6790) on :
 
Wayward the law is still new, the fact that chronic patients who are continuously suffering will undergo extra out of pocket expenses they weren't experiencing before that will break them in the short run and disrupt their treatments unless they can, according to your advice, find a LOAN from someone, is disgusting and reprehensible.

Any changes in healthcare law should have been able to address any problems that existed without creating new ones, or it shouldn't have been attempted, period.

The rebutting article also cited the CBO report which MotherJones attempted to emotionally disregard in an absurd and illogical fashion, as well as public polling numbers which show that the public does not support this law, which has thousands of implications about the continuance and longevity of the law going forward in 2014 and 2016...
 
Posted by NobleHunter (Member # 2450) on :
 
quote:
Any changes in healthcare law should have been able to address any problems that existed without creating new ones, or it shouldn't have been attempted, period.
End result: The status quo endures forever.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by NobleHunter:
quote:
Any changes in healthcare law should have been able to address any problems that existed without creating new ones, or it shouldn't have been attempted, period.
End result: The status quo endures forever.
Or not? Or we could, gasp, make fixes without harming people?
 
Posted by NobleHunter (Member # 2450) on :
 
In a country of over 300 million people?

No.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by NobleHunter:
In a country of over 300 million people?

No.

You seriously believe it is impossible to pass a law without harming someone merely because of population size?

Are you kidding me?
 
Posted by NobleHunter (Member # 2450) on :
 
Without harming anyone? To juggle nearly uncountable and often mutually contradictory interests so that no one is negatively effected? Without providing for every possible exception or special circumstance? I don't understand how it could.

I may be interpreting harm more broadly than you intended.
 
Posted by Seneca (Member # 6790) on :
 
You assume that contradictory interests exist.

Can you tell me which contradictory interests exist in healthcare?
 
Posted by NobleHunter (Member # 2450) on :
 
Well, maximizing profits versus maximizing the people who get healthcare. Hells bells, maximizing revenue versus most appropriate treatment. Or availability of doctors versus doctors salaries. Paying out insurance versus not paying out. Essentially anything that ends up in court.

Generally, if three people are in a room, you can assume there are four contradictory interests. If one of the people is dead.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by NobleHunter:
Well, maximizing profits versus maximizing the people who get healthcare. Hells bells, maximizing revenue versus most appropriate treatment. Or availability of doctors versus doctors salaries. Paying out insurance versus not paying out. Essentially anything that ends up in court.

Generally, if three people are in a room, you can assume there are four contradictory interests. If one of the people is dead.

Those "problems" were not "fixed" by this law, in some ways they were made worse or not addressed at all. To the extent they were addressed at all they didn't necessarily improve for anyone at the detriment of others.
 
Posted by NobleHunter (Member # 2450) on :
 
*blinks* Yeah. I didn't say they were.

I'm saying that addressing any one of them will result in someone losing out. You said:

quote:
Any changes in healthcare law should have been able to address any problems that existed without creating new ones, or it shouldn't have been attempted, period.
The requirment to not create new problems means no law is possible. It would make fixing something as complicated healthcare impossible. Because contradictory interests.

Even adopting whatever your ideal of healthcare provision would result in new problems and people getting hurt. So would mine. I'd advocate for mine because I think it hurt would be fewer people that the status quo and the problems would be more manageable.
 
Posted by Seneca (Member # 6790) on :
 
quote:
The requirment to not create new problems means no law is possible.
Absurd. What problems does creating a law outlawing murder create?
 
Posted by NobleHunter (Member # 2450) on :
 
Murder is the unlawful killing of another person, yes?

It complicates self-defense, because either you can't kill in self-defense (problem) or one side or the other has to meet a burden of proof. Thus a murderer could go unpunished (problem) or an innocent punished (problem), depending to which side the law errs.
 
Posted by Seneca (Member # 6790) on :
 
Murder is not killing in self defense. Murder requires intent to kill for a reason other than self-defense. The burden of proof is on the prosecution, not the defendant.

As for murderers going UNpunished, how does creating a law outlawing murder, where there would be none otherwise, create this problem?
 
Posted by NobleHunter (Member # 2450) on :
 
Because a more perfect law would not allow murderers to go unpunished? Or rather the problem is that it could affirm and validate a murderer's actions by erroneously affirming them to be in self-defense, which is possible if the burden of proof rests too strongly on the prosecution.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Because a more perfect law would not allow murderers to go unpunished?
That still doesn't mean that a law outlawing murders is causing murderers to go unpunished. The same would be true and worse WITHOUT the law...

quote:
Or rather the problem is that it could affirm and validate a murderer's actions by erroneously affirming them to be in self-defense, which is possible if the burden of proof rests too strongly on the prosecution.
Who cares if their actions are validated? Without murder being illegal it doesn't matter at all...

Are you starting to see the problem with believing that laws can fix problems and relying on that logic?
 
Posted by NobleHunter (Member # 2450) on :
 
I think the friends and family of the victim might care. That would remain true even if murder wasn't illegal; at least then their loved one wouldn't be slandered by the legal system.

Now you're saying laws can't fix problems?
 
Posted by Seneca (Member # 6790) on :
 
What actual harm is caused by a legal system "slandering" someone that wouldn't also be caused by same murderer running around in a system where murder was not illegal?

Indeed, any such harm would be worse where it was legal.

Laws can fix problems, but only very rarely and it is harmful for them to fix problems that are related to economic self reliance.
 
Posted by NobleHunter (Member # 2450) on :
 
Because now the reputation of the person has been damaged and there is little to no recourse. If the murder was not illegal, the victim's reputation would be intact, since the murderer would not have need to falsely claim self-defense.

The murderer running around free is a separate problem.

Economic self-reliance for most people, where there is any level of specialization of labour, is only possible in the presence of law. Unless you think you can stop everyone else from taking your stuff.

But that's not what you meant. You and I have a fundamental disagreement about the nature and effect of laws.
 
Posted by Seneca (Member # 6790) on :
 
Really? You're telling me Nicole Brown Simpson's reputation was harmed because OJ got off on her murder? I don't think so...

Stopping people from taking your stuff? Simple. Lock it up and buy a gun to defend your home...

We do have a fundamental disagreement about the nature of laws. Law is meant to protect citizens, not harm them by stealing from some to give to others.
 
Posted by Seneca (Member # 6790) on :
 
Interesting study on all the delays in Obamacare.

quote:
As the administration touts the benefits of ObamaCare in a push to sign up more people before the March deadline, a FoxNews.com review shows how much of the law has really been pushed off.

Since its inception, provisions of the law have been delayed a total of 28 times; the average delay was six months and three weeks. Put another way, the cumulative delays add up to an astonishing 15 years and three months.

The administration has been announcing changes to the law at a fairly steady clip.

The White House's latest delay was rolled out on Feb. 10, and allowed companies with between 50 and 99 workers to skirt the mandate to provide health care until 2016.

Of the White House's 28 delays to the law, 13 have been set to last at least one year. Eight revisions last a month or more. The shortest delay, announced in December 2013, gave Americans one extra day to purchase coverage that would begin on Jan. 1, 2014 through HealthCare.gov. Ultimately, that delay was extended to a vague "more time."

Who Fares Worst?

In some cases, groups most loyal to President Obama have fared poorly under the law's recent delays.

While 71 percent of Latinos voted in 2012 for Obama, Spanish-speakers needed to wait over two months for their version of HealthCare.gov, Cuidadodesalud.gov. In September 2013, the White House said Spanish-speakers would need to wait just three to four more weeks. The White House is still facing complaints that the site was not translated correctly.

The Longest Delay

Americans who work at companies employing 50-99 workers in the 36 states that use HealthCare.gov expected their employers to be required to offer them health insurance on Jan. 1, 2014.

After a pair of one-year delays, they will be guaranteed work-provided insurance -- but only in 2016. The owners of those small businesses aren't faring well under the delays either -- the launch date for their federal exchange site, Small Business Health Options Program (SHOP), was pushed back to November 2015 in late 2013.

When Does it End?

Only one of the 28 delays doesn't have an end-date announced by the White House. On Dec. 24, 2013, more time was offered to those who wanted to sign up for coverage that would start in 2014 but could not because of HealthCare.gov's glitches. The deadline to choose January coverage was originally Dec. 23, but the last day to sign up for coverage retroactive to January has not been declared -- other than March 31, the scheduled final day to choose a plan for this coverage year.

Democrats and the Health Care Law

Thirteen Senate Democrats, or over a quarter of the caucus, have openly distanced themselves from the law's rollout. Those Democrats have largely been in favor of further delays or extensions, staving off the law's regulations. Since the October rollout, no Democrat has introduced legislation to bar the White House's delays, which would in turn speed along the rollout.

All changes to the law directed by the White House have slackened the Affordable Care Act's original intent and regulation start-dates.

If no additional delays are pushed beyond 2016, Obama is set to see the law fully implemented for no more than one quarter of his time in office.


 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
Since its inception, provisions of the law have been delayed a total of 28 times; the average delay was six months and three weeks. Put another way, the cumulative delays add up to an astonishing 15 years and three months.

That's not an astonishing amount, because it is largely unquantified despite the use of dates. A quantitative assessment would be to document how many provisions would have originally affected how many people over a given duration of time, and then what fraction of these provisions have been affected, and for how many people. Nothing in your citation indicates that the impact of these delays affect even 1% of the provisions/population.
 
Posted by G3 (Member # 6723) on :
 
All is well!
 
Posted by Seneca (Member # 6790) on :
 
Remember Julie Boonstra? The cancer patient who dared to criticize Obamacare because it made her life worse by threatening her treatments and increasing her out of pocket costs? Well apparently Michigan Representative Gary Peters has decided he doesn't like her ability to speak out and is using his position in Congress to send threatening letters to TV networks airing her ads that criticize the law. When logic fails, use your hammer to shut the other side up, right?

quote:
A Michigan cancer patient is fighting back after her critical claims about ObamaCare were called into question by a Democratic congressman, who went so far as to threaten Michigan television stations running her ad.

Julie Boonstra, who was diagnosed five years ago with leukemia, was featured in an ad last week by the conservative Americans for Prosperity. In it, she said her insurance plan was canceled because of the Affordable Care Act, and claimed her out-of-pocket costs are now "so high it's unaffordable."

The target of that ad, Michigan Rep. Gary Peters, subsequently had his campaign lawyers write to Michigan TV stations, effectively warning that their FCC licenses could be at risk unless they demanded more proof from AFP.

But Boonstra, in an interview with Fox News on Monday, defended her claims and blasted Peters for trying to take down the ad.

"They're not scaring me. Cancer scares me," she said. "I battle cancer every day. They're not going to intimidate me."

Boonstra's claims were first called into question by a Washington Post fact check column. Writer Glenn Kessler noted that under the law, Boonstra's premium dropped from $1,100 a month to just more than $500, and that out-of-pocket costs would be capped at $6,350. "Over the course of a year, the premium savings amounts to $6,348 -- just $2 shy of the out-of-pocket maximum," he wrote, arguing that whatever extra money she would have to pay out of pocket could be offset by premium savings.

Attorneys for Peters, who is running for Senate in Michigan, fired off letters last week to station managers citing the Washington Post column and informing them that "for the sake of both FCC licensing requirements and the public interest, your station should immediately require AFP to provide the factual documentation for its claims if you are going to continue airing this advertisement."

His team ominously cited court rulings that said failing to prevent "false and misleading" ads could be grounds for loss of license.

But AFP and Boonstra are defending the ad and the claims. Boonstra acknowledged that her premiums have been cut in half, but said the out-of-pocket expenses are unpredictable and unaffordable.

"Under my old policy, I knew what I could afford every single month because I wasn't hit with extra charges. Now I don't know what I have to pay month to month," she said. "Leukemia tests are extremely expensive."

She added: "I am not lying. ... I was lied to."

Isn't this logic funny? Obamacare supporters think that she's lying because over time her costs are similar to what she was paying before. Um hello, she is a CANCER PATIENT with serious cancer. How many cancer patients can count on being alive in a year? How many people can front $6,000.00+ where they didn't have to before? She may not have a year to "recoup costs," if she has to pay those out of pocket costs quickly then it may break her where as before she could push the costs further out. It is particularly hilarious that Obamacare supporters were suggesting she could just get as loan or go into debt to pay her expenses, when apparently people going into debt over medical care was one of the major reasons they were pushing the ACA in the first place!
 
Posted by G3 (Member # 6723) on :
 
The best part, the threat of the station losing its broadcast license...
 
Posted by Wayward Son (Member # 210) on :
 
quote:
It is particularly hilarious that Obamacare supporters were suggesting she could just get as loan or go into debt to pay her expenses, when apparently people going into debt over medical care was one of the major reasons they were pushing the ACA in the first place!
What you fail to note, Seneca, is that by the end of the year she would have paid off that $6350 loan, because she would have recouped the costs during the year. As opposed to long-term loans for tens or hundreds of thousands of dollars that cost the person everything.

And I would be suprised if she can afford to pay $1,100 per month, but being in debt for $6350 for six months will "break her."
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Wayward Son:
quote:
It is particularly hilarious that Obamacare supporters were suggesting she could just get as loan or go into debt to pay her expenses, when apparently people going into debt over medical care was one of the major reasons they were pushing the ACA in the first place!
What you fail to note, Seneca, is that by the end of the year she would have paid off that $6350 loan, because she would have recouped the costs during the year. As opposed to long-term loans for tens or hundreds of thousands of dollars that cost the person everything.

And I would be suprised if she can afford to pay $1,100 per month, but being in debt for $6350 for six months will "break her."

To be more clear here, she wouldn't have ad to go into any debt to pay off that loan at all, because such payments are billed after the fact. Rather she could have applied the money she was saving on premiums to the bills (which do not have to be paid all at once, and by the end of the year would have broken about even just based on the numbers provided. (And that's comparing just the premiums of the old plan to the total cost, premiums and copays/deductibles, of the new plan. Once you account for the fact that the old plan had some amount of copay and deductible as well, she's actually coming out well ahead of where she was before, because that, less $2, it all active savings on costs.
 
Posted by Seneca (Member # 6790) on :
 
quote:
What you fail to note, Seneca, is that by the end of the year she would have paid off that $6350 loan, because she would have recouped the costs during the year. As opposed to long-term loans for tens or hundreds of thousands of dollars that cost the person everything.
Short term debt is still not free, nor is it widely available to terminally-ill cancer patients...

quote:
And I would be surprised if she can afford to pay $1,100 per month, but being in debt for $6350 for six months will "break her."
Actually it sounds very plausible. It sounds like she was barely making it work prior to that, but such a huge expense due immediately was not feasible.

quote:
To be more clear here, she wouldn't have ad to go into any debt to pay off that loan at all, because such payments are billed after the fact. Rather she could have applied the money she was saving on premiums to the bills (which do not have to be paid all at once, and by the end of the year would have broken about even just based on the numbers provided. (And that's comparing just the premiums of the old plan to the total cost, premiums and copays/deductibles, of the new plan. Once you account for the fact that the old plan had some amount of copay and deductible as well, she's actually coming out well ahead of where she was before, because that, less $2, it all active savings on costs.]
Wrong. They wouldn't simply wait a year to bill her, most likely they would bill her at the end of every month.
 
Posted by Pete at Home (Member # 429) on :
 
(note that I pointed out this ACA problem with oncology way back in April 2013 ...)
 
Posted by Wayward Son (Member # 210) on :
 
quote:
They wouldn't simply wait a year to bill her, most likely they would bill her at the end of every month.
True, but how long would they wait for her to pay? [Wink]

Remember, she has $529 available each month to cover the copay costs. If she made partial payments each month, she would cover the full amount by the end of the year.

Most creditors are fairly lienent when it comes to payments, especially for those who are making a good-faith effort. Most creditors don't want to be the one to make a lien against a cancer patient's house because they are $1000 behind for a couple of months. [Wink]

So while it would be better for her to have a nice, even $1100 payment each month, juggling the copays will probably not break her. And she will be pocketing whatever copays her previous plan required. [Smile]

Compare her situation to someone with cancer who lost his/her insurance and couldn't get another policy because of "existing conditions." Seriously, which situation would you rather be in?

If this really is the worst that Obamacare has done, then the program is doing really well.
 
Posted by Wayward Son (Member # 210) on :
 
PolitiFact has weighed in, and they seem to agree with my analysis, although correcting me in a couple of points.

quote:
The new plan also requires her to pay 20 percent of all her medical bills, while the insurance company picks up the remaining 80 percent. For someone needing expensive treatment, like chemotherapy, those out-of-pocket costs can add up quickly.

But the Affordable Care Act requires caps on out-of-pocket expenses paid by policyholders. Without seeing the plan, we don’t know what that cap is, however, the law says for an individual it can’t be higher than $6,350. Some of the more pricier plans have caps that are even lower.

So at most, Boonstra would pay $2 more over the course of the year under her new policy. And if the annual cap is lower than $6,350, her new plan could actually save her money. It's also possible she is receiving more benefits under the new plan, but the two plans were not provided to compare.

During an interview on Fox News, Boonstra said she preferred the certainty of her expensive premium. It meant at most she would pay $1,100 a month. While her new policy prevents any out-of-pocket expenses after $6,350, if her bills are high enough, that lump sum could hit her all at once.

"To me it’s unaffordable," she said. "When I had a health care plan I could budget for and had a stable amount, it suited me better. I do not care for not knowing what my expenses will be month to month."

Hospitals are often willing to work with customers to pay off the patient portion of the bill over time. It’s possible Boonstra would be able to arrange such a deal so she isn’t paying $6,350 in one month.

Boonstra has not said whether she could reach such an agreement with her doctors at the University of Michigan, said Levi Russell, a spokesman for Americans for Prosperity.

"The private financing options that she may or may not be able to work out is well beyond her point. She hasn’t weighed in on it," Russell said. "If that’s the argument, the promise should have been, ‘You can not keep it, but hopefully you can work out financing options.’"

"If I do not receive my medication, I will die."

Boonstra receives oral chemotherapy to treat her leukemia. It’s unclear what other medication she takes. But she is still receiving the same medication on her new policy, Americans for Prosperity confirmed.

The cost of the medication and and any other prescriptions are undoubtedly more than they were before, since she previously had no out-of-pocket costs aside from the monthly premiums.

But just like medical treatment, prescriptions are included in the annual cap. Meaning once she reaches $6,350 in out-of-pocket expenses for the year, she will no longer have to pay for her medication.

While having to arrange fincancing with a hospital is not ideal, and I'm sure Boostra would prefer her old plan, it is not the end of the world. As PolitiFact summaries:

quote:
[T]he ad is, at worst, misleading and, at best, lacking critical context. It leads viewers to believe that Boonstra lost her doctor along with her insurance and her life-saving medication. She has kept her current doctor and still receives the treatment she needs.

Further, the ad said the new plan is unaffordable. While the plan does create less cost certainty, annual caps will limit her bills. At most she will end up paying about the same for her health care as before.

If this is the worst case that the opposition can find, then Obamacare is way, way better than I expected. [Smile]
 
Posted by Seneca (Member # 6790) on :
 
You really don't understand this.

Someone who is terminally ill and struggling to survive can't just "stretch" the money. She had found herself a delicate economic equilibrium prior to this law and she was surviving. This law disturbed her life and threw all of that balance out of alignment.

You say, "well, she could just get a loan or try and 'make an arrangement with the hospital,' what is ironic is that many opponents of Obamacare were saying people could do this BEFORE the law, but people pushing that law said it was 'unacceptable' and 'unsustainable' and 'plain wrong.'

Why is it OK now to expect people to have to do those things but not before when those tactics you suggest she employ were supposedly reasons to push for this law?

Also, Obama campaigned 24/7 on this idea that for those who liked their insurance and liked their healthcare, nothing would change and they could keep everything the way they liked it. This wasn't a misunderstanding, he hammered this point home thousands of times constantly. There are even memos proving that while his campaign and administration knew this would not be true, they knew due to the massive opposition to the law prior to passage that if they did not sell the American people on that lie that they would lose enough democratic votes where the law would not pass.
 
Posted by Seneca (Member # 6790) on :
 
Looks like Biden has opened his mouth again.

This time he is telling women that if they don't like their jobs, they can just quit, spend time with their kids and get free healthcare from the government. Ain't welfare grand?

quote:
Vice President Biden is under fire for suggesting working women would benefit from ObamaCare by being able to quit their jobs to spend time at home.

"How many of you are single women with children in a dead-end job?" Biden asked, during an appearance on "The View" on Tuesday. "You're there because of your health insurance. You'd rather have the opportunity to spend the next couple years with your child. [Do] you want to stay in that job, even though you can get health insurance absent that job? And it gives women a great deal more freedom."

The VP has been hit as out of touch for the remarks.

"It's like 'Joe, are you living in an altered reality?'"conservative blogger Crystal Wright told Fox News on Wednesday.

"The vice president's spin is essentially 'Your house is burning down, but that's OK, you'll have less house work to do,'" Heather Higgins, president and CEO of Independent Women's Voice, said Thursday.


 
Posted by Wayward Son (Member # 210) on :
 
quote:
Why is it OK now to expect people to have to do those things but not before when those tactics you suggest she employ were supposedly reasons to push for this law?
Because it was a different type of "loan." Not one that could be paid off in a year. One that would cost a person his home, his car, and his life savings.

This is only a cash-flow issue. She paying, at most, $2 more a year for the insurance. For the same doctor. For the same treatment. And, perhaps, for more options and more benefits. This is not a disaster.

A disaster is when you have leukimia and you lose your insurance and have to pay 3-4 times more for a policy that isn't as good. A distaster is when you lose your insurance and can't get another policy.

I ask you again, which situation would you rather be in: in Broonstra's shoes, having to pay more in the first few months of the year but getting that money back by the end of the year; or someone with leukimia who lost his insurance and couldn't get another policy because you have a "pre-existing condition?"

The fact that the Right Wing Press sees these two situations as equivalent shows the utter moral vacuum they are working in. [Mad]

Would Broonstra be better off with her old insurance? Yes. Is she going to have to sell her home, empty her bank account, be destitute because she lost that insurance? No. And she may even have more benefits now than she did before.

Broonstra's situation is no where near equivalent to those situations the ACA was designed to address. The fact that the Right is trying to sell it as being the same shows that they really don't have a clue as to what is a real medical financial distaster. [Mad]
 
Posted by Pete at Home (Member # 429) on :
 
A friend of mine, a retired army psychiatrist, worked in the army until retirement with the promise of free lifetime medical coverage for him and his wife. The ACA now requires him to register for medicare B at a cost of $112 for him plus $112 for his wife. This is a 5th amendment violation, removing an entitlement that he earned, property, without due process or compensation.
 
Posted by Wayward Son (Member # 210) on :
 
This was the reason the AFA was pushed. This is a disaster. When the Right starts telling stories like this, then we have a problem. Not someone who can't afford to pay the copay until the end of the year. [Roll Eyes]

quote:
When I was just 26 years old, I was diagnosed with Hodgkin’s Lymphoma and overnight, my world imploded. I could not work and my husband had to take a lower paying job to care for me and our three year old son. We found ourselves without health insurance and entered a bureaucratic nightmare where we were told we were not eligible for help because we owned our own home. When I was released from the hospital and my husband went looking for help to pay for my life-saving chemotherapy, he was told by a state worker that if he had to choose between my drugs, oil to heat our house during a 60F cold snap or food for our child, that "life is full of tough choices." She advised him that the best thing he could do for his family was to abandon us so we would be eligible for free medical care. We lost our home and our marriage did not survive the stress. If I had been able to work I would not have been insurable. (Posted 10-16-09)

 
Posted by Pete at Home (Member # 429) on :
 
What I described isn't a disaster. It's simply dishonorable and unconstitutional conduct, inflicting a mild wrong on our retired servicemen and servicewomen.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pete at Home:
What I described isn't a disaster. It's simply dishonorable and unconstitutional conduct, inflicting a mild wrong on our retired servicemen and servicewomen.

Pete, what about the recent budget cuts to servicemember retirements? Could those be considered unconsitutional as well?

I was always under the belief that what the government giveth, the government can taketh away. There are no guarantees except death and taxes. Is my impression incorrect?
 
Posted by NobleHunter (Member # 2450) on :
 
If you listen to Pyr, taxes aren't guaranteed. And I'm not putting any money on death, either. [/unhelpful]
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by Pete at Home:
What I described isn't a disaster. It's simply dishonorable and unconstitutional conduct, inflicting a mild wrong on our retired servicemen and servicewomen.

Pete, what about the recent budget cuts to servicemember retirements? Could those be considered unconsitutional as well?

I was always under the belief that what the government giveth, the government can taketh away. There are no guarantees except death and taxes. Is my impression incorrect?

There's consistently changing case law as to this very question. But I think the breaking of the free medical for life contract is pretty clear cut.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Pete at Home:
A friend of mine, a retired army psychiatrist, worked in the army until retirement with the promise of free lifetime medical coverage for him and his wife. The ACA now requires him to register for medicare B at a cost of $112 for him plus $112 for his wife. This is a 5th amendment violation, removing an entitlement that he earned, property, without due process or compensation.

I'd add 14th amendment, section 4 there as well- such changes amounts to defaulting on or otherwise forcibly restructuring a federal debt
 
Posted by Seneca (Member # 6790) on :
 
It is really disheartening to see the liberal elements of the MSM going after anyone who dares voice displeasure with this law. Their defense of it is reaching religious levels of devotion and stubborn blindness to facts.

It has been demonstrated that Boonstra can't front the funds that the new law now subjects her to, and all the ACA supporters can say is she needs to "get a loan" or "work out a deal" with the hospital. What lender will loan to someone terminally ill? My God...

Also, why should she now have to go into debt all because liberal politicians wanted to change her healthcare? Seems grossly unfair.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
It has been demonstrated that Boonstra can't front the funds that the new law now subjects her to, and all the ACA supporters can say is she needs to "get a loan" or "work out a deal" with the hospital. What lender will loan to someone terminally ill? My God...

WHat lender is necessary? All she has to do is pay the bills as she has the funds available. The hospital will be the de facto "lender". she could pay the same amount each money as she was before, the only difference is that now she's splitting the check between the insurance company and the hospital instead of sending it all to the insurance company.
 
Posted by Seneca (Member # 6790) on :
 
Hospitals send bills to collection agencies faster than you think, sometimes in a matter of weeks. Those agencies will call up tow trucks and even attempt to help the hospital to foreclose on your home.
 
Posted by Wayward Son (Member # 210) on :
 
quote:
What I described isn't a disaster. It's simply dishonorable and unconstitutional conduct, inflicting a mild wrong on our retired servicemen and servicewomen.
Sorry, Pete. I was continuing my response to Seneca, not to your post. You kinda snuck in there... [Embarrassed]
 
Posted by Pete at Home (Member # 429) on :
 
NP, w. [Smile] . Just distinguishing my position from Seneca's.

While I can be ferociously loyal.and irrational as any soul, I like to think that my arguments are based on principles rather than loyalty. I'll even criticize Mormons as a group or the LDS church institution, to whom I feel tremendous respect and loyalty either though I no longer identify among them. When I take issue with a fact or argument that someone makes here, that doesn't mean that I disagree with their overall position or conclusion.

[ February 28, 2014, 02:59 PM: Message edited by: Pete at Home ]
 
Posted by msquared (Member # 113) on :
 
Seneca

It depends on the hospital I guess. My wife and I have made payments on fees owed to hospitals many times. We call them and work out a plan for 6-12 months and it has worked out every time. They do not even charge us interest on the payment plan. We just call them up and tell them we can make monthly payments of $XX per month for X months until it is paid off. Never had an issue.

msquared
 
Posted by Wayward Son (Member # 210) on :
 
quote:
Also, why should she now have to go into debt all because liberal politicians wanted to change her healthcare? Seems grossly unfair.
It is unfair, and I wish her company had not cancelled her insurance. (Since she is paying almost exactly as much per year for the insurance, I'm not sure why they couldn't have continued it. [Confused] ) But the MSM has emphasized that there would be winners and losers, even if the Administration didn't emphasize it. She, unfortunately, is one of the losers.

But compared to the losers in the previous system (inability to get health insurance because of "pre-existing conditions," health insurance too expensive to afford, etc.), we are all much better off overall.

Even Broonstra would prefer the high-deductable heath insurance she has now than being refused any health insurance because of pre-existing leukimia. [Eek!]

quote:
Hospitals send bills to collection agencies faster than you think, sometimes in a matter of weeks. Those agencies will call up tow trucks and even attempt to help the hospital to foreclose on your home.
While that is possible, it is highly unlikely for a $5500 bill that the patient will pay before the end of the year (and can prove it). Once again, would you want to be the hospital known for repossessig a patient's house for a $5000 bill? [LOL]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
Hospitals send bills to collection agencies faster than you think, sometimes in a matter of weeks. Those agencies will call up tow trucks and even attempt to help the hospital to foreclose on your home.

They cannot if you're making a good faith effort to pay, even $5-10/month.

And even if the account does go to a medical collection company, they are very stringently regulated in what they can actually do to try to collect.

In the one year timespan in question, putting the premium difference down each month, after prescription copays, would mean that the account could never go to collection before it was payed off.
 
Posted by Seneca (Member # 6790) on :
 
You guys are obviously behind the times.

http://www.huffingtonpost.com/2012/04/24/debt-collection-agents-hospitals_n_1449896.html

quote:
Next time you're at the hospital, be on notice: The person taking down your information and admitting you for treatment might not be a hospital employee but a staffer from a debt-collection agency.

Minnesota Attorney General Lori Swanson filed suit against a debt-collection agency called Accretive Health in January after an employee left a laptop containing personal information about for 23,500 patients in a rental car last July. Swanson's lawsuit alleges that Accretive Health's access to patient records violates federal privacy laws.

The case brings attention to the little-known practice of hospital companies embedding debt collectors in their facilities, the New York Times reports.

Americans are being subject to increasingly harsh tactics by debt collectors seeking to recoup money for their clients by using tactics including threats, insults and lies, recent research shows. Lisa Lindsay, an Illinois woman recovering from breast cancer, endured an arrest and a brief stay in jail over an unpaid $280 hospital bill that wasn't even hers.

Hospitals are under increasing financial pressure as health care costs escalate and payment rates from Medicare, Medicaid and private health insurance companies become smaller. And largely because of a decades-old federal law requiring hospitals to provide emergency medical care to anyone, regardless of their ability to pay, hospitals take on tens of billions of dollars in bad debt each year. In 2010, hospitals were stuck with $39.3 billion in unpaid bills, which amounted to 5.6 percent of their total expenses, according to the American Hospital Association.

Cash-hungry hospitals aren't the only obstacle to patients' getting the health care they need. Health insurance premiums continue to rise even as benefits get more meager, joblessness and the sluggish economy are causing many Americans to go without medical care or become uninsured, and the size of hospital bills themselves can be impossible to predict.

Anxiety about dollars and cents has driven hospitals into the arms of aggressive debt collectors, according to the Times:

As a growing number of hospitals struggle under a glut of unpaid bills, they are turning to companies like Accretive. To win promised savings, all hospitals have to do is turn over the management of their front-line staffing -- ranging from patient registration to scheduling and billing -- and their back-office collection activities. Accretive says it has such arrangements with some of the country’s largest hospital systems to help reduce their costs.
Accretive Health works with dozens of U.S. hospitals, including Fairview Health Services and North Memorial Health Care in Minnesota, according to the Times and a press release from Swanson's office. Debt collectors are instructed to ask patients for credit cards or checks when they arrive at an emergency room seeking treatment, the Times reports.


Hospitals across the U.S. are trying new methods of avoiding unpaid bills. HCA, the largest for-profit hospital chain, and other companies have started demanding upfront payments as high as $350 from people in emergency rooms, Kaiser Health News reported in February. In 2011, about 80,000 people walked out of HCA emergency rooms before getting any medical care because of the company's $150 fee, according to Kaiser Health News.

So spare me this nonsense that hospitals can't aggressively pursue debt. They can even get you PUT IN JAIL.
 
Posted by LetterRip (Member # 310) on :
 
Seneca,

it varies by state. I think most states, as long as you continue to make payments (even token amounts), cannot send you to collections or pursue you legally.
 
Posted by Seneca (Member # 6790) on :
 
Any information to back that up? Didn't seem to help Lisa Lindsay did it?

In my area some of the houses around me in my neighborhood are for sale and are owned by local hospitals who foreclosed on them.

Seems like this is going in many areas and it is spreading.

quote:
As a growing number of hospitals struggle under a glut of unpaid bills
quote:
Accretive says it has such arrangements with some of the country’s largest hospital systems to help reduce their costs.
quote:
Hospitals across the U.S. are trying new methods of avoiding unpaid bills. HCA, the largest for-profit hospital chain


[ February 28, 2014, 08:17 PM: Message edited by: Seneca ]
 
Posted by LetterRip (Member # 310) on :
 
Seneca,

was she making payments every month? From what I could find that is the key factor. Also, as I said, it varys from state to state (apparently Texas is a 'debtors heaven'.)

http://answers.yahoo.com/question/index?qid=20070405075932AAufd4c
 
Posted by Seneca (Member # 6790) on :
 
So depending on where you live, the effects of the ACA may screw you over worse than others? How nice. Is there a reason that in order to fix perceived problems with the healthcare system we had to make it harder for people who had managed to make the previous system work OK for them?
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
in order to fix perceived problems with the healthcare system we had to make it harder for people who had managed to make the previous system work OK for them
It comes down to numbers of people. If 90% of the population had net benefits due to ACA, would you eliminate it?

And what percentage of the population do believe are having the problems? As we have seen, Republican propagandists have put forward a number of individual cases as examples of Obamacare problems (every one I have seen has been false - of course, without apologies from those who put them forward) - why aren't there hundreds of individual documented cases on significant material harm? And if there were, would that counter the benefits that have been received by millions of people?
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Greg Davidson:
quote:
in order to fix perceived problems with the healthcare system we had to make it harder for people who had managed to make the previous system work OK for them
It comes down to numbers of people. If 90% of the population had net benefits due to ACA, would you eliminate it?

And what percentage of the population do believe are having the problems? As we have seen, Republican propagandists have put forward a number of individual cases as examples of Obamacare problems (every one I have seen has been false - of course, without apologies from those who put them forward) - why aren't there hundreds of individual documented cases on significant material harm? And if there were, would that counter the benefits that have been received by millions of people?

Actually what we saw beforehand was of the falsely stated 48.6 million that supposedly lacked healthcare, we are actually likely to see a larger number than that if you factor in people who will remain uninsured + people who will see their quality of insurance and care decrease. So the law is actually making things worse for more people. Even Obamacare's supporters admit that the law will leave 31 million people uninsured, and it has easily decreased the quality and raised cost for at least 40 million Americans who are likely to see their wages decreased or employer coverage decreased when the health law hits them after Obama stops delaying the employer mandate when he no longer cares about winning mid-term elections.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by G3:
Already my predictions are coming true!

quote:
Originally posted by G3 on 12-04-2013 04:38 PM:
However, the law can change at any moment and polling data prior to the 2014 elections may drive significant change if the polling data proves inconvenient for Barry and the democrats ...


And even more true ....again:
quote:
The Obama administration is set to announce another major delay in implementing the Affordable Care Act, easing election pressure on Democrats.

As early as this week, according to two sources, the White House will announce a new directive allowing insurers to continue offering health plans that do not meet ObamaCare’s minimum coverage requirements.

Prolonging the “keep your plan” fix will avoid another wave of health policy cancellations otherwise expected this fall.
The cancellations would have created a firestorm for Democratic candidates in the last, crucial weeks before Election Day.

The White House is intent on protecting its allies in the Senate, where Democrats face a battle to keep control of the chamber.

“I don’t see how they could have a bunch of these announcements going out in September,” one consultant in the health insurance industry said. “Not when they’re trying to defend the Senate and keep their losses at a minimum in the House. This is not something to have out there right before the election.”

Totally nailed it.
 
Posted by Pete at Home (Member # 429) on :
 
Politician has idea that he thinks will make things better. Idea passed into law. Snags upon implementation. Politician slows down implementation to iron things out due to popular complaint. Sounds like Democracy functioning as designed.

Mind you I think the ACA's problems run deeper than that. But this particular event isn't that telling about the ACA's biggest problems.

"totally nailed it."

Congradulations. In other news, I predict the sun will set tonight and rise tomorrow.
 
Posted by G3 (Member # 6723) on :
 
quote:
A supposedly temporary “fix” that President Obama announced in November to address the problem of the millions of Americans who lost coverage as a result of his health care law has now been extended through Oct. 1, 2016, the Department of Health and Human Services announced Wednesday.
Oct. 1, 2016.
 
Posted by Seneca (Member # 6790) on :
 
Looks like it's not working as planned.

quote:
ObamaCare appears to be making little progress in signing up uninsured Americans, one of the law's primary goals, according to two new surveys.

Only one in 10 uninsured people who qualify for private plans through the new health insurance marketplaces enrolled as of last month, according to a survey by the consulting firm McKinsey & Co., The Washington Post reported on Thursday.

The McKinsey survey found that only 27 percent of people who have selected a plan on the exchanges described themselves as having previously been without insurance. That percentage is up from 11 percent a month earlier, the report said.

The Obama administration has said 4 million people have signed up for private coverage through the insurance exchanges although it is not known how many of them had been uninsured.

The administration has said 9 million people are eligible for Medicaid, a number that includes renewals. Outside experts estimate that the Medicaid eligible number may be lower, around 3.5 million.

According to McKinsey, the most common reason for not signing up for insurance cited by both previously insured and previously uninsured survey respondents was the perceived challenges in being able to afford coverage.

A second survey by researchers at the Urban Institute, a Washington D.C.-based think tank, found that Americans with lower incomes and those who are uninsured are less likely to know about the ObamaCare marketplaces than others, the Post reported.

The study, based on data from December, concluded that about 23 percent of uninsured respondents, 27 percent of adults in low-income families, and nearly 23 percent of those ages 18 to 34 had not heard about the marketplaces.

Gary Cohen, the Centers for Medicare and Medicaid Services official who oversaw the insurance marketplaces through their troubled rollout, told an insurance industry conference on Thursday that the administration doesn't know how many uninsured Americans are signing up.

"That's not a data point that we are really collecting in any sort of systematic way," Cohen told attendees when asked how many of the enrollees were previously uninsured, according to The National Journal.

On Wednesday, the Republican-led House backed a one-year delay in the penalty that individuals would have to pay for failing to sign up for health insurance, the 50th time Republicans have forced a vote to repeal, gut or change ObamaCare.

The vote was 250-160, with 27 Democrats joining Republicans on legislation to postpone the individual mandate under the law. The measure stands no chance in the Democratic-led Senate and the White House has threatened a veto.

The 4-year-old law requires U.S. citizens and legal residents to have qualifying health care coverage or face a tax penalty based on household income. The penalty would be phased in at 1 percent of taxable income this year, 2 percent in 2015 and 2.5 percent in 2016.

Meanwhile, in a virtual town hall meeting with Spanish-language media outlets on Thursday, President Obama disputed that his credibility had been undermined by the chaotic health care rollout and his failure to secure legal status for millions of Latinos in the U.S. illegally.

"The main point that I have for everybody watching right now is, you don't punish me by not signing up for health care," Obama said. "You're punishing yourself or your family if in fact there's affordable health care to be had."

Obama's push to boost enrollment comes as the end-of-March deadline to enroll is rapidly approaching — and with it, renewed concerns that if the Obama administration misses its target, the insurance pool could become unsustainable and undermine the broader law's success.

So amid all this chaos the
quote:
"The main point that [Obama has]for everybody watching right now is, you don't punish me by not signing up for health care"
That's it Barry, THAT'S what those silly citizens are trying to do, they're trying to PUNISH YOU! THAT'S THE REASON THEY HAVEN'T SIGNED UP! [Roll Eyes]
Any problems with people signing up with the law is just a way to attack Obama. It doesn't actually represent any real problems with the exchanges, cost, coverage, desirability, medicaid recovery, IPAB, etc, etc.

I'd say this qualifies as almost as serious of a mental disorder as Putin is displaying, though maybe a different kind. Obama and the democrats are lashing out at anyone who is having trouble with this law.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Seneca:

quote:
"The main point that [Obama has]for everybody watching right now is, you don't punish me by not signing up for health care"
That's it Barry, THAT'S what those silly citizens are trying to do, they're trying to PUNISH YOU! THAT'S THE REASON THEY HAVEN'T SIGNED UP! [Roll Eyes]

What a incredible display of narcissism. All about you Barry, it's always all about you.
 
Posted by scifibum (Member # 945) on :
 
You guys are kidding yourselves if you don't think a lot of the opposition to the ACA has been motivated by a desire to see Obama fail.
 
Posted by G3 (Member # 6723) on :
 
No, it's racism. I think you're supposed to call us racists. That's the approved meme.
 
Posted by scifibum (Member # 945) on :
 
That's pretty hypocritical, considering most of your material is copied and pasted from the right wing blogosphere.
 
Posted by Seneca (Member # 6790) on :
 
So the numbers reported from the administration are really just the "right wing blogosphere?"

Obama is a member of the "right wing blogosphere?"

[Confused]
 
Posted by scifibum (Member # 945) on :
 
Seneca, you're demonstrating poor reading comprehension. G3 implied that I only argue from "approved memes". I said most of his material comes from the right wing blogosphere - in other words, he has a pattern of doing what he's wrongly accusing me of doing (I do not, in fact, get my opinions from left wing sources, which I understand may be hard for G3 to imagine).

I did not say that EVERY copy and paste comes from there. I did not say that this one does.
 
Posted by Seneca (Member # 6790) on :
 
How instead of attacking G3's supposed "favorite sources" you respond to this quote from Obama:

quote:
"The main point that I have for everybody watching right now is, you don't punish me by not signing up for health care," Obama said. "You're punishing yourself or your family if in fact there's affordable health care to be had."

 
Posted by NobleHunter (Member # 2450) on :
 
It sounds like he wants people to evaluate the law on its merits rather than pure partisan reflex.
 
Posted by G3 (Member # 6723) on :
 
I am talking about the memes used to oppose Obamacare. If you believe it's out of a desire to see some kind of personal failure in Barry, then you're deluded.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by NobleHunter:
It sounds like he wants people to evaluate the law on its merits rather than pure partisan reflex.

Didn't read down that far ...

See? If you oppose it, it's pure partisan reflex. Or maybe it's racism. One of the two. Can't be anything else.
 
Posted by NobleHunter (Member # 2450) on :
 
No. Please try and respond to what I'm actually saying.

ETA: Removed unnecessary snark.

[ March 07, 2014, 12:35 PM: Message edited by: NobleHunter ]
 
Posted by Seneca (Member # 6790) on :
 
Obama was saying the "MAIN point," amid all the genuine problems that his own administration admit are occurring is that people who aren't signing up are doing it to punish him...
 
Posted by D.W. (Member # 4370) on :
 
He's wrong that it was about him. He has a legitimate reason to try to convince people it's not worth trying to hurt his party. I don't think he's correct that the tactic is not valid.

Besides, he made sure people couldn't "hurt themselves" until after the election. Why shouldn't they stall at this point?
 
Posted by NobleHunter (Member # 2450) on :
 
Or he's just addressing one motivation among many. A movitation, mind you, that his political opponents have encouraged at every opportunity.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Besides, he made sure people couldn't "hurt themselves" until after the election. Why shouldn't they stall at this point?
Skipping needed medical care because you don't have sufficient coverage to afford it, which he\ was talking about, is not something that has been put off till after the election.
 
Posted by D.W. (Member # 4370) on :
 
Those who know they need coverage will get it. People living paycheck to paycheck do not (or cannot) afford to "insure" against potential illness / injuries.

They may not BE ABLE TO put it off till after the election if they get sick or are injured but they WILL gamble that this won't happen.

When you are strapped for cash insurance is an investment or not justifiable. It is not something you get "just incase". The reality of how people buy and use insurance is nowhere near the same for those writing the laws and those they need to sign up.

The only way to change this quirk of economics and human nature is to mandate insurance by law. Take the teeth out of that mandate and you are the same as grandma telling you, "You really should save more money for a rainy day." Good advice, that is most likely ignored.
 
Posted by Seneca (Member # 6790) on :
 
So in reality Obama just took the whole problem of uninsured going to the ER and getting free care that he was fake-complaining about and expanded it to be much worse by allowing people to wait to get sick then sign up for health insurance.

Then again it probably wasn't an accident. My guess is this is a very deliberate calculation designed to break the private insurance industry completely and try to push us to single payer, as the ACA's authors have publicly suggested.
 
Posted by NobleHunter (Member # 2450) on :
 
Well, private insurance is a ****ing awful way to provide healthcare.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by NobleHunter:
No. Please try and respond to what I'm actually saying.

I am. I am not trying to be snarky or anything, that really is the general response to opposing Obamacare.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by NobleHunter:
Well, private insurance is a ****ing awful way to provide healthcare.

Yeah, the only thing worse is public healthcare.
 
Posted by D.W. (Member # 4370) on :
 
quote:
So in reality Obama just took the whole problem of uninsured going to the ER and getting free care that he was fake-complaining about and expanded it to be much worse by allowing people to wait to get sick then sign up for health insurance.

Then again it probably wasn't an accident. My guess is this is a very deliberate calculation designed to break the private insurance industry completely and try to push us to single payer, as the ACA's authors have publicly suggested.

With how the implementation and penalty delays have been implemented I believe that is where we are trending. I'm not prepared to say this was the intent yet. I still hold idealism and political cowardice as likely as deliberate sabotage to the current industry.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by D.W.:
quote:
So in reality Obama just took the whole problem of uninsured going to the ER and getting free care that he was fake-complaining about and expanded it to be much worse by allowing people to wait to get sick then sign up for health insurance.

Then again it probably wasn't an accident. My guess is this is a very deliberate calculation designed to break the private insurance industry completely and try to push us to single payer, as the ACA's authors have publicly suggested.

With how the implementation and penalty delays have been implemented I believe that is where we are trending. I'm not prepared to say this was the intent yet. I still hold idealism and political cowardice as likely as deliberate sabotage to the current industry.
So you won't take Harry Reid at his word?
 
Posted by NobleHunter (Member # 2450) on :
 
G3, the general response is not my response. Please try and distinguish between the two.
 
Posted by D.W. (Member # 4370) on :
 
I take nobody at their word Seneca. What in particular are you referring to?
 
Posted by Seneca (Member # 6790) on :
 
http://www.forbes.com/sites/theapothecary/2013/08/10/sen-harry-reid-obamacare-absolutely-a-step-toward-a-single-payer-system/
 
Posted by D.W. (Member # 4370) on :
 
Are you asking me if I think he speaks for all those who pushed for and helped implement ACA? No, I don’t' think he does. I'm actually for a single payer system. I just don't know if I believe that intentionally orchestrating chaos was the path mapped out to achieve it.

I believe it's possible, I'm just not convinced yet.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Seneca:
http://www.forbes.com/sites/theapothecary/2013/08/10/sen-harry-reid-obamacare-absolutely-a-step-toward-a-single-payer-system/

Do we look like the sort of people that take a senator's opinion for gospel? I am OK with single payer; it's the fascistic aspects of the aca I dislike. The system was fascist enough before the AcA. Now the little clinics are getting mowed down in favor of mcMed.
 
Posted by Seneca (Member # 6790) on :
 
SP is pretty awful, I'm not a big fan of a government denying care and then having a monopoly on the system so you can't go elsewhere for care.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
SP is pretty awful, I'm not a big fan of a government denying care and then having a monopoly on the system so you can't go elsewhere for care.

That's not single payer, That's a rather broken version of a fully public health care system.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Seneca:
SP is pretty awful, I'm not a big fan of a government denying care and then having a monopoly on the system so you can't go elsewhere for care.

Either you or I does not know what single payer means. I think the rich will always have their platinum plans; that is how all technology works with higher payers paying for research by being the early adopters. My ideal is a govt system of the basic established tried, true, and less expensive systems. Paid for by a selectice usage tax so imports carry their fair share if the burden.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by NobleHunter:
G3, the general response is not my response. Please try and distinguish between the two.

OK, how about the latest official one (that I actually kind of forgot about): calling those that say bad things about Obamacare liars? Official because it was done by Harry Reid on the floor of the senate.
 
Posted by Pete at Home (Member # 429) on :
 
I guess the answer is no, NH. G3 seems to be unable to distinguish gay Canadians from Nevada senators.
 
Posted by Seneca (Member # 6790) on :
 
Ooops!

Union research says Obamacare will worsen income inequality

quote:
As national Democrats prepare to run against the GOP on income equality issues, a giant union has issued a scathing Obamacare document that could undermine that case.

"The Irony of ObamaCare: Making Inequality Worse" is the title of the UNITE HERE (Culinary parent) document that is posted here and soon to be making its way to Capitol Hill. It is devastating to the Democrats. To wit:

Ironically, the Administration’s own signature healthcare victory poses one of the most immediate challenges to redressing inequality. Yes, the Affordable Care Act will help many more Americans gain some health insurance coverage, a significant step forward for equality. At the same time, without smart fixes, the ACA threatens the middle class with higher premiums, loss of hours, and a shift to part-time work and less comprehensive coverage.

The paper argues that the Affordable Care Act will transfer a billion dollars in wealth to insurance companies, create an unlevel playing field in the market, force employers to cut back hours and result in pay decreases. It lays it out in detail, with examples of union workers affected by Obamacare.

And then it concludes:

For two years, labor unions and employer partners have patiently explained to the Obama Administration and Congress the potential damage that the ACA poses to these unique, successful non-profit health plans.

Having already made efforts to accommodate businesses, churches and congressional staff, it is ironic that the Administration is now highlighting issues of economic inequality without acting to preserve health plans that have been achieving the goals of the ACA for decades. Without a smart fix, the ACA will heighten the inequality that the Administration seeks to reduce.

We take seriously the promise that “if you like your health plan, you can keep it. Period.” UNITE HERE members like their health plans. UNITE HERE’s plans are ready to compete with the corporate giants of the health insurance industry if Washington will simply create a level playing field.

UNITE HERE leader D. Taylor has sent the paper to national union leaders, with a cover letter (also attached here) that pivots at one point over comments attributed to New Jersey Sen. Robert Menendez:

In other words, rollback what you have and take one for the team. Ironic given that Congress and the President carved out an exemption for staffers on the ACA.

We cannot sit idly by as the politicians carve up our health plans while they carve out exceptions for themselves and every special interest feeding at the trough in Washington.

Anyone who thought the unions would just slink back into the fold better rethink that notion.


 
Posted by G3 (Member # 6723) on :
 
This being the active Obamacare thread, let's drop the latest in here ...

A couple of days ago, Barry toddles off to a town hall for Spanish-language media to discuss ObamaCare and promote enrollments - we're in the full court press you know. One of the people there questions Barry on the economics of it all for low-income Americans who are now forced to buy comprehensive health insurance. Like many, they can't afford the affordable health care Barry is forcing them to buy.

Barry's response? Pshaw, all those low-income folks need to do is stop spending money on luxuries like cable television and cell phones! I'm paraphrasing but you can see the entire thing here and see that is essentially his response. For those that refuse to follow links, I will attempt to transcribe:
quote:
I guess what I would say, if you looked at that person's budget, looked at their cable bill, their telephone, their cell phone bil, other things that they're spending on, it may turn out that, it’s just they haven’t prioritized health care.
Yeah, take that suckers.
 
Posted by Wayward Son (Member # 210) on :
 
Speaking of the latest, The Detroit News took another look at Broostra's health plan.

quote:
Boonstra said Monday her new plan she dislikes is the Blue Cross Premier Gold health care plan, which caps patient responsibility for out-of-pocket costs at $5,100 a year, lower than the federal law’s maximum of $6,350 a year. It means the new plan will save her at least $1,200 compared with her former insurance plan she preferred that was ended under Obamacare’s coverage requirements.
(Emphasis mine.)
 
Posted by D.W. (Member # 4370) on :
 
Was she going up to the max out of pocket? If her out of pocket (healthy and not using it to the max) is higher then this isn't a fair way to break down the difference.

I know a lot of low income people who would look at that $6,3500 number and wonder why the hell they had insurance.

Cap costs luckily are not going to affect most of us. For people who live paycheck to paycheck beyond a couple thousand you are just talking degrees of financial ruin.
 
Posted by Wayward Son (Member # 210) on :
 
But as discussed before, she was paying over $1000/month premiums for her previous, "better" insurance, almost twice the premium for her new coverage. So she can afford the insurance and the co-pays. It is the only the cash-flow that is the problem.

And as discussed before, hospitals will usually work with you if you can't afford to pay right away (especially if they know you are good for it).

And as I mentioned before, if she saves the difference, in a few years she will have the co-pay in the bank. (Turns out it would take 4 1/4 years.)

This is not to say that her situation is easy, or that she may not prefer to be on her old plan. But my point was that her situation is being held up as an example of why Obamacare is a disaster. According to the Right, this is an example of how bad Obamacare is!

You gotta admit, compared to someone unable to get insurance because of some existing condition, like leukimia, Broostra is not that badly off. [Wink]
 
Posted by D.W. (Member # 4370) on :
 
Wasn't suggesting she was. I agree that she is seeing an improvement in healthcare plans. But without that context, the "savings" is very theoretical for most purchasers.

I'm all for everyone having health insurance. I just think that selling a plan based on maximum out of pocket expenses is an awful metric to use. Those who can manage to pay that amount aren't in need of the ACA to mandate they be covered anyway.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Wayward Son:
Speaking of the latest, The Detroit News took another look at Broostra's health plan.

quote:
Boonstra said Monday her new plan she dislikes is the Blue Cross Premier Gold health care plan, which caps patient responsibility for out-of-pocket costs at $5,100 a year, lower than the federal law’s maximum of $6,350 a year. It means the new plan will save her at least $1,200 compared with her former insurance plan she preferred that was ended under Obamacare’s coverage requirements.
(Emphasis mine.)
How is this news? We already knew the total annual out of pocket was less, but the monthly out of pocket is more. You were also shown several examples of how common it is for hospitals NOT to "work" with you to magically arrange payment plans and to send you to collections after a very short period of time.

What's the point of an annual out of pocket that is less if she can't make the full year before they send her to collections? Why are you not getting this? Please scroll up and re-read the relevant cites.
 
Posted by Seneca (Member # 6790) on :
 
Looks like another victim of Obamacare has raised her ugly head! Liar! Charlatan! Impostor! Where is Harry Reid and MSNBC to excoriate her?

quote:
WASHINGTON – Months after cancer survivor Annette Frey was dropped by her insurance provider and forced to sign up for ObamaCare, the New Yorker is still finding herself on the losing end of a bureaucratic runaround.

At the heart of her maze of problems is the fact that the plan she signed up for on the New York exchange listed doctors she needed as "in network" -- she later found out they were not. Frey tells FoxNews.com she’s at her wit’s end trying to decode what she needs to do to be able to see the doctor who diagnosed her lung cancer two years ago.

She also wants to be able to get referrals to see specialists in Manhattan and approval for six-month checkups, which include CAT scans and pulmonary function tests.

But so far, she hasn’t been able to.

Frey, now a small business owner, was forced to wait weeks to find out if she would even be able to see her primary care physician.

She was then repeatedly told one thing by her doctor’s office, promised another by her insurance provider and left in limbo while trying to untangle the contradicting information on her own. Stuck in a cycle of misinformation, Frey has made close to 200 calls looking for services she says were promised when she signed up through the New York state exchange.

New York’s exchange, called NY State of Health, allows customers to pick from dozens of plans offered by 16 insurance companies operating through it.

Frey chose the most expensive one.

“I signed up for United Healthcare specifically because of the doctors I needed that were ‘in network’ – something I went to great lengths to verify before signing up,” she told FoxNews.com.

But Frey says there was almost immediate confusion over which doctors and hospitals were actually participating in the plan. The lists of providers and services, she says, weren’t matching up.

“Trying to make an informed choice with this insurance was virtually impossible,” she said.

Frey, who has worked in the health care field for 15 years, said she tried to contact doctors listed in the exchange to verify their participation only to be told they weren’t in the network.

“I’m not stupid. I did my homework,” she said. “I called the doctors and they would say, ‘We are absolutely not taking that insurance.’”

United Healthcare says that Frey's case is unique and doesn't reflect how the company supports its members.

"Our New York State of Health Marketplace network is evolving in real-time," United Healthcare said in a written statement to FoxNews.com. "Ms. Frey’s doctor has opted not to participate in individual exchange networks. We apologize to Ms. Frey for any inconveniences she experienced as this does not reflect how we like to support our members."

Bounced back and forth between doctors, the Department of Financial Services and even New York Gov. Andrew Cuomo’s Albany office -- which she called twice in an act of desperation -- a frustrated Frey said not knowing if she was insured was taking its toll.

“I don’t think people understand the stress,” she said. “My insurance is making me sick. I can’t do this every time I need to see a doctor.”

As one of millions dropped by her previous insurance company in October due to the health law, Frey was forced to find a new policy.

“I cried,” she said. “I am a tough New Yorker but I cried.”

She wasn’t alone.

To date, more than 6 million individual and small business policies have been canceled in what has been one of the most politically damaging hits ObamaCare has had to absorb. Last fall’s wave of cancellations came as the troubled federal website HealthCare.gov debuted to a list of technical glitches, some so severe the site had to be shut down for hours at a time.

The insurance cancellations undercut President Obama’s oft-repeated pledges that people would be allowed to keep their doctors and their insurance plans if they were satisfied with them. Obama tried to address the situation by letting state insurance commissioners and insurers re-offer canceled plans. New York, though, did not go along with that reprieve.

Frey says she decided to go with United Healthcare because of its big-brand name. But she claimed the “insurance -- the most expensive one in the exchange – was almost unusable.”

In addition to having trouble finding in-network physicians, Frey says the locations listed were also wrong.

“They have doctors signed up at locations, they don’t even work or see patients, and others whose location is correct but they still are not actually in the exchange insurance,” she said. “It’s a big mess and there seems no end in sight.”

Once she picked a plan that included her primary care physician in late December, she was then told she couldn’t actually use the insurance for several weeks. When Frey pushed back, she was then told she would be able to see her doctor for a Jan. 8 appointment.

“I was assured that everything was ok,” she said. “I said I needed confirmation I was insured and could see the doctor and that I needed to know that to be able to sleep at night.”

She says she was given that assurance and on Jan.8 she went to see her doctor.

But following the visit, she received a notice from United that denied her claim, once again saying her doctor, the one whose name was now printed on the insurance card they sent her, was not in-network. That dispute remains unresolved.

United Healthcare says its involvement with the exchanges are a work in progress.

"We are in active negotiations with hospitals and physicians to participate in the exchange network and will continue to update our directories to reflect those changes," the insurance company said. "We also will continue to review our processes to ensure that we avoid issues like Ms. Frey had."

Multiple calls to NY State of Health were not returned.


 
Posted by Wayward Son (Member # 210) on :
 
quote:
You were also shown several examples of how common it is for hospitals NOT to "work" with you to magically arrange payment plans and to send you to collections after a very short period of time.
What do you think a collection agency does? Stand on your doorstep until you cough up the cash? They make payment arrangements. They will let you pay in installments, just as long as you pay.

The examples you cited are people who would not pay at all (if only because they didn't owe anything, but that's a different problem [Smile] ). That's when things get rough.

Yes, Broostra could get thrown to a collection agency, and yes, it should not happen. But it would only happen after the hospital refuses to work with her. And why would the hospital go through the expense of hiring a collection agency when they could get their payments without one??

It's possible, but unlikely.

And if an unlikely possibility is the worst that the Right can scream about--unlike the many instances where people were denied coverage before Obamacare--then it is doing a pretty good job. [Smile]
 
Posted by Wayward Son (Member # 210) on :
 
quote:
Looks like another victim of Obamacare has raised her ugly head! Liar! Charlatan! Impostor! Where is Harry Reid and MSNBC to excoriate her?
I doubt you'll be hearing much excoriation about this, Seneca, because this is a well-known problem with the computer system. NPR had a report about it a few weeks ago. They are working on fixing it, but it is the old GIGO problem; the insurance companies but in bad data.

It will sift out eventually, but yes, it is a problem. So no one is going to scream at this one, unlike the other outright fraudulent ads we've seen in past.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Wayward Son:
quote:
Looks like another victim of Obamacare has raised her ugly head! Liar! Charlatan! Impostor! Where is Harry Reid and MSNBC to excoriate her?
I doubt you'll be hearing much excoriation about this, Seneca, because this is a well-known problem with the computer system. NPR had a report about it a few weeks ago. They are working on fixing it, but it is the old GIGO problem; the insurance companies but in bad data.

It will sift out eventually, but yes, it is a problem. So no one is going to scream at this one, unlike the other outright fraudulent ads we've seen in past.

Impossible! All people complaining about Obamacare are lying. Holy Leader Reid says it is so!
 
Posted by Wayward Son (Member # 210) on :
 
You've been listening to Holy Leader Limbaugh too much, Seneca. [Big Grin]
 
Posted by Seneca (Member # 6790) on :
 
So you claim Reid never said that? By the way I don't listen to Limbaugh.
 
Posted by Wayward Son (Member # 210) on :
 
He didn't say what you said he said. [Smile]

He said all the ads that he had seen were lies, which is an exaggeration, but not as bad as you'd think.

quote:
By our count on You Tube, Americans for Prosperity has run about 50 anti-Obamacare ads since July. ...

The Fact Checker, for instance, has examined five of these ads, and has given four of them Two Pinocchios. However, one received just a single Pinocchio, and we praised it for sticking relatively close to the facts for an attack ad. ...

PolitiFact, meanwhile, has looked at six of these ads. In two cases, it said it did not have enough facts for its Truth-O-Meter, but otherwise it awarded one “half true,” two “mostly false,” and one “false” for these ads. Our colleagues at FactCheck.org do not use a rating system, but have faulted two of the ads for lacking context or being wrong.

We should note that AFP is very aggressive with its ads. In the past, it has earned Four Pinocchios from The Fact Checker, and more than 80 percent of its PolitiFact ratings have been Pants on Fire, False or Mostly False. (The percentage declines if you include ads that did not yield a rating.) It has never earned a True or Mostly True rating, which for some political organizations might be a badge of honor.

So while saying all ads are lies is wrong, it has been shown that a vast majority of the ones checked have levels of untruthfulness in them. [Smile]

And if you are citing a new ad, you cannot hold Harry to his statement for that.

And I simply mentioned Limbaugh because of your "Holy Leader Reid" statement. I have heard no one on the left call him "holy" or even particularly moral. [Smile] He certainly is not a highly-beloved figure whose every word is cherished and believed.

The only ones I know of to suggest that Reid is "holy" are the right-wing pundits. So I simply used the highest-profile one as an example.

If you believe Reid to be "holy," let me dissuade you of that notion. And if you believe others believe him to be "holy," I would suggest you check your sources. They might be just a bit biased. [Wink]
 
Posted by Seneca (Member # 6790) on :
 
That is not what Reid said that is relevant here.

Do you want to look up the actual quote or do I need to do it for you? He gave a speech, it was well documented...

You are ignoring the first quote he made that is relevant.
 
Posted by Seneca (Member # 6790) on :
 
In other news, it seems Obama has gutted his own law. "Hardship" is not defined...

quote:
In what might be the death knell for ObamaCare's most controversial component -- the individual mandate to buy insurance -- the administration has added a mega-exemption that critics say would allow virtually anybody to skirt the rule.

"This is a huge public policy decision that could affect millions of Americans," House Speaker John Boehner said, adding that the latest change, made ahead of the March 31 enrollment deadline, applies to "essentially everyone."

"The door's wide open," economist Doug Holtz-Eakin, who leads the conservative-leaning American Action Forum, told Fox News. "[The] mandate which they said was absolutely crucial to ObamaCare is falling apart day by day."

The most recent exemption appears to have been included last week, in an ObamaCare application document. There already had been 13 distinct exemptions, but this document added one more.

The document said that individuals can now qualify for a "hardship exemption" -- meaning they would not have to pay a penalty for not buying insurance -- if they "experienced another hardship in obtaining health insurance."

The document does not define what "another hardship" means, and suggests the administration might not be a stickler when it comes to proof either. It says anyone seeking this exemption should "submit documentation if possible."

Of all the exemptions created so far, this category appears to be the broadest. Prior exemptions were created for people who are homeless, who filed for bankruptcy, who experienced a fire and who dealt with other financial emergencies. Already, the 13 exemptions previously on the books could apply to millions. One created in December would give a pass this year to many of those whose policies were canceled due to ObamaCare and who struggled to find an affordable option -- last week, the administration quietly extended that waiver through 2016.

All along, the administration has rejected congressional attempts to officially delay the individual mandate in its entirety. The White House even threatened to veto one such bill.

But the 14 exemptions now on the books raise the question of whether the mandate has been pushed off in all but name.

"There's a real question as to whether the White House just abandoned the individual mandate," Boehner said Thursday. "It just seems they are hoping no one will notice."

Health and Human Services Secretary Kathleen Sebelius defended the "hardship exemptions" during testimony Thursday before a House subcommittee.

"It's been really aimed at people who could not afford coverage one way or the other," she said. She noted that the list includes people who live in states that did not expand eligibility for Medicaid.

But Holtz-Eakin, former director of the Congressional Budget Office under the George W. Bush administration, said that for someone to qualify for the latest waiver, they could simply say they couldn't get through on HealthCare.gov or plans were too expensive or a special condition they have didn't appear to be covered.

As a consequence, he said, there could be "chaos" in the insurance market. Insurance companies, in exchange for taking on older and sicker patients as part of the Affordable Care Act, were counting on millions of young and healthy Americans signing on. The individual mandate -- and the penalty that comes with it -- was supposed to compel people who might not otherwise buy insurance to enter the system.

Now that the mandate is being softened, it's unclear whether insurance companies will have enough of those new customers to keep premiums down for everyone else.


 
Posted by noel c. (Member # 6699) on :
 
"Now that the mandate is being softened, it's unclear whether insurance companies will have enough of those new customers to keep premiums down for everyone else."...

They have a way to cover that contingency. It is called the U.S. Taxpayer, who is the statutory re-insurer... What a convoluted obamination this thing is, twisting in the wind as we remove the previously insured into Medicare, and throw those still desirous of maintaining their policies into a private market of government-planned disarray.

The only way for insurance companies to develop new actuarial tables is to hear Barry speak the words of the defacto reality; "There is no personal mandate.".
 
Posted by D.W. (Member # 4370) on :
 
So we've made discrimination based upon pre-existing conditions illegal, put early 20's under their parents umbrella (since we can't employ them at a reasonable rate) and that's about it?

And the insurance companies totally fell for it? Score!
 
Posted by Wayward Son (Member # 210) on :
 
quote:
That is not what Reid said that is relevant here.

Do you want to look up the actual quote or do I need to do it for you?

I assume you are referring to the quote from his Feb 26 speech:
quote:
Despite all that good news, there’s plenty of horror stories being told. All are untrue, but they’re being told all over America.
That was quoted at the beginning of my link.

Is there another quote and/or speech you are referring to? If so, you will need to specify which one.

I can't imagine your quote would be much different, though, so I can't imagine it would affect what I said.
 
Posted by Seneca (Member # 6790) on :
 
Wow, here's another "unforeseen" consequence. (not really)

quote:
The largest doctors group in the country is raising alarm that an obscure ObamaCare rule could stick them with the tab for patients who skip out on paying their premiums.

The American Medical Association, which originally supported the Affordable Care Act, warned the rule could pose a "significant financial risk" for doctors and hospitals, and on Wednesday blasted out guidelines to help members try and avoid those costs.

At issue is a 90-day "grace period" which lets patients who are not paying their premiums keep coverage for 90 days before it can be canceled.

Under the rule, insurers are responsible for paying any claims during the first month of that period -- but not necessarily for any claims during the final 60 days.

"Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers," AMA President Ardis Dee Hoven said in a statement.

The concern from physicians comes on top of widespread concerns from the insurance industry about the mix of new customers being signed up for coverage under the newly launched health insurance exchanges. The deadline for that coverage is March 31, and so far the Obama administration is lagging behind its enrollment projections.

But while insurance companies worry about having to take on costlier patients, medical practices are worried what happens when those patients stop paying their insurers.

The AMA has been urging the Obama administration to tweak the rules so that insurers are at least required to notify doctors as soon as a patient falls behind on insurance payments. In the interim, the guidelines sent out Wednesday were meant to help doctors and hospitals "minimize" those risks -- by, among other things, closely tracking grace-period notifications and checking whether state laws allow insurers to deny claims during these periods.

The main concern is that insurers could be allowed to place all claims incurred during the last 60 days in a "pending status" -- and then deny them if coverage ultimately is canceled.

But the administration argues that the grace-period rule is limited. It only applies to people who already have paid one month's premium, and requires insurers to tell doctors "as soon as practicable" when a customer is falling behind.

"Grace periods are important to ensure that consumers aren't dropped from coverage, especially for those experiencing economic challenges," said Alicia Hartinger, spokeswoman for the Centers for Medicare & Medicaid Services. "It is also important to us that providers know in a timely fashion whether their patients are in a grace period or not."

One possible -- and controversial -- solution for hospitals is for them to help struggling patients pay their premiums. But, as the AMA guidelines noted, the Department of Health and Human Services has strongly advised against this and threatened to take action if necessary.

The AMA said doctors "should exercise extreme caution" before even discussing that possibility with patients.

Doctors will essentially be blackmailed into paying their own patients' health insurance premiums or risk being stuck with even larger expenses if those patients stop paying for their insurance.

As if there wasn't already disincentive enough for people choosing medical careers, this combined with the huge medicaid expansion will only exacerbate the doctor shortage.

Given how much the ACA has harmed the medical industry, only financial fools would ever want to pursue MDs anymore.

[ March 20, 2014, 04:14 PM: Message edited by: Seneca ]
 
Posted by TomDavidson (Member # 99) on :
 
quote:
only financial fools would ever want to pursue MDs anymore
I would like to suggest that the single most important factor in driving down medical costs will be reducing the total salaries of healthcare providers. Given this -- given that this is only one of three categories where real savings and improvement is possible, in fact -- it seems to me that people who become doctors hoping to get rich must be implacable enemies of any attempt to keep healthcare affordable.
 
Posted by Pete at Home (Member # 429) on :
 
nonmedical bureaucracy and medicine costs are driving the price of medicine, not doctor salaries.

The ACA, at least with oncology where I've seen how it operates, takes money out of clinics where the patients get more time with the doctors, and actually gives more compensation for medicines distributed to the hospitals where the bureaucracy and corporation pockets the profit. Private Oncologists can end up taking a loss on meds alone when they deal through medicaid.
 
Posted by Grant (Member # 1925) on :
 
I tend to believe that health insurance has been driving the rising cost of healthcare. Doctors and hospitals can charge whatever they desire as long as patients are not the ones actually doing the paying, and there is no cost transparency. I believe this is why Lasix surgery is so cheap.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
nonmedical bureaucracy and medicine costs are driving the price of medicine
Bureaucracy, pharmaceuticals and equipment, and physician salaries are the major drivers of medical cost. It's certainly true that hospitals are the enemy of private practices and clinics, though; they're motivated to consolidate.

---------

quote:
I tend to believe that health insurance has been driving the rising cost of healthcare.
This is absolutely true.
 
Posted by Seneca (Member # 6790) on :
 
I think I prefer a surgeon working on my brain to be extremely well paid for what he does. The alternative experience was the medical profession in the USSR. Should we look at the quality of docs they got for that pay level?

If someone is going to have to go through nearly 3 decades of education and training and probably heavy debt, it seems insane in a capitalist system to reduce their pay.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by TomDavidson:


This is absolutely true.

I said the same thing in August of last year, and Pyr and LR disagreed. I still tend to believe the same, but have not been able to find something concrete that I think would convince them. Pyr and LR tend to favor complex systems of explaining economics (and everything else), while I tend to favor simplistic systems.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Grant:
... Pyr and LR tend to favor complex systems of explaining economics (and everything else) ...

Man, that totally made me laugh out loud.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
I think I prefer a surgeon working on my brain to be extremely well paid for what he does. The alternative experience was the medical profession in the USSR. Should we look at the quality of docs they got for that pay level?

If someone is going to have to go through nearly 3 decades of education and training and probably heavy debt, it seems insane in a capitalist system to reduce their pay.

I seem to remember reading that Cuban doctors were very well trained, despite the fact that they were paid very little. That seemed to be the driver behind many of them trying to escape Cuba and work in Florida.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by G3:
quote:
Originally posted by Grant:
... Pyr and LR tend to favor complex systems of explaining economics (and everything else) ...

Man, that totally made me laugh out loud.
I hope they don't take it derogatorily. I did not mean it as such. They just think differently then me. I don't believe that one method is inherently superior then another.
 
Posted by Seneca (Member # 6790) on :
 
quote:
That seemed to be the driver behind many of them trying to escape Cuba and work in Florida.
Do you think that maybe that particular possibility crossed their minds BEFORE they started studying medicine...?
 
Posted by PSRT (Member # 6454) on :
 
While health insurance costs are a driver of health care costs, health insurance and health care costs really started to grow rapidly when we started allowing prescription drug advertisements...
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Do you think that maybe that particular possibility crossed their minds BEFORE they started studying medicine...?

I have to admit this is a possibility, but it does not change the fact that you can have cheaply paid, well trained doctors.

Special Forces operators are cheaply paid for the level of training (provided free of charge by the government of course) and physical/mental abilities they have, until they go into the private sector as either mercenaries or private security.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by Seneca:
Do you think that maybe that particular possibility crossed their minds BEFORE they started studying medicine...?

I have to admit this is a possibility, but it does not change the fact that you can have cheaply paid, well trained doctors.

Special Forces operators are cheaply paid for the level of training (provided free of charge by the government of course) and physical/mental abilities they have, until they go into the private sector as either mercenaries or private security.

Answer this question: are there enough doctors right now for the demand and expected demand with the ACA's expansion of medicaid?

If the answer is no, which it MUST be, is there any other possible conclusion that decreasing doctor pay will NOT increase the number of doctors? Nope. I guarantee you that decreasing doctor pay will NOT yield any new doctors.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Answer this question: are there enough doctors right now for the demand and expected demand with the ACA's expansion of medicaid?

I have no clue. I would guess no. The last I heard there was a shortage of physicians in the United States, and there are an increasingly growing number of health problems, particularly among the growing demographic of the elderly, due to the aging of the baby boomer generation.


quote:
If the answer is no, which it MUST be, is there any other possible conclusion that decreasing doctor pay will NOT increase the number of doctors? Nope. I guarantee you that decreasing doctor pay will NOT yield any new doctors.
I don't imagine that decreasing doctor pay will increase the number of students enrolling in medical school, unless the cost of medical school is substantially lowered, and medical schools begin accepting more students.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by TomDavidson:


This is absolutely true.

I said the same thing in August of last year, and Pyr and LR disagreed.
Please cite what you're talking about, because otherwise that's pretty nonsensical. Unless you're mistaking trying to describe the nominal mechanism by which a given system is supposed to work with actually believing that it will work properly.

I've never directly advocated any private insurance based system for regular care, but specifically supported single payer as the best path for universal access and price stability.


The private insurance model is horrible, and while the ACA will reign in some of it's worst excesses, doing so will only ultimately show just how poor a system it is when it actually has to provide its nominal service instead of just being a tool to squeeze money out of people.
quote:
Pyr and LR tend to favor complex systems of explaining economics (and everything else), while I tend to favor simplistic systems.
I'm not sure what you're talking about here either. I'm very willing to go into the weeds about complex systems- but being willing to discuss real complexity doesn't mean that the principles that I describe are all that complicated.
 
Posted by Grant (Member # 1925) on :
 
quote:
Pyr: Please cite what you're talking about, because otherwise that's pretty nonsensical. Unless you're mistaking trying to describe the nominal mechanism by which a given system is supposed to work with actually believing that it will work properly.

I've never directly advocated any private insurance based system for regular care, but specifically supported single payer as the best path for universal access and price stability.

The private insurance model is horrible, and while the ACA will reign in some of it's worst excesses, doing so will only ultimately show just how poor a system it is when it actually has to provide its nominal service instead of just being a tool to squeeze money out of people.


Jeez. Calm down. Do you think I'm lying? Or just nonsensical? It was on August 8th last year. Thread that started out about hip replacement then morphed into a discussion about corporatism, etc.

Go ahead and tell me how I have it all wrong, Pyr. That's why I come to Ornery.

quote:
I'm not sure what you're talking about here either. I'm very willing to go into the weeds about complex systems- but being willing to discuss real complexity doesn't mean that the principles that I describe are all that complicated.
The principals you describe are very complicated to my very tiny brain, Pyr.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by PSRT:
While health insurance costs are a driver of health care costs, health insurance and health care costs really started to grow rapidly when we started allowing prescription drug advertisements...

Amen! Under the current regine the feds pay for the medical research while big pharma spend its research dollars basically in marketing research.

I strongly disagree with the proposition of impoverishing our physicians. Just how much medical access to the poor have in Cuba when their physicians are literally whoring themselves to tourists on the beach? I'd rather have doctors earn their living and pay their loans practicing medicine than moonlighting in the sex trade.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Grant:
quote:
Pyr: Please cite what you're talking about, because otherwise that's pretty nonsensical. Unless you're mistaking trying to describe the nominal mechanism by which a given system is supposed to work with actually believing that it will work properly.
Jeez. Calm down. Do you think I'm lying? Or just nonsensical? It was on August 8th last year. Thread that started out about hip replacement then morphed into a discussion about corporatism, etc.

And if you go back and review, I think you'll find that my position was that providing such base on doctor's evaluations that they were necessary was not a driver of health care costs. Nothing specifically to do with insurance, except that insurance does help a slightly larger portion of the population how needs them have access. I didn't say that insurance wasn't a bad model for providing such services or that, especially as it is structured, it doesn't serve to inflate costs by allowing prices to increase arbitrarily.

I did contest the notion that we can only control prices by denying some portion of the population who needs care the care that they need; that we're dealing with a zero sum game that justifies forcing people to suffer for the greater good, instead of prioritizing getting everyone the level of service they need to be healthy and functional.


quote:
quote:
I'm not sure what you're talking about here either. I'm very willing to go into the weeds about complex systems- but being willing to discuss real complexity doesn't mean that the principles that I describe are all that complicated.
The principals you describe are very complicated to my very tiny brain, Pyr.
I can break the core down to four pretty simple points:

-Money is a public accounting measure, created by the community at large by fiat as it needs it.

-Similarly, taxation at the issuing level effectively destroys money by removing it from accounts.

-We can and should create and distribute sufficient financial resources such that all members of society are ensured a baseline standard of living that does not prevent them from pursuing whatever productive opportunities they feel best suit them (ie: lower middle class), and ensures that everyone who is willing to work is guaranteed a baseline level of employment, regardless of current market conditions.

-Adam Smith was right on the money when he said that the fundamental mechanism of a healthy, free market is people trying to honestly appeal to the un-forced self interest of those that they wish to gain something from in order to work out mutually profitable transactions. Myths that are propagated about personal self-interest and individual profit maximization as being ideal market goals actually promote the very kind of mercantile exploitation that he was arguing leads to pathological market failures.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
I strongly disagree with the proposition of impoverishing our physicians.
Indeed- rather we should be seeking to eliminate the educational costs that are actually at the root of why they need such high salaries to actually attain a reasonable level of compensations for their service. Doctors don't actually seem most of their salaries- rather they mostly work to pay back loan companies. Without that kind of drag (which really applies across the board, but it's at its worst among doctors due to extended level of education that is needed just to meet the basic level of skill needed to be functional in the field) most most of this particular issue would go away to the benefit of doctors and patients alike.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pyrtolin:
And if you go back and review, I think you'll find that my position was that etc etc etc etc......... leads to pathological market failures.

See, Pyr. About the point you get to the "etc etc etc" part, all I start hearing is the noise the teacher makes for Charlie Brown.

I did go back and review, and it appears my discussion was more with LR, and that you were never really a part of it except to say that the price of Lasix was cheap because it had to compete with glasses and contacts.

My bad, dude. I shall never take your name in vain again.
 
Posted by Seneca (Member # 6790) on :
 
Even if you decrease the cost of education and thus the debt that doctors incur, lowering salary is a lifelong change that affects doctors long after their debt is gone. Such a chance will be a major disincentive to more young people who would be considering the field.

We already have a shortage. With the laws of supply and demand, why would you attempt to force a lower price for something higher in demand? It will dry up the supply even further...
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:

We already have a shortage. With the laws of supply and demand, why would you attempt to force a lower price for something higher in demand? It will dry up the supply even further...

I believe the shortage is due primarily because of the high cost of medical school, combined with the fact that medical schools are limiting the amount of students they accept. I believe there are actually more applicants right now then can be accepted.

Edit: We had this discussion once before too:
http://www.ornery.org/cgi-bin/ubbcgi/ultimatebb.cgi/topic/6/15771.html#000011
When Pete first introduced me to how Cuban doctors "supplement their income."

[ March 20, 2014, 07:00 PM: Message edited by: Grant ]
 
Posted by TomDavidson (Member # 99) on :
 
quote:
I think I prefer a surgeon working on my brain to be extremely well paid for what he does. The alternative experience was the medical profession in the USSR.
This seems to me to be a false dichotomy.
 
Posted by Pete at Home (Member # 429) on :
 
I agree strongly re increasing the supply of doctors by making medical education more affordable, decreasing medical debt, opening more law schools, and penalyzing any medical bodies that stand in the way. To the extent that lowers physician salaries, fine. I don't think generalists are really overpaid, though. And the idea of intentionally going out there to lower doctors salaries seems ... ungrateful and crass.

Medicine should be a lucrative profession, for all the years of study put in.

Medical expensees as a.proportion of GNP have shot up exorbidantly in the last decade but AFAIK doctor's salaries have not. The number of doctors had not shot up. In the light of such facts, it seems foolish to proclaim that doctors high salaries are the main cause of high medical costs. If that were since true, it is not now true. I suspect that the statement is misinformed.

[ March 20, 2014, 08:29 PM: Message edited by: Pete at Home ]
 
Posted by Seneca (Member # 6790) on :
 
Many of you are dancing around the fact that you are trying to make the medical industry less capitalist in a capitalist system. How can you do that and still expect sufficient doctors when those people will see the capitalist rewards elsewhere and pursue them?

You can't, not without lowering quality of care.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
How can you do that and still expect sufficient doctors when those people will see the capitalist rewards elsewhere and pursue them?

I can't help but nitpick here, Seneca. I'm not necessarily against capitalism, but you must see that there is nowhere else for doctors to go to reap the same level of capitalist rewards as they do here. Where would they go to pursue them? Canada? No. Mexico? They don't have enough money. The UK? More socialist then Canada. Australia?

The argument that doctors in the US will flee to pursue better capitalist rewards elsewhere does not seem to stand up, at least to me.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Seneca:
Many of you are dancing around the fact that you are trying to make the medical industry less capitalist in a capitalist system. How can you do that and still expect sufficient doctors when those people will see the capitalist rewards elsewhere and pursue them?

You can't, not without lowering quality of care.

Are you addressing me, Seneca? Because I am thought you agreed with me that more doctors should be trained. That will reduce doctor compensation, but not by that much.

The AMA-AOA monopoly on training and approving doctors is not a "capitalist" system. It's a medieval economic system the name of which escapes me at the moment ... Sid Meier Civilization fans may remember that term.

It's that non-capitalist structure responsible for the scarcity of US doctors. Even the AMA admits now that they ****ed up and underestimated the number of doctors that would be necessary.

I hope you were not addressing me as one of the persons going against doctors. I think doctor salaries should be high, but I don't think allow a medeival-style guild to artificially restrict the number of doctors to dangerous levels in order to inflate those salaries. From your earlier statements I Thought you agreed with me.


-----

@Grant who challenged Seneca as to where doctors would go for better salaries. No, not to other countries. Into other lines of work. Picture prestigious surgeons and top line physicians walk awak from their practice to work for big pharma and big hospital corp PUBLICITY. Or to become professonal witnesses for hire in court cases. Medicine keeps getting more expensive for the country because the medical industry keeps funneling more of its resources into marketing, getting more people to take more drugs for more.reasons.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Seneca:
If someone is going to have to go through nearly 3 decades of education and training and probably heavy debt, it seems insane in a capitalist system to reduce their pay.

Well, I think you hit on a critical point, but from the wrong side. Why should anyone have to go into "heavy debt" to receive an education, and particularly an education in something like medicine (or engineering, or science, etc) that is so critical to the well being of the country? Six figure educational debt is the first thing that needs to go away.
 
Posted by Seneca (Member # 6790) on :
 
Exactly Pete.

Or they just never become doctors in the first place. They would rather go into a more lucrative and less restricted and less punitive field.

It takes 15+ years to effectively train up a new doctor. That's counting high school when kids have to get serious about GS for undergrad admission, then undergrad, then med school then residency.

The damage that Obamacare is doing is taking a system where we already have a doctor shortage and deterring young people from wanting to become doctors even more than all the current hurdles. Assuming Obama will continue to refuse to see the error of his ways and best case scenario we can repeal this awful law 1 to 2 years after he's gone, it will be another 10 to 15 years after that before the system recovers. That is the longterm damage we're looking at.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Seriati:
quote:
Originally posted by Seneca:
If someone is going to have to go through nearly 3 decades of education and training and probably heavy debt, it seems insane in a capitalist system to reduce their pay.

Well, I think you hit on a critical point, but from the wrong side. Why should anyone have to go into "heavy debt" to receive an education, and particularly an education in something like medicine (or engineering, or science, etc) that is so critical to the well being of the country? Six figure educational debt is the first thing that needs to go away.
Because even as bad as that is, with the high salaries it doesn't take all that long to pay them off. But artificially lowering lifelong salaries as some have suggested, paired with lowering education costs or not, will draw less interest from young people.

Besides, as technology and science advances I'm not sure in our culture and society that it will be possible to reduce the level of training and cost associated with the myriad new techniques that will become more and more necessary as new education is constantly stacked higher and higher and more and more information is required and expected in medicine.

Look at the difference of today's doctors vs a century ago. Now imagine 50 years from now and how microbiology will change. What society considers competent medical training will NOT become easier, it will become harder.

[ March 21, 2014, 10:50 AM: Message edited by: Seneca ]
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Seneca:
Because even as bad as that is, with the high salaries it doesn't take all that long to pay them off. But artificially lowering lifelong salaries as some have suggested, paired with lowering education costs or not, will draw less interest from young people.

But the problem is it's not really an efficient use of resources to require that everyone who wants to be a doctor indebt themselves to a financial group and work for a large chunk of their life to pay it back (for the record I'm closing in on 20 years of paying my non-medical education debt back). It distorts the decisions on where you goto work away from the greatest needs to the greatest compensation opportunities. While that's a fine principal in economics when were talking abou the best use of say a limited steel resource, is it really the best principal in medicine to divert doctors to high-end plastic surgery from general care for the poor?

I have the same issue with how mortgages are working these days. Being able to borrow so much of the cost of housing does put more people in houses, but at the cost of inflating the prices and ultimately the debt load for everyone. Is it really worth doubling the debt load everyone is under to put 10% more people in houses they own rather than rent?

All these debt loaded transactions remind me of the cigarrette smoking model. The "good" or the high is definitely present, but the vast majority of it is just trying to get most of us back to where we would have been without the cigerette smoking or massive lending ever having started in the first place, and adding in a whole bunch of negative consequences in on the side.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pete at Home:


The AMA-AOA monopoly on training and approving doctors is not a "capitalist" system. It's a medieval economic system the name of which escapes me at the moment ... Sid Meier Civilization fans may remember that term.

Manorialism doesn't seem to fit. Mercantilism maybe?

quote:


@Grant who challenged Seneca as to where doctors would go for better salaries. No, not to other countries. Into other lines of work. Picture prestigious surgeons and top line physicians walk awak from their practice to work for big pharma and big hospital corp PUBLICITY. Or to become professonal witnesses for hire in court cases. Medicine keeps getting more expensive for the country because the medical industry keeps funneling more of its resources into marketing, getting more people to take more drugs for more.reasons.

I suppose this is possible, but not for ALL doctors. I suppose some of them could go on into other professions that are lucrative, but how many would want to do that?

I mean, if you are going to start talking about socializing the occupation of physician, or setting salary/income caps by law, then you may as well talk about starting to socialize the pharmaceutical industry as well. Thus the beast grows. Nom Nom Nom Nom.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by Pete at Home:


The AMA-AOA monopoly on training and approving doctors is not a "capitalist" system. It's a medieval economic system the name of which escapes me at the moment ... Sid Meier Civilization fans may remember that term.

Manorialism doesn't seem to fit. Mercantilism maybe?

quote:


@Grant who challenged Seneca as to where doctors would go for better salaries. No, not to other countries. Into other lines of work. Picture prestigious surgeons and top line physicians walk awak from their practice to work for big pharma and big hospital corp PUBLICITY. Or to become professonal witnesses for hire in court cases. Medicine keeps getting more expensive for the country because the medical industry keeps funneling more of its resources into marketing, getting more people to take more drugs for more.reasons.

I suppose this is possible, but not for ALL doctors. I suppose some of them could go on into other professions that are lucrative, but how many would want to do that?

I mean, if you are going to start talking about socializing the occupation of physician, or setting salary/income caps by law, then you may as well talk about starting to socialize the pharmaceutical industry as well. Thus the beast grows. Nom Nom Nom Nom.

Does it really matter EXACTLY how many we lose when there's already a shortage and there will still be MORE loss?
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Because even as bad as that is, with the high salaries it doesn't take all that long to pay them off. But artificially lowering lifelong salaries as some have suggested, paired with lowering education costs or not, will draw less interest from young people.

Perhaps it would, but I don't know if it would be substantial. I tend to believe the vast majority of young people do not choose their professions based upon either cost of education or lifelong salaries. I know I didn't. I wish I had, LOL. I would have made some very different choices.

I don't believe that every individual that in their early teens decides to become a doctor does so out of desire for a high salary. Young people are like that, especially many that come from families that can afford sending someone through medical school.

Obviously, you would lose all those individuals who are thinking to themselves, "man, I want to have money when I grow up, I'll become a doctor". When they find out you are lowering their pay, they will say "hell with that, I'll become a stock broker/banker/druglord". I just don't know exactly how many of those young people becoming doctors think that way. I can certainly agree that many of them STAY doctors because of the pay, lol.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Does it really matter EXACTLY how many we lose when there's already a shortage and there will still be MORE loss?

No. Unless you are able to replace them faster then you lose them.
 
Posted by Pete at Home (Member # 429) on :
 
"I suppose this is possible, but not for ALL doctors"

No, not all; just the ones who are most popular and ambitious. Sad thing is that many of these guys end up going for these alternative jobs, honestly believing that they are going to make a difference. And then they go into it, they start making heaps of money, and a formerly good human being loses his soul.

Consider a former Sunday School teacher and friend of mine, Martin McNiell. . My ex and I spent hours at their house. His late wife Michelle McNiell was our ward Relief society president.

This used to be a good man.

When a talented doctor gives up medicine to take on the profession of using his medical authority to manipulate a.court of law, ... Como se dice ... "algo muere in el alma." Is there a Spanish translator in the house? Best I can so is "something in the soul just dies"


MERCANTILISM!

Thank you, Grant!

[ March 21, 2014, 11:33 AM: Message edited by: Pete at Home ]
 
Posted by Pete at Home (Member # 429) on :
 
Curious who would oppose the following:

AMA and AOA certification and all.appertaining tests and documentation should be required by law to be offered in Spanish, and admitting any person who passes the US objective tests who has credentials from any existing US, Canadian, British, German, Cuban, Argentinian or Mexican medical school existing at this the time of this law's passage.

(The last clause "existing at the time of this law's passage" to prevent new med schools being created subsequent to the law in order to take advantage of the law.
 
Posted by Seneca (Member # 6790) on :
 
Requiring OTHER languages?

We can't even get English installed as a national language, which would do wonders for cutting bureaucratic waste and slimming the government down, so you want to require more languages in more places?

And I say that as a Japanese American...

Most other 1st world nations have national languages. It isn't a matter of mere pride or ego, it's a way to build cultural and societal cohesion, as well as a way to make government work more efficiently. The last thing we need to do is legislatively cater to more languages.

If the market demands it, then it could happen voluntarily, but forcing it by law seems absurd.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pete at Home:
Curious who would oppose the following:

AMA and AOA certification and all.appertaining tests and documentation should be required by law to be offered in Spanish,

I have no opposition to the concept, but why only Spanish? Why not German or French or Japanese? Wouldn't accepting doctors to practice in the United States who do not understand and could not document in English create problems?
 
Posted by Seneca (Member # 6790) on :
 
In other news, another glitch...

quote:
A newly discovered glitch in the main ObamaCare website reportedly is giving thousands of people the wrong information about whether they qualify for premium subsidies.

The Philadelphia Inquirer discovered the glitch while entering hypothetical incomes into the calculator on HealthCare.gov. The newspaper found that the calculator is using the wrong year's poverty guidelines -- a simple mistake that, for months, has resulted in would-be enrollees getting inaccurate guidance.

Because of the glitch, some people may be initially told they qualify for subsidies when they don't. Others may be told they don't qualify when they do.

It's unclear how many people have been affected, but the mistake raises the possibility that thousands are giving up the hunt for insurance after being told, inaccurately, that they don't qualify for government aid.

"It's just another one of those, 'Why did they do that?'" Robert Laszewski, president of Health Policy and Strategy Associates, told the Inquirer.

HealthCare.gov, and some of the state-run sites, were marred by technical problems after they launched last October. Many of those problems have been addressed, but the Inquirer report shows that glitches are still being rooted out.

The Centers for Medicare & Medicaid Services is fixing the newly discovered problem with the income calculator. A spokesman told FoxNews.com there is a "small difference" but "we have updated this tool for clarity."

The incorrect information has only been generated since about mid-February. CMS stresses that the estimates in question are unofficial, and customers are told that on the website itself.

"The window shopping tool on the learn side of HealthCare.gov is intended only to be used as an unofficial estimate that consumers can use before completing their application, which is where they get their official determination," spokesman Aaron Albright said. "We encourage consumers to complete their Marketplace application, where they will get an accurate determination of their tax credits."

The calculator in question is a tool meant to help those window-shopping for policies. It gives customers an initial estimate of whether they would qualify for subsidies.

Most federal programs are using 2014 poverty levels as the basis for these kinds of estimates, but the Affordable Care Act mandated that the 2013 guidelines be used this year (in part because sign-ups began last year).

Yet, HealthCare.gov continued to use the higher 2014 guidelines.

The result is that people whose incomes are just over the high end of the 2013 guidelines are told they qualify, only to find out later they don't.

Likewise, those just over the low end are told they don't qualify -- according to the Inquirer, only if they ignore that message, and click through to use another tool on the site, will they find out they do qualify.

The Inquirer reports this mostly would affect people in states that have not expanded Medicaid.

While the administration apparently is addressing the problem, its discovery comes a mere 10 days before the enrollment deadline. The White House and other branches of the administration are in a full court press to get people signed up -- and inaccurate estimates telling people they don't qualify for subsidies is another setback.

The insurance industry is waiting to see whether the administration enrolls enough young, healthy people to help offset the cost of taking on older, sicker patients.

Meanwhile, the American Medical Association, which originally supported the Affordable Care Act, is raising concern about another obscure aspect of the law which they claim could stick doctors with the tab for patients who skip out on paying their premiums.

The American Medical Association warned the rule could pose a "significant financial risk" for doctors and hospitals, and on Wednesday blasted out guidelines to help members try and avoid those costs. At issue is a 90-day "grace period" which lets patients who are not paying their premiums keep coverage for 90 days before it can be canceled.

Under the rule, insurers are responsible for paying any claims during the first month of that period -- but not necessarily for any claims during the final 60 days.

"Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers," AMA President Ardis Dee Hoven said in a statement.

No problem, just a few bugs right? How long has this site been up?

But no, we still cannot delay the individual mandate. Delaying mandates and exemptions are only for Obama's biggest donors and union buddies, not for the little people.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by Pete at Home:
Curious who would oppose the following:

AMA and AOA certification and all.appertaining tests and documentation should be required by law to be offered in Spanish,

I have no opposition to the concept, but why only Spanish? Why not German or French or Japanese? Wouldn't accepting doctors to practice in the United States who do not understand and could not document in English create problems?
My guess is the way the progs would push this is that if a patient complained they couldn't understand their doctor, then that patient would be sued for discrimination. [Razz]
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Seneca:
Requiring OTHER languages?

We can't even get English installed as a national language, which would do wonders for cutting bureaucratic waste and slimming the government down, so you want to require more languages in more places?

And I say that as a Japanese American...

Most other 1st world nations have national languages. It isn't a matter of mere pride or ego, it's a way to build cultural and societal cohesion, as well as a way to make government work more efficiently. The last thing we need to do is legislatively cater to more languages.

If the market demands it, then it could happen voluntarily, but forcing it by law seems absurd.

I would agree with you if medicine were at this point an actual capitalist system, rather than a chimera of 25% Mercantilism (at the physician end) and 75% Fascism (at the insurance, hospital, and pharma ends).

I respectfully submit that my proposal does address an existing demand. If it did not, then spanish-only doctors would be unable to make a living.

You ask why not count Japan?

Because Japan is our friend.

Please think about this, Seneca. My proposal is PUNISHMENT to states that currently send us their criminals and desperate people in order to rob our country and get money sent back to the home country.

What I propose is intentional brain drain. Use the channels that Mexico and Cuba have SRT up to steal from us, to take back from them.

Please think about this.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
The AMA-AOA monopoly on training and approving doctors is not a "capitalist" system. It's a medieval economic system the name of which escapes me at the moment ... Sid Meier Civilization fans may remember that term.

You're thinking of a Guild System, not Mercantilism, actually. Mercantilism is more the belief that a country should, effectively be run as a for profit enterprise- that it needs to make money from other countries in order to operate properly, prioritizing the accumulation of financial wealth over production of real assets.
 
Posted by Pete at Home (Member # 429) on :
 
As for French... Grant, my friend ... have you never been to a French doctor?

I have.

Merde alors.

You may also notice I did not mention Spain.
 
Posted by Grant (Member # 1925) on :
 
Pete,

I approve of the intent to brain drain Mexico and Cuba with promises of milk and honey, but wouldn't asking these individuals to at least learn some English be better for everyone involved? Isn't that fair compensation for all the milk and honey the United States is offering?

I really don't have a significant problem with them not knowing English. I doubt we could completely solve the doctor shortage by accepting a horde of Spanish-only speaking doctors. I just think that it would be better for all involved for them to have some English.

It couldn't be too hard since most of the medical terminology is in latin anyways.
 
Posted by Pete at Home (Member # 429) on :
 
Two principles here. Spain is not our friend, but even if it was, no point in stealing ****.

Germany is our friend, so even though their doctors are the only AFAIK who are better educated than ours, it would be rude to steal from a friend and ally.

France is friend and ally like Germany, AND their doctors suck. If we hated them we should take their dentists, who unlike their doctors seem (AFAIK) nearly as good as ours.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pyrtolin:
You're thinking of a Guild System, not Mercantilism, actually. Mercantilism is more the belief that a country should, effectively be run as a for profit enterprise- that it needs to make money from other countries in order to operate properly, prioritizing the accumulation of financial wealth over production of real assets.

quote:
European guilds imposed long standardized periods of apprenticeship, and made it difficult for those lacking the capital to set up for themselves or without the approval of their peers to gain access to materials or knowledge, or to sell into certain markets, an area that equally dominated the guilds' concerns. These are defining characteristics of mercantilism in economics, which dominated most European thinking about political economy until the rise of classical economics.
http://en.wikipedia.org/wiki/Guild#Medieval_guild

I too was dubious at first, Pyr. Which is why I added a question mark at first. It seems though that the difference between guilds and mercantilism is that mercantilism is run on a national level whereas a guild is run on a professional level. They're basically the same thing from that point on, neh?
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Grant:
Pete,

I approve of the intent to brain drain Mexico and Cuba with promises of milk and honey, but wouldn't asking these individuals to at least learn some English be better for everyone involved? Isn't that fair compensation for all the milk and honey the United States is offering?

I really don't have a significant problem with them not knowing English. I doubt we could completely solve the doctor shortage by accepting a horde of Spanish-only speaking doctors. I just think that it would be better for all involved for them to have some English.

It couldn't be too hard since most of the medical terminology is in latin anyways.

Grant, Hermano, I think the market can take care of the Spanish-only issue. I humbly submit that doctors are the last persons on earth that we need special coercion laws to motivate to learn the bleeping language. Let them hire (and pay for!!!) translators!
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
Many of you are dancing around the fact that you are trying to make the medical industry less capitalist in a capitalist system. How can you do that and still expect sufficient doctors when those people will see the capitalist rewards elsewhere and pursue them?

Who is proposing that?
I think the British NHS system is also suboptimal because it does socialize the system and loses the advantages taht a market brings.

A single payer system, on the other hand, still allows of active competition and personal reward for performance while removing the rent seeking behaviors that are endemic to the insurance model.

The doctors and hospitals that provide the best service make the most money by attracting as high a volume of patients as they are able to provide the infrastructure to service, while individuals that need care are freed to make decisions based on their actual needs and not artificially cut out of the market due to personal financial situations that are completely tangential to their actual needs (or, even worse, actively deteriorate as a direct result of their need for care).

Single payer helps make the system more capitalistic, because it cuts out the middle man between the two parties trying to make a mutually profitable transaction- consumers looking for better health and doctors who are compensated for providing it.
 
Posted by NobleHunter (Member # 2450) on :
 
Isn't the US doctor shortage (like the Canadian one) generally focused in rural areas? And I'm assuming those areas don't have high numbers of non-English speakers.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pete at Home:
Two principles here. Spain is not our friend, but even if it was, no point in stealing ****.

Germany is our friend, so even though their doctors are the only AFAIK who are better educated than ours, it would be rude to steal from a friend and ally.

France is friend and ally like Germany, AND their doctors suck. If we hated them we should take their dentists, who unlike their doctors seem (AFAIK) nearly as good as ours.

I accede to your desire to only steal Cuban and Mexican doctores.
 
Posted by Pete at Home (Member # 429) on :
 
Yes and no, NH.

Rural America is overridden by Spanish-speaking farm workers.

Centrist proposals to bus inner city workers to farm jobs have met with indifference or hostility by both Demowhores and Republiwhores.
 
Posted by NobleHunter (Member # 2450) on :
 
Right, I forgot agriculture runs on robots and foreign labor.

You'd have to pay me a lot of money to do farm work, so the economics would never fly. But then I'm a poof from the suburbs.
 
Posted by Seneca (Member # 6790) on :
 
Single payer is dumb because a multi-payer system allows competition among payers.

No competition among payers means that no matter how bad the government gets at approving healthcare, they won't go broke for customers fleeing because they can't. Also, they are the government and no matter how poorly the government does it never goes broke or goes bankrupt. No thanks.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by NobleHunter:
Right, I forgot agriculture runs on robots and foreign labor.

You'd have to pay me a lot of money to do farm work, so the economics would never fly. But then I'm a poof from the suburbs.

NH, even if we set aside national politics, it would.still be stupid to set the market at what it would take to motivate you and I to pick ****ing tomatoes.

Admit or deny?
 
Posted by Pyrtolin (Member # 2638) on :
 
I think it's rather amusing that people are complaining about pressing foreign doctors to learn English, where the US is about the only major country that doesn't take it for granted that people should be expected to know two or three languages to be considered fully educated.

If the US had large populations of people that only spoke other languages than english or Spanish, then it would be useful to help encourage people proficient in those languages pass US medical practice qualifications by giving them a native option as well- giving the test in a given language doesn't suggest in any way that they don't have a conversational command of English, rather it helps get a more honest evaluation of the actual relevant skills of those that have a better native command of technical jargon in their own language.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Pete at Home:
quote:
Originally posted by NobleHunter:
Right, I forgot agriculture runs on robots and foreign labor.

You'd have to pay me a lot of money to do farm work, so the economics would never fly. But then I'm a poof from the suburbs.

NH, even if we set aside national politics, it would.still be stupid to set the market at what it would take to motivate you and I to pick ****ing tomatoes.

Admit or deny?

The total consumer price of the tomatoes, perhaps, but the production cost itself should absolutely be set there, if for not other reason that help maintain the proper level of pressure needed to drive innovation in developing ways to make it less individual labor intensive. If we let the labor price slipp too far below the real cost of what it actually takes to encourage people to want to do that work, there's little room for benefit from applying innovation to improve the process.
 
Posted by NobleHunter (Member # 2450) on :
 
Admit, if you're going to be picky about it. [Razz]

Pyr, considering both Pete and I are educated well beyond what's required for picking tomatoes it'd be madness to set the wage that high. I'm reasonably sure a lower wage could still provide enough incentive to get people to do the work.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Pyrtolin:
A single payer system, on the other hand, still allows of active competition and personal reward for performance while removing the rent seeking behaviors that are endemic to the insurance model.

There's no active economic competition in a single payer model. Anymore than there is in a popularity contest. All that happens in this model is the basis of competetion changes from efficiency to something else. And while that may maximize that something else, it won't maximize efficiency.

There's no basis for a belief that government control of price won't maximize rent seeking behaviors from everyone in the industry. Right now they are at least arguably pitted against each other, though existing government manipulation has more often than not warped that incentive and put them on the same side.
quote:
The doctors and hospitals that provide the best service make the most money by attracting as high a volume of patients as they are able to provide the infrastructure to service,...
There is absolute no basis to this belief absent an absolute glut of available "doctor" resources, which we don't have and is unlikely to come into existence in a lower compensation model. The most money will be earned by the doctors and hospitals that maximize throughput period. Jettisoning any time consuming process will improve the bottom line far more than being best in class in a service.
quote:
while individuals that need care are freed to make decisions based on their actual needs and not artificially cut out of the market due to personal financial situations that are completely tangential to their actual needs (or, even worse, actively deteriorate as a direct result of their need for care).
Individuals will remain absolutely limited by the amount and availability of high quality care. No amount of reducing the profitibility of medicine or increasing its institutional nature encourages new capacity to be generated. All this will really do is stunt innovation and capacity while changing the basis on which its allocated from economic to political graft.
quote:
Single payer helps make the system more capitalistic, because it cuts out the middle man between the two parties trying to make a mutually profitable transaction- consumers looking for better health and doctors who are compensated for providing it.
In no world does single payer make it "more capitalistic". Government control and price fixing is pretty much the epitome of inefficient anti-capitalistic behavior, that ensures allocation of resources will be based on factors that have no relationship to the underlying economics.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Government control and price fixing is pretty much the epitome of inefficient anti-capitalistic behavior, that ensures allocation of resources will be based on factors that have no relationship to the underlying economics.
You understand that "price fixing" as practiced in most socialized healthcare states actually represents the government using its buying power to demand concessions from providers? And purchasing standardized equipment, generally at a remarkable savings?
 
Posted by Seneca (Member # 6790) on :
 
quote:
In no world does single payer make it "more capitalistic". Government control and price fixing is pretty much the epitome of inefficient anti-capitalistic behavior, that ensures allocation of resources will be based on factors that have no relationship to the underlying economics.
Bingo, and when the government low-balls all doctors the way they TRY to do right now with medicaid and medicare, unlike the current system, in a SP system the doctors will have no alternatives except to quit their careers.

No matter how bad a job the government does, it never gets fired or goes out of business. That is the difference here.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
There's no active economic competition in a single payer model. Anymore than there is in a popularity contest. All that happens in this model is the basis of competetion changes from efficiency to something else. And while that may maximize that something else, it won't maximize efficiency.
In a single payer model, providers are freed to compete on efficiency of care, quality of service, and overall outcomes instead of, where health issues are concerned, the false arena of nominal price.

There is plenty of economic competition- it's just in terms of the directly important factors and not a proxy (the ability of any given individual to pay out of pocket for what they need, specifically) that has little to do with any of them.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
No matter how bad a job the government does, it never gets fired or goes out of business.
You know, I keep hearing this put forward as a matter of religious belief from a certain type of capitalist, but I think there's enough counter-evidence on both sides -- that plenty of businesses succeed despite being neither efficient nor desired, and that plenty of governments doing bad jobs are pushed to do better ones -- that it strikes me as a platitude and oversimplification rather than an accurate model on which to base any kind of policy approach.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Government control and price fixing is pretty much the epitome of inefficient anti-capitalistic behavior, that ensures allocation of resources will be based on factors that have no relationship to the underlying economics.
What control? Again, single payer is not nationalized health care. The private providers have control over what service they provide and how to allocate their resources. Single payer just means all of the bills for a baseline set of essential care are paid directly out of the public purse instead of by the individuals. Price fixing it's completely orthogonal to the issue.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by TomDavidson:
You understand that "price fixing" as practiced in most socialized healthcare states actually represents the government using its buying power to demand concessions from providers? And purchasing standardized equipment, generally at a remarkable savings?

I understand. And like I said, none of that price forcing is designed to increase the amount of services available or to allocate resources among medical services efficiently. Central planning does not lead to efficient results. Are you really arguing otherwise?
quote:
Originally posted by Pyrtolin:
In a single payer model, providers are freed to compete on efficiency of care, quality of service, and overall outcomes instead of, where health issues are concerned, the false arena of nominal price.

They can do that today. However, in the single payer model they will only get paid by volume of payable events. That means nothing you just listed will be incentivized.
quote:
There is plenty of economic competition- it's just in terms of the directly important factors and not a proxy (the ability of any given individual to pay out of pocket for what they need, specifically) that has little to do with any of them.
There is absolutely no economic competition on a proxy or non-proxy basis.

When the person using a service is not the same as the person paying for it there is a fundemental misalignment occuring in determining if the service is worth the cost. It literally can not occur properly. Using the state's judgement as a "proxy" for that determination is quite literally the antithesis of rational economic decisions.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
No amount of reducing the profitibility of medicine or increasing its institutional nature encourages new capacity to be generated.
Indeed. I'm not sure why you bring those up, except that you seem to want to keep trying to use the false metric of nominal price as if were a useful economic indicator instead of actually switching leaning on the strengths of single payer which effectively eliminate price as a factor and instead use relevant results as the economic factors.

The point isn't to reduce the profitability of medicine, it's to remove the incentive to derive profit from interfering with the provision of care and instead ensure that it's derived directly from the effectiveness of care.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seriati:
quote:
Originally posted by TomDavidson:
You understand that "price fixing" as practiced in most socialized healthcare states actually represents the government using its buying power to demand concessions from providers? And purchasing standardized equipment, generally at a remarkable savings?

I understand. And like I said, none of that price forcing is designed to increase the amount of services available or to allocate resources among medical services efficiently. Central planning does not lead to efficient results. Are you really arguing otherwise?

What central planning? Right now we have a system that is effectively "centrally planned" by insurance company. The point of single payer is to discard that planning and instead let the market operate on direct patient/physician transactions.

quote:
quote:
Originally posted by Pyrtolin:
In a single payer model, providers are freed to compete on efficiency of care, quality of service, and overall outcomes instead of, where health issues are concerned, the false arena of nominal price.

They can do that today.
Only if they're rich enough to have that luxury. The average person very often has to forgo needed care, not because their doctor says it's not necessary or others need it more, but because they don't have enough money to pay of it, which is an absurd way to prioritize need.


quote:
However, in the single payer model they will only get paid by volume of payable events. That means nothing you just listed will be incentivized.
No, that means that the things I listed, which would be the only way they could increase the volume of payable events over others that do better at them, will explicitly be what gets incentivized.

quote:

When the person using a service is not the same as the person paying for it there is a fundemental misalignment occuring in determining if the service is worth the cost. It literally can not occur properly. Using the state's judgement as a "proxy" for that determination is quite literally the antithesis of rational economic decisions.

That's only true where no direct need for a service exists- where it is effectively a luxury that should be allocated based on personal social credit earned to entitle the individual to luxury. When you're talking about essential medical services, using personal wealth as an override for professional judgement on the part of the providers, who are actually trained to make the assessment of what is and is not needed, is absurd.

Single payer actively removed the central planning aspect by putting control of the dispensation of service and resources directly in the control of the professionals that are trained to evaluate on the ground who is best served by receiving them. It explicitly removes central planning that is inherent to any individual payment system, whether enacted through insurance or personal wealth.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Pyrtolin:
quote:
No amount of reducing the profitibility of medicine or increasing its institutional nature encourages new capacity to be generated.
Indeed. I'm not sure why you bring those up,
Because its material. The one historical truth of what you propose is that everytime its tried it depresses innovation and availability, yet your "economic" (and have to use that term very loosely since you don't seem to believe it relates to money) is premised on their being an overabundance of supply.
quote:
except that you seem to want to keep trying to use the false metric of nominal price
What's false here? You can't encourage doctor's by appeal to their capitalistic interest in profit, which is what you keep doing with your arguments, then pretend that the price they receive for thier work is irrelevant.
quote:
as if were a useful economic indicator instead of actually switching leaning on the strengths of single payer which effectively eliminate price as a factor and instead use relevant results as the economic factors.
So we if we use "economic" factors other than actual ecomonic factors, because these proxy factors will actually lead to better results, in your view then this makes economic sense. I agree if we measure medical quality in gold star stickers, we should all have better care just by making more stickers. Of course that's not relevant.

Your description of the economics of single payer will fail, at least until you nationalize the doctors themselves. Even then it'll still fail.
quote:
The point isn't to reduce the profitability of medicine, it's to remove the incentive to derive profit from interfering with the provision of care and instead ensure that it's derived directly from the effectiveness of care.
Which is a good goal, yet nothing you've described even moves us in that direction.
 
Posted by Seneca (Member # 6790) on :
 
So how do Doctors right now enjoy the government as a payer? They don't.

From the WSJ

quote:
Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts...


...The number of doctors who opted out of Medicare last year, while a small proportion of the nation's health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. [/b]Other doctors are limiting the number of Medicare patients they treat even if they don't formally opt out of the system.[/b]

Even fewer doctors say they are accepting new Medicaid patients, and the number who don't participate in private insurance contracts, while smaller, is growing—just as millions of Americans are poised to gain access to such coverage under the new health law next year....


...CMS said 9,539 physicians who had accepted Medicare opted out of the program in 2012, up from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.

Meanwhile, the proportion of family doctors who accepted new Medicare patients last year, 81%, was down from 83% in 2010, according to a survey by the American Academy of Family Physicians of 800 members. The same study found that 4% of family physicians are now in cash-only or concierge practices, where patients pay a monthly or yearly fee for special access to doctors, up from 3% in 2010.

A study in the journal Health Affairs this month found that 33% of primary-care physicians didn't accept new Medicaid patients in 2010-2011.

The pullback in Medicare acceptance is being felt in certain quarters. Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can't find doctors willing to treat them—mainly from affluent urban and suburban areas where many patients can pay out of pocket if their doctor doesn't accept Medicare. "In most places, doctors can't pick and choose because Medicare is the biggest game in town, or the only game in town," he said.

Some experts attribute the rise in defections to Medicare payment rates that haven't kept pace with inflation and the threat of more cuts to come. Under a budgetary formula enacted by Congress in 1997, physicians could see Medicare reimbursements slashed by 25% in 2014 unless Congress intervenes to delay the cuts, which it has done several times.


"Medicare has really been pushing its luck with physicians," said economist Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change. "By allowing the SGR and its temporary fixes to persist, Medicare is risking a backlash by senior citizens who say, 'Hey, this program isn't giving me the access to doctors I need.' ."

Some doctors say Medicare's reimbursement rates—as low as $58 for a 15-minute office visit—force them to see 30 or more patients a day to make ends meet. "Family physicians have been fed up for a long time and it's getting worse," said Jeffrey Cain, president of the American Academy of Family Physicians. By disengaging with Medicare and other third-party payers, he says doctors can practice based on what patients need, not what insurers will pay.

Other doctors are dropping out of Medicare to avoid deeper government involvement in medicine, much of which is occurring in Medicare. For example, Medicare is now paying incentives to doctors who switch to electronic medical records and who send data on quality measures to the federal government. Doctors who are part of the Medicare program who don't do so will face penalties starting in 2015.

While the leaders of some large doctor groups have endorsed such initiatives, Dr. Ginsburg says, "there are a lot of physicians, particularly older physicians, who say, 'I don't want to do this. Let me run out the rest of my career practicing like I've always done.' "


Some doctors are particularly concerned about patient privacy. Earlier this year, gynecologist Mary Jane Minkin, a professor at the Yale School of Medicine, opted out of Medicare and the Yale Medical Group when she saw that the electronic records system displayed patients' gynecological records to other providers they consulted. "There's no reason the dermatologist has to know about my patients' libido issues," Dr. Minkin said.

All but 10 of the 70 Medicare patients in her practice have continued to see her, Dr. Minkin said, even though they must pay out of pocket to do so.

Doctors have three options for dealing with Medicare. Those who participate bill Medicare directly and must agree to accept its reimbursement rates for all covered services. So-called nonparticipating doctors still file Medicare reimbursement claims but can charge as much as 10% over Medicare's rates for some services, and they must bill patients for the difference. Those who opt out can charge patients whatever they want, but they must forgo filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them.


That prospect rankles many elderly people—in part because they must continue paying their Medicare premiums or risk losing their Social Security benefits. Republican-sponsored legislation in the House and Senate would let seniors use their Medicare benefits to pay doctors privately, but opponents believe that would undermine the entire system, and the bills aren't given much chance of passage.

Doctors who don't take Medicare say they don't necessarily raise rates significantly. Some say not having to submit claims and file mandated reports allows them to keep their overhead low. They can also adjust their fees to fit patients' needs.

"We give discounts to teachers and preachers, and anybody who comes in wearing spurs gets $5 off," said Juliette Madrigal-Dersch, a pediatrician and internist in Marble Falls, Texas. She says she also treats patients who develop cancer free of charge. "I couldn't do that if I took Medicare. It's considered an illegal enticement."
Dr. Madrigal-Dersch is president of the Association of American Physicians and Surgeons, a conservative group that advocates private-pay medicine. "It's gone from being a fringy, rebellious thing to a business model," she added.

If the government is such a great payer, then why are doctors running from it?

Note how doctors who don't use medicaid/medicare are able to keep costs lower without all the conditions and strings attached, as well as make a better living for themselves. Everyone notice the point about "illegal enticements?" There are other accounting, billing and operating restrictions as well. If you think doing business with the government is easy, try running a doctor's office for a few years.

Essentially, medicaid/medicare is becoming a system that more and more doctors are fleeing every year.

If you mandated the government as the SP, these problems would spread to the entire medical industry. Anyone hazard a guess as to what that would do to our doctor supply? Can anyone make the case that it would INCREASE our doctor supply?

[ March 21, 2014, 05:59 PM: Message edited by: Seneca ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Because its material. The one historical truth of what you propose is that everytime its tried it depresses innovation and availability, yet your "economic" (and have to use that term very loosely since you don't seem to believe it relates to money) is premised on their being an overabundance of supply.
That's completely nonsensical. Countries that use single payer models have both better availability of services and better overall outcomes across the entire populations than we do, where a select few get first pick of all the resources and best results and most people are left struggling to keep up with basic needs.

quote:
What's false here? You can't encourage doctor's by appeal to their capitalistic interest in profit, which is what you keep doing with your arguments, then pretend that the price they receive for thier work is irrelevant.
The false thing is pretending that individual ability to pay for a given service correlates to need for that service and thus should dictate it's allocation. The amount doctors should make should depend on what medical practices are willing to pay them to employ their services or, in the case of private practices, the volume of patients that they personal are able to personally attract and keep well treated. Neither of which should be falsely influenced by the individual wealth of any given patient.

quote:
So we if we use "economic" factors other than actual ecomonic factors, because these proxy factors will actually lead to better results, in your view then this makes economic sense. I agree if we measure medical quality in gold star stickers, we should all have better care just by making more stickers. Of course that's not relevant.
What do you mean by "actual" economic factors? You seem to be confusing money, one particular economic tool, with all possible economic factors.

In medicine, the things taht patients tend to value and will build their loyalty to a given provider are the relevant economic factors,. Those tend to be things like quality of care, effectiveness of care, impact of care on their overall lives, etc... I'm sure there are more factors that come into play, and they might vary quite a bit on an individual level, but none of the relevant factors for health are personal wealth- and forcing the system to only operate on a personal wealth basis instead of on the real economic factors that would otherwise guide people is an active distortion of the market, that puts it in control of those who command wealth and takes control away from the professional providers.

quote:
Your description of the economics of single payer will fail, at least until you nationalize the doctors themselves. Even then it'll still fail.
We have plenty of real world implementations that say otherwise, as single payer models outperform both nationalized ones and individual wealth based ones.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Essentially, medicaid/medicare is becoming a system that more and more doctors are fleeing every year.
Because of political manipulation intended to make it unappealing in order to drive people away from it and justified out of false claims of a need for the money issuing sovereign to try to save money or even turn a profit, instead of simply generating money as needed to keep the market healthy.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Because of political manipulation intended to make it unappealing in order to drive people away from it and justified out of false claims of a need for the money issuing sovereign to try to save money or even turn a profit, instead of simply generating money as needed to keep the market healthy.
This is an eternal state of government propagated by both parties. Show me a bill creating these bad conditions that was ONLY approved by Republicans. Show me ONE BILL.

This will always be the way the government interacts with healthcare, which is why it shouldn't.
 
Posted by Seneca (Member # 6790) on :
 
quote:
The false thing is pretending that individual ability to pay for a given service correlates to need for that service and thus should dictate it's allocation. The amount doctors should make should depend on what medical practices are willing to pay them to employ their services or, in the case of private practices, the volume of patients that they personal are able to personally attract and keep well treated. Neither of which should be falsely influenced by the individual wealth of any given patient.
You are ignoring the proof that the government as a payer does NOT pay what care costs! They low-ball, constantly and almost always have and always will. No one with any sense of how the government works or how the budgets are allocated ever expects this to change.

There can be no profit to be had when the government will always pay less than what care costs. This is why the government is a lousy payer. And you want to make government the ONLY payer? Can you imagine what that will do to doctors? Many will quit, and many more potential doctors will see the writing on the wall and never go to med school.

You cannot deny the known reimbursement stats for medicare and medicaid.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
You cannot deny the known reimbursement stats for medicare and medicaid.
Why should we use those broken systems reimbursement rate, rather than as a baseline at least, paying the bills for service as presented by providers based on a cost of service plus a reasonable marginal markup?
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by Pyrtolin:
quote:
You cannot deny the known reimbursement stats for medicare and medicaid.
Why should we use those broken systems reimbursement rate, rather than as a baseline at least, paying the bills for service as presented by providers based on a cost of service plus a reasonable marginal markup?
You are failing to address how government has never managed to successfully be a competent payer in the national medical industry. Why would you assume it would be any different in a "new system" which would basically be created by the same corrupt legislature and bureaucracy which created the old one? How can you possibly argue with this point? You would need to throw out every legislator and every bureaucrat who approved and made the current system function and then hope you never got anyone who would repeat the mistake.

Humans are greedy and humans are imperfect. Put them together in groups and you amplify those problems. At least when private companies get excessive with these faults, then citizen consumers can punish them by walking away and refusing to do business with them. In a single payer government healthcare system, you can't refuse to do business with the government payer when the government inevitably exhibits the same faults. There is nowhere else to go.

Until you change the human condition and get rid of greed and sloth, you can never change this truth.

[ March 21, 2014, 06:32 PM: Message edited by: Seneca ]
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Greg Davidson:
quote:
Listen very carefully. If a person is still thinking the ACA is a good deal at this point that person is either mentally challenged, uneducated, or incapable of research.
Red, are you literally saying that not a single person has a better deal because of ACA? Because that statement would be as arrogant and incorrect as any statements of any who denied the entire truth of your own experience.

But let me also add that I do appreciate that you did lay out specific predictions - you do have the courage of your convictions, and in 18 months we'll see how accurate our predictions are.

I never saw Red suggest that no single person was going to benefit from the ACA.

He said that a significant number of people are going to be economically gang raped.

Red, damnit, contact me.
I think that's an argument worth of honest response.

[ March 21, 2014, 07:42 PM: Message edited by: Pete at Home ]
 
Posted by NobleHunter (Member # 2450) on :
 
I don't suppose it's worth pointing out that the US is the only country in the first world without single payer, a public option, or nationalized healthcare... But we're still supposed to believe socialized medicine is doomed to fail?
 
Posted by Pete at Home (Member # 429) on :
 
Most of the world gets a good proportion of its meds and med techniques from our fascistic system. So basically your medical system is based on the fruits of our fascist system. We should tax you. [Razz]
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by NobleHunter:
I don't suppose it's worth pointing out that the US is the only country in the first world without single payer, a public option, or nationalized healthcare... But we're still supposed to believe socialized medicine is doomed to fail?

In response I would have to point out that the United States seems to have better health care then the rest of the first world, just more expensive, and not easily available to those without jobs or low paying jobs.

As you have pointed out, socialized medicine is not necessarily doomed to fail, but is the system we have now failing, and is the ACA helping or accelerating such failure if it is occuring?
 
Posted by NobleHunter (Member # 2450) on :
 
Well, the ACA is failing 'cause reasonable reforms (what I call reasonable, at least) were, and are, politically impossible.

Think people are freaking out now? Just try wiping out the insurance industry.

The US's results aren't notably better, though. And considering you guys seem to have similar problems as we do regarding doctor shortages and coverage of rural areas, you don't seem to be getting what you're paying for.
 
Posted by Pete at Home (Member # 429) on :
 
The aca did not make us medicine more socialistic; it made us more fascistic. More corporate. More private and less free at the same time.
 
Posted by PSRT (Member # 6454) on :
 
quote:
In response I would have to point out that the United States seems to have better health care then the rest of the first world,
Well, no. At best, our outcomes are the same as the rest of the world... while, as you note, not being available to millions.

quote:
As you have pointed out, socialized medicine is not necessarily doomed to fail, but is the system we have now failing, and is the ACA helping or accelerating such failure if it is occuring?
THe system we had was certainly doomed to cease being able to functionally serve the majority of our citizens. I think ACA is going to accelerate our trip to an inevitable single payer system, which will substantially increase the quality of life for most Americans.

In terms of medical advances, over the last 30 years or so the rest of the first world has been making a larger and larger percentage of important health advances, while we create new variants of previously existing drugs. So I don't think moving to a single payer system is going to decrease the available health care options. If anything, getting away from a profit driven model will probably increase the health care options, since chasing the dollars has proved primarily beneficial to the drug companies... not patients.
 
Posted by Pete at Home (Member # 429) on :
 
Yes, NH, that's the lingo of how an uberfascist system was sold ton the left. Socialism isn't politically feasible so let's try national socialism. Future generations of lefties will wonder how this generation could have been so gullible.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by PSRT:
Well, no. At best, our outcomes are the same as the rest of the world... while, as you note, not being available to millions.

I remain insanely unconvinced. I think you are going to have to show me a few sources of information that support the idea that US Healthcare is not better in some ways.

It also seems to me that old system was indeed available to millions, just not affordable if you did not have a job or a low paying job. I'm guessing this is still the case under the new ACA.



quote:

THe system we had was certainly doomed to cease being able to functionally serve the majority of our citizens. I think ACA is going to accelerate our trip to an inevitable single payer system, which will substantially increase the quality of life for most Americans.

So the best thing about the ACA that you see is that it will convince us to try something else? That's not exactly a ringing endorsement but it seems to be an honest and hopeful one.
 
Posted by NobleHunter (Member # 2450) on :
 
There's better and there's proportionally better. Getting an Audi to be better than your neighbor's Kia isn't all that much to brag about if you're paying for a Rolls-Royce.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by NobleHunter:
There's better and there's proportionally better. Getting an Audi to be better than your neighbor's Kia isn't all that much to brag about if you're paying for a Rolls-Royce.

You are describing value. Other first world systems may not be as good, but they get better bang for their buck.

I will agree to that. It's those last few mph of top speed that seem to cost so much.

Very good analogy.

Edit: So, is it possible to get an Audi that costs like an Audi? Or do we have to choose between the Rolls or the Kia? Can we have speed, and value?

[ March 21, 2014, 09:25 PM: Message edited by: Grant ]
 
Posted by Seneca (Member # 6790) on :
 
Funny that some are finally admitting the ACA'S was created to fail in order to push single payer. Hopefully the people advancing this agenda fail and we repeal the ACA.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Funny that some are finally admitting the ACA'S was created to fail in order to push single payer. Hopefully the people advancing this agenda fail and we repeal the ACA.

::grumblegumblegrumble::

I don't remember anybody admitting that the ACA was created to fail. I think Pyr admitted that the best thing about it was that as a consequence to it's suckitude, or failings, however you want to put it, it would lead to a single payer system. That's very different then saying that it was created to do that.

After we repeal the ACA, then what Seneca? Where do we go from there? Back to the system that was driving up healthcare costs until my entire paycheck goes to paying for insurance? Or do you have something else in mind?

It's one thing to complain about Obamacare. It's another thing to have an alternative, other then "back to the way things have always been". Ecastor! That's why liberalism is so appealing to most people, at least they try to fix problems. How about a conservative solution?
 
Posted by Seneca (Member # 6790) on :
 
Most of the reason doctors have been able to do less pro-bono work is government regulation and increased malpractice insurance costs. Reduce those and docs can go back to providing sufficient voluntary charity care as they used to.
 
Posted by PSRT (Member # 6454) on :
 
quote:
http://www.pnhp.org/single_payer_resources/us_care_quality_is_no_better_than_other_countries.php
First hit on my search for how we compare to other countries, Grant. Its not that we're awful, but that we pay SO much more for the same thing.

THe ACA wasn't created in order to fail. It was created as a compromise between what democrats wanted, and what republicans wanted. Its significantly better than what we had (as can be seen from the trends in health care costs before/after it went into effect), but since what we had was god-freaking awful... what we have is still not good, compared to what most of the first world has.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by PSRT:
[QB] First hit on my search for how we compare to other countries, Grant. Its not that we're awful, but that we pay SO much more for the same thing.

You will have to do a little better then that. The report linked only covers survival rates for some specific diseases, and the raw data is not present, it is transformed into some sort of standardized score that I don't really have the time to figure out.

If I could continue the car analogy, judging the quality of healthcare in a nation by looking only at survival rates, is like judging an automobile only by it's top speed.

There are several other factors to consider. There are wait times. There is availability, the number of doctors per capita. There is technology, the availability and research of new tools. There are pharmaceuticals, the availability and cost of old and new drugs.

You can tell me that all that technology and wait times etc does not matter if the survival rates are the same, but healthcare is about more then how many people you can keep alive. In the end, everybody dies, so the survival rates are always going to be similar. You can save a guy from an MI today, and he's still going to die next week, next month, next year of the same thing or something else. The reaper always wins, all you can do is try to kick him in the nuts and say "not today". I've personally kicked the reaper in the sack several times and sometimes he comes back to get his own within the hour.

I know for a fact that you can load up an ambulance or an ER with tons of state of the art equipment, busloads of highly trained doctors, nurses, paramedics, and experimental drugs that will make a dead man's heart start thumping, and all of it is not going to give you a significant jump on a Mexican ambulance or ER that contains a hammer and a mule for dealing with cardiac arrest. The reason why is that even with all those tools and all that training, you only have a small window to actually make a difference.

That doesn't mean that Mexican ambulances and ERs are just as good as American ones.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Most of the reason doctors have been able to do less pro-bono work is government regulation and increased malpractice insurance costs. Reduce those and docs can go back to providing sufficient voluntary charity care as they used to.

That's your plan? That's your entire plan? The whole thing can be solved by increasing the ability of doctors to do pro-bono work?

Well, I can't say it lacks simplicity.

What specific government regulations do you, or the Republican party, propose cutting? How do you plan to reform medical malpractice laws?

I don't want to get ahead of myself, I know I haven't given you time to answer the questions above, but it sounds to me like you are trying to stop a Rhino with a BB gun. I think you need to caliber up.

[ March 22, 2014, 10:54 AM: Message edited by: Grant ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
I don't remember anybody admitting that the ACA was created to fail. I think Pyr admitted that the best thing about it was that as a consequence to it's suckitude, or failings, however you want to put it, it would lead to a single payer system. That's very different then saying that it was created to do that.
Right- it's not that the ACA is designed to fail, it's that the private insurance model is fundamentally flawed and unsavable, the ACA just reduces its ability to be parasitic. But once it can't be parasitic, it can't be profitable enough to sustain.

quote:
Reduce those and docs can go back to providing sufficient voluntary charity care as they used to.
In other words, force doctors to work for free to make up the short fall instead of getting paid for their work. Brilliant.

Though the ACA does address this as well by enacting programs to help reduce the rate at which mistakes and malpractice occur, which is hands down the best way to reduce malpractice costs.
 
Posted by Pete at Home (Member # 429) on :
 
Pyr, on what planet is voluntary just another word.for coerced?

The ACA exacerbates the dicincentives on doctors offering pro bono care. Private oncologists used to get reimbursed for onco meds from medicaid for their pro bono clients. Now unless.they are part of a big corporate hospital they get less.than full reimbursement, so for the privilege of doing pro bono work they have to pay for some of the chemo meds out of pocket.
 
Posted by Greg Davidson (Member # 3377) on :
 
Enrollment via exchanges looks to be heading to exceed 6 million, just under the 7 million estimate done for budgeting purposes. Some states - the ones that tried to provide better health care for their citizens such as California - are actually achieving enrollment significantly above expectations.

We are 4 months into the 18 month period I identified in the start of this thread, and I stand by my prediction

quote:
I predict it will still be the law of the land, no death spirals, some boring fixes will be put in place to address parts of the law that were not working, and the minority of the population directly affected by the exchanges (ie; those without health insurance from their employer) will generally be satisfied. The annual rate of healthcare cost growth will continue close to 50 year lows. Polling will indicate that more Americans will favor continuing the law than repealing it. And Republicans will still be benghazi'ing some weird aspect of Obamacare that motivates their base but that the majority of Americans just don't care about.

 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Pete at Home:
Pyr, on what planet is voluntary just another word.for coerced?

In a world where something must be done by someone, but the only way that it's going to get done is for someone to step forward and offer to do it for free.

quote:
The ACA exacerbates the dicincentives on doctors offering pro bono care.
Why should we be forcing the system to rely on pro bono care? IF someone provides the care, then we should pay them for providing it. It's completely absurd that we should be demanding that someone step up and do it for free to get it done when we're perfectly capable of providing them a reasonable level of compensation for doing it by fiat.
 
Posted by Pete at Home (Member # 429) on :
 
I agree with Seneca that we should clear the way and stop blocking doctors from doing pro bono.

I don't think it will fix the whole problem but it would help the credibility of a government claiming to be about solutions, rather than about aggregating power.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Pete at Home:
I agree with Seneca that we should clear the way and stop blocking doctors from doing pro bono.

I don't think it will fix the whole problem but it would help the credibility of a government claiming to be about solutions, rather than about aggregating power.

I'd think we'd get much better service if we didn't force them to have to step up and do it pro bono in the first place. Why should we make someone have to do it for free when we could offer to pay them to do it instead?

At that point, if they declined to accept payment, you could say that it was truly voluntary, but not if there was no option to get paid in the first place.
 
Posted by Seneca (Member # 6790) on :
 
Show me where people have a right to free healthcare in the Constitution. Can't seem to find it.
 
Posted by PSRT (Member # 6454) on :
 
Its certainly good governance to provide affordable health care for everyone, and so far, the health care and insurance industries and the free marketplace have failed abysmally at that job. Not only here, but just about everywhere.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Pete at Home:
I agree with Seneca that we should clear the way and stop blocking doctors from doing pro bono.

I don't think it will fix the whole problem but it would help the credibility of a government claiming to be about solutions, rather than about aggregating power.

I'd think we'd get much better service if we didn't force them to have to step up and do it pro bono in the first place. Why should we make someone have to do it for free when we could offer to pay them to do it instead?

At that point, if they declined to accept payment, you could say that it was truly voluntary, but not if there was no option to get paid in the first place.

I sit around the table with doctors in my family who complain how the aca has destroyed their ability to do pro bono.

Your changing of my question into coercion seems perverse and obfuscationary.
 
Posted by noel c. (Member # 6699) on :
 
"Its certainly good governance to provide affordable health care for everyone, and so far, the health care and insurance industries and the free marketplace have failed abysmally at that job. Not only here, but just about everywhere." ...

Yes, make medical care good, inexpensive, and universally available... I cannot imagine why someone did not think of that before... but why stop there? Legislate against wrath, greed, sloth, pride, lust, envy, and gluttony. Things would be better still.

While we are on this law-making spree, repeal mortality so we can skip health-care altogether. Why shoot low?
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
Show me where people have a right to free healthcare in the Constitution. Can't seem to find it.

Nothing in the Constitution mentions free healthcare. What the Constitution does mention is the duty, and a reason for the existence of the government, is to "promote the general welfare".

Now, by the "government" I believe Madison meant the idea of the government as a collective institution of all it's citizens, much like a corporation is supposedly a collection of it's shareholders and employees, but is a separate entity of itself, rather then our vision of government as some beauracratic behemoth full of squabbling politicians and civil servants.

Hamilton would probably also be the first to talk about the slippery slope of the general welfare clause, and how it can seen as giving the government a kind of carte blanche to do whatever it has to do to keep people safe, or healthy, or fed, or housed, or educated, or have good teeth and gums, or pretty, or without erectile dysfunction, etc.

But the point is that the fathers did see as one of the duties and reasons for the existence of government looking out for the welfare of it's citizens. What "welfare" actually means is debateable, but one can suppose that healthcare costs that are skyrocketing out of control so that even the middle class are having trouble affording their insurance isn't a good thing.

As to "free" healthcare, that seems to be a later "right" that was developed by liberalism during the early 20th century. I think FDR mentioned healthcare as a "right" in one of his speeches, and maybe Woodrow Wilson did too.

I don't know about government making healthcare "free", but I would like to see it become more affordable, and I would like to see a plan that doesn't seem to exacerbate the problems we currently have like the ACA does, depending on who you listen to (Greg D would differ).

The reason why I asked to have some alternative conservative plans presented, is because it seems to me that 99 to 100% of the commentary by the conservative elements on the forum, deal consistently with complaining and picking apart the ACA. No productive alternatives or plans are ever discussed. When was the last time there was a thread started by a conservative here that dealt with conservative alternatives to ACA? Never? Do you know what all that complaining makes conservatives look like? It makes them look like AmeriCANTS.

Instead, it would have been nice for the conservative members to post some alternatives, to be proactive and positive rather then reactive and negative. Conservatism can't be just about saying "no" all the time, and saying "where is that in the constitution". Sometimes you gotta think outside of the box, horror of horrors.

There are problems with this of course. Conservatism and general and the Republican Party in particular are ill suited for proposing and passing healthcare reform, for the reasons that you just exhibited, Seneca. A large percentage of conservatives do not believe that it is a duty, or a role of the government, to meddle with healthcare. Either it is not a role of the government outright, or the government should not fool with the market. Well, if the free market is responsible for the high cost of healthcare, I say the free market has f***ed up.

As far as I know, the Bush II administration looked seriously at some proposals for healthcare reform, and had ample opportunity with 4 years of Republican controlled congress. But it never got anywhere, big surprise. If President Bush and the Republicans in congress been able to push healthcare reform, then maybe conservatives wouldn't have to complain about the ACA today.

The point is that conservatives here and everywhere need to stop being AmeriCANTS. Some solutions need to be offered and put forward. Have the liberals complain and gnaw on the proposals all they want, at least they will be the ones being negative at that point. Stop being AmeriCANTS and start being AmeriCANS.


There are plenty of proposals for market-based healthcare reform out there, from both conservatives AND liberals, that should appeal to ANYONE who would like something at least BETTER then what we have now.

http://www.nationalaffairs.com/publications/detail/conservative-health-care-reform-a-reality-check

http://www.nationalaffairs.com/publications/detail/the-health-insurance-solution

http://www.nationalaffairs.com/publications/detail/how-to-replace-obamacare

My personal favorite:

http://www.forbes.com/sites/aroy/2013/01/23/david-goldhills-dream-for-universal-consumer-driven-health-care/

None of these are actually plans. Some of the articles are simply what a better plan might look like, or how to make a better plan. But they are the beginnings of viable alternatives. They are a place to start.

I bet there are even more plans and proposals out there that would be approved by conservatives in the US. Why don't some of you conservatives or centrists go out there and drag them up.

I'm just tired of hearing "wah wah wah" about Obamacare.
 
Posted by Greg Davidson (Member # 3377) on :
 
Regarding the Constitutional argument against a requirement to provide health care, I believe that the focus of that argument should be on the ~1986 law signed by Reagan that mandated that no one could be turned away from an emergency room. If we are not going to make it acceptable for poor people to due because of the inability to pay for modern medical care, then subsequent legislation such as ACA can be construed as merely regulating further what is originally mandated.
 
Posted by noel c. (Member # 6699) on :
 
"Well, if the free market is responsible for the high cost of healthcare, I say the free market has f***ed up." ...

You think there was a free health-care market before Barry's UCA?

"If President Bush and the Republicans in congress been able to push healthcare reform, then maybe conservatives wouldn't have to complain about the ACA today." ...

<choke> ... Bush put through the budget busting Senior Perscription Benefits plan, which simultaneously destroyed some excellent retirement benefits offered through employers... just like the UCA.

"I bet there are even more plans and proposals out there that would be approved by conservatives in the US. Why don't some of you conservatives or centrists go out there and drag them up." ...

You have not been paying attention Grant. There have been conservative alternatives focused around eliminating artificial State sponsored insurance monopolies, and addressing "pre-existing condition" exclusions. Liberals did not like it. The problem has not been a issue of "no", it has been one of controlling the executive, and legislature, simultaneously. Just look what kind of obamination can be passed when the stars align properly... even Barry was not happy with it until he discovered that it would still effectively destroy the existing medical care delivery system.

Things will change in 2016, and some form of viable healthcare reform will emerge.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Greg Davidson:
Regarding the Constitutional argument against a requirement to provide health care, I believe that the focus of that argument should be on the ~1986 law signed by Reagan that mandated that no one could be turned away from an emergency room. If we are not going to make it acceptable for poor people to due because of the inability to pay for modern medical care, then subsequent legislation such as ACA can be construed as merely regulating further what is originally mandated.

I had no clue you were such a believer in President Reagan as a supreme arbiter of what is and what is not constitutional, Greg. Does this mean you believe EVERYTHING Reagan did, every law he passed, is automatically constitutional, simply because Reagan did it?

I hate it every time a conservative here says "you can't do that", a liberal says "Saint Reagan did it"! That's a horrible argument. The only thing it accomplishes is possibly making a conservative's head explode as they try to wrap their head around the concept of saying something like "to hell with Ronald Reagan".
 
Posted by TomDavidson (Member # 99) on :
 
quote:
The only thing it accomplishes is possibly making a conservative's head explode...
Are you saying that's insufficiently helpful?
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by Grant:
[QUOTE] The reason why I asked to have some alternative conservative plans presented, is because it seems to me that 99 to 100% of the commentary by the conservative elements on the forum, deal consistently with complaining and picking apart the ACA. No productive alternatives or plans are ever discussed. When was the last time there was a thread started by a conservative here that dealt with conservative alternatives to ACA? Never? Do you know what all that complaining makes conservatives look like? It makes them look like AmeriCANTS.

I can tell you that "never" is not correct. I, for one, created a thread suggesting a alternative. Unfortunately, there is a successful meme at work here to create the belief that no alternatives have *ever* been offered by anyone anywhere. It's simply not true and never was.
 
Posted by G3 (Member # 6723) on :
 
quote:
Originally posted by TomDavidson:
quote:
The only thing it accomplishes is possibly making a conservative's head explode...
Are you saying that's insufficiently helpful?
Your near total reliance on logical fallacies (as has been demonstrated in multiple thread recently) and simple trolling by others like this really isn't helpful, no.

G3: Please see your email. -OrneryMod

[ March 24, 2014, 12:51 PM: Message edited by: OrneryMod ]
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by G3:
I can tell you that "never" is not correct. I, for one, created a thread suggesting a alternative. Unfortunately, there is a successful meme at work here to create the belief that no alternatives have *ever* been offered by anyone anywhere. It's simply not true and never was.

Well, if anyone is responsible for such a meme, then it is me, and I take responsibility for it. I appreciate your correction. I now know that "never" is not correct. I will change my meme to "very few alternatives have *ever* been offered by any anyone anywhere, and that the vast majority of the discussion has been driven by complaints about the ACA, rather then discussing alternatives".

I don't even know what a flippin "meme" is.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
I had no clue you were such a believer in President Reagan as a supreme arbiter of what is and what is not constitutional, Greg. Does this mean you believe EVERYTHING Reagan did, every law he passed, is automatically constitutional, simply because Reagan did it?
The 1986 law was also pushed by the Democrats in Congress. I am merely making the actual point I said I was making - the law that mandated emergency room coverage for everyone was the larger step in terms of moving from a general welfare clause to a universal guarantee (of emergency room care). The ACA, coming in light of that earlier law, can be seen as a modification of the earlier low - how do you get people to pay over time for a more efficient form of the health care that they have been given a right to obtain. If there is a valid Constitutional attack, it needs to go after both the access to emergency room care and the ACA.

[ March 24, 2014, 09:20 AM: Message edited by: Greg Davidson ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seneca:
Show me where people have a right to free healthcare in the Constitution. Can't seem to find it.

The why are you pushing for free care instead of setting up a system to ensure that the care is paid for?
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Pete at Home:
I sit around the table with doctors in my family who complain how the aca has destroyed their ability to do pro bono.

Are you saying that, if for a given patient, they had the option to be paid or do it for free, that they'd choose to do it for free? That's good and noble, I suppose, but economically it's dumb. IF they're doing productive work everyone is better off if they're getting to proper public accounting points for that work.
 
Posted by Pyrtolin (Member # 2638) on :
 
AS an interesting alternative to single payer, I wonder how a baseline/sliding scale system would work.

In its most basic form, it operates like single payet- take a cue from Maryland and build a baseline reimbursement chart that accounts for the costs of providing services based on type of facility, location, and other such factors (research facilities and rural facilities might get paid more for a certain kind of service than, say, a highly specialized suburban clinic that has much less overall overhead; I'm not sure exactly how the costs line up, but I do know that the MD system as managed to ensure consistent pricing and profitability for all providers across the board, while keeping provider price growth in check (as part of the system they explicitly have a waiver to set Medicare/Medicaid pricing as well using their metrics instead of the arbitrary political levels that come out of Congress)

Where is differs is that doctors are free to arrange payment from their patients as they see fit, based on their own work loads and individual funding needs. For every dollar they collect from a patient, the Federal reimbursement is lowered by, say, 10-20 cents.

So now a doctor that can heep a low overhead can feel free to work pro bono, and simply collect the baseline public reimbursement for that work, or the doctor can charge some nominal fees to increase margins a bit or to help manage overall patient load.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Greg Davidson:
The 1986 law was also pushed by the Democrats in Congress. I am merely making the actual point I said I was making - the law that mandated emergency room coverage for everyone was the larger step in terms of moving from a general welfare clause to a universal guarantee (of emergency room care). The ACA, coming in light of that earlier law, can be seen as a modification of the earlier low - how do you get people to pay over time for a more efficient form of the health care that they have been given a right to obtain. If there is a valid Constitutional attack, it needs to go after both the access to emergency room care and the ACA.

I see what you are saying and I think you are making a good point. The argument is provided by the law itself rather then the fact that Reagan signed it.

The law you pointed out stipulates that Hospital ERs cannot refuse care. Same thing for ambulances on duty. By doing this you are saying that an individual has a RIGHT to emergency care.

The question remains one of degree. Does the fact that we say that an individual has a constitutional, or lawful right to emergency care, mean that they have a right to all kinds of care?

A second question can be brought up about cost. Once you look beyond the right of an individual TO have healthcare, you have to look to whose RESPONSIBILITY it is to pay for it. The law pointed out does not release an individual from the responsibility for paying for the emergency care mandated to be provided. The question becomes: is it the Government's responsibility, or duty, to PAY for it's citizens healthcare?

I mean, every citizen has a right to bear arms. Doesn't mean that the government is handing them out for free. Though some people believe that would be a better system then what we have currently.
 
Posted by Seneca (Member # 6790) on :
 
Great point Grant. The Constitution actually makes more of a case for the government to provide firearms than it does for the government to provide healthcare.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
The question becomes: is it the Government's responsibility, or duty, to PAY for it's citizens healthcare?
Also- to what extent does the public as a whole benefit from ensuring a given baseline level of health, given that health is one of the most critical factors in any given individuals ability to productively participate in society.
 
Posted by TomDavidson (Member # 99) on :
 
We could almost literally kill two birds with one stone by giving free guns to people with very expensive healthcare. This would presumably eliminate Seneca's constitutional objections.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by TomDavidson:
We could almost literally kill two birds with one stone by giving free guns to people with very expensive healthcare. This would presumably eliminate Seneca's constitutional objections.

Or maybe just define medical services as arms in a war against poor health and disease. EG: Antibiotics are just the kind of bullet that we're best able to shoot invading bacteria with.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pyrtolin:
Also- to what extent does the public as a whole benefit from ensuring a given baseline level of health, given that health is one of the most critical factors in any given individuals ability to productively participate in society.

It's related, yet it isn't. No one is denying that the public as a whole benefits from having healthy citizens. No one denies that the public as a whole benefits when there is no unemployment, or no poverty, or no stupidity. The public as a whole would benefit from universal conscription and mandatory stretching and calisthenics before work.

The question is, are there limits to the power of the government to tax and spend in pursuit of the "general welfare", and why?

Instead of typing forever, I'm going to quote from an article by Andrew McCarthy. Yes, it's from National Review, and I wanted to put that warning out there in case some liberals believed that looking into National Review was like looking into the Ark of the Covenant.

quote:
Alexander Hamilton contended that Congress’s taxing authority is “plenary, and indefinite,” and that “the objects to which it may be appropriated [i.e., the general welfare] are no less comprehensive.” He successfully persuaded George Washington to adopt this construction during the first presidential administration. Yet it was widely rejected. In fact, the Framers of the Constitution denied a Hamiltonian proposal to include a provision authorizing the federal government to spend public funds on internal improvements. Most presidential administrations, moreover, recognized that Hamilton’s construction of the general welfare could, as James K. Polk’s crystal ball warned, “absorb the revenues of the country, and plunge the government into a hopeless indebtedness.”

Second is the position that is generally credited to James Madison but was shared by Thomas Jefferson — the one I believe is correct. It holds that the preamble’s General Welfare Clause, right before the Constitution’s exacting enumeration of Congress’s powers, merely makes clear that Congress has the authority to raise revenue and spend in furtherance of those specified powers. Those powers include many things: declaring war, raising armed forces, regulating interstate and international commerce, establishing post offices and the lower federal courts, etc. But they do not include welfare-state programs.




Don’t be cowed by shrieking from the Left. The Constitution, of course, does not say we cannot have Social Security, health care, education, and other such programs that Congress is given no power to create. It creates a federalist system of dual sovereignty. Welfare programs can legitimately be created only by state and local governments. It is at that level that the people most intimately familiar with the local culture and conditions can best determine what they desire and what they are willing to pay in order to have it — without those desires and costs’ being imposed on other states that have different notions of what government may demand of the citizen.

If anything should be patent by now, as we rapidly sink trillions deeper into debt’s death spiral, it is this: If Congress’s tax-and-spend authority is not restricted to the specific grants of power enumerated in Article 1, Section 8 — a restriction confirmed by the Tenth Amendment’s guarantee that powers not granted by the Constitution to the national government are retained by the states and the people — the Hamiltonian gloss on general welfare both bankrupts the country and destroys state sovereignty.

As is seemingly always the case, there is also a “third way” — a “moderate” compromise between the Hamiltonian and Madisonian “extremes.” This is the Monroe position. President James Monroe understood the existential danger of Hamilton’s no-limits approach. Still, as John Eastman explains, he was unwilling to adopt Madison’s strict limitations. His middle position was that the concept of “general welfare” did not restrict Congress to section 8’s enumerated powers, but it did contain its own restriction — the word general.

Spending, he inferred, had to be for the general welfare: It could not be a redistribution of wealth strictly for the benefit of local or regional interests; it had to accomplish some legitimate national interest. To be more concrete, Eastman recounts that one early Congress declined to fund the dredging of the Savannah River but approved an appropriation for a lighthouse at the entrance of the Chesapeake Bay: The latter was valid because it benefited coastal trade for the nation, the former invalid because it would solely benefit Georgia and South Carolina.

I understand there is a little ptolemic quote in there. I apologize, but it is National Review, and I did warn you.

Here is what I think, and it may be unrelated to all the above:

If a citizen CAN get out of a jam on their own, then it is their responsibility to do so. If they cannot, and it is a general problem, then the government should step in. This is a general guideline I have pulled out from my nether regions so feel free to tear it apart but know that the guideline is subject to change in the crucible of thought and criticism.

The cost of healthcare is a national problem. The spiraling cost of healthcare effects everybody. It is not a problem an individual can solve themselves. I can't make a dent in the cost of healthcare on my own. I can exercise on my own, I can eat healthy on my own, etc etc.

The market, free, corporatist, mercantilist, socialist, whatever, has screwed up the cost of healthcare. What we had wasn't working. We need something better, and the problem is to the point that the government needs to step in.

You can argue weather it should be a state or federal problem, but the idea is that it is a problem should be clear.

A lot of all this is in the articles I linked in National Affairs. Did no one actually read any of them? I promise it will not make you melt.
 
Posted by Pete at Home (Member # 429) on :
 
Yes, pyr, socialized med is the next reasonable step after providing education.

But the aca is a step in the wrong direction.

Anyone who understands how new techs are implemented (development costs covered by early implimenters, etc) should grasp why taxing and burdening the high end nonelective health care is the stupidest way to implement universal coverage ... unless the object was to stop development of new medical techs in their tracks.

US med system needed to be made less fascistic, not more so.

..
 
Posted by Pete at Home (Member # 429) on :
 
To be more.clear, I view the pre-aca system as mercantile on the doctor certification end and fascist on the pharma end.

The ACA seems to be fascifying the middle, I.e. the business of providing medicine, which used to be more private enterprise (as much as it could with the above constraints) but now is being weighted towards big hospital mega corps.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
has screwed up the cost of healthcare
The big problem is that he baseline cost of healthcare is completely tangential to factors that any individual has control over. Sure there's a narrow window of personal health issues that tend to feed back on themselves, but the most pervasive and costly issues are either epidemiological (eg: most communicable diseases) or stem from some manner of genetic malfunction (eg: cancer at the worst end). And even many of the personal health issues tend to stem from at least one of those two baseline sources at the root, with losing personal control of the situation effectively just bing one of the symptoms of the underlying malfunction at work.

In general the Monroe position seems to very explicitly reflect the nature of healthcare
quote:
Spending, he inferred, had to be for the general welfare: It could not be a redistribution of wealth strictly for the benefit of local or regional interests; it had to accomplish some legitimate national interest.
That seems to sum up the combination of the general welfare clause and the practical effect of the 10th amendment very well, and I can't see how baseline healthcare does not effectively serve as a textbook example of a general legitimate national interest that doesn't specifically benefit any given individual or region more than any other.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pyrtolin:
That seems to sum up the combination of the general welfare clause and the practical effect of the 10th amendment very well, and I can't see how baseline healthcare does not effectively serve as a textbook example of a general legitimate national interest that doesn't specifically benefit any given individual or region more than any other.

It still becomes a question of degree and duty, Pyr. It is the duty of the government to CONTROL healthcare, or to FIX it. Does medicine need to be socialized or can it be effectively consumer-run?

I believe the government should only control things that cannot be controlled or administered effectively otherwise. It is the difference between limited government and unlimited government.

But we're leaving people at the station. We agree that the government should do SOMETHING. Maybe not exactly what, but SOMETHING. We need to go back and pick up some more people who still believe that the government shouldn't be doing anything at all.

Well, maybe that's not a problem for the liberals. All liberals agree that something should be done. But not all conservatives. So it is more of a conservative problem.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
It still becomes a question of degree and duty, Pyr. It is the duty of the government to CONTROL healthcare, or to FIX it. Does medicine need to be socialized or can it be effectively consumer-run?

I believe the government should only control things that cannot be controlled or administered effectively otherwise. It is the difference between limited government and unlimited government.

I don't think there's much of a question there, either, though. I don't see anyone here suggesting that government should control or run health care, but just how the funding mechanism for a private market should work. Should consumers have to bear athe direct financial burden for the baseline, or should the market be financed such that consumer decisions aren't limited by financial concerns.
 
Posted by Seneca (Member # 6790) on :
 
This comes down to the fear of liberty that progressives are pushing. They want people to be afraid to be responsible for their own needs and so want to cede ever more control to the government.

Surely you can see where this is leading right?

How long before the government starts controlling calorie intake?
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
This comes down to the fear of liberty that progressives are pushing. They want people to be afraid to be responsible for their own needs and so want to cede ever more control to the government.

Surely you can see where this is leading right?

How long before the government starts controlling calorie intake?

Personally, I believe a person should be able to control their own calorie intake. If they are unable to control their calorie intake, it is not the fault of the government or duty of the government to save them. I don't know if there are liberals out there who disagree, but we're getting off track again.

Are we going to sit down and look at what can be done, or keep complaining about what has been done? Please don't tell me that the solution is to get rid of President Obama. That's not an alternative plan.

[ March 24, 2014, 01:06 PM: Message edited by: Grant ]
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pyrtolin:
Should consumers have to bear athe direct financial burden for the baseline, or should the market be financed such that consumer decisions aren't limited by financial concerns.

Consumer decisions need to be limited by something. It's always too easy to spend other people's money, that includes the government's, or the community's. Otherwise I'm going to get laser beams on my sharks instead of particularly vicious sea bass.

Now, the government can control that spending by setting limits, which means the government is controlling healthcare, which is what we don't want, right? So we look for alternatives.

[ March 24, 2014, 01:16 PM: Message edited by: Grant ]
 
Posted by NobleHunter (Member # 2450) on :
 
It's been 50 years in Canada and our government hasn't gotten past passive-aggressive suggestions on calories.
 
Posted by Seneca (Member # 6790) on :
 
The plan should be to embrace real liberty. Let people make their own choices and be responsible for them.

Yes, some will choose behaviors that kill themselves, as our obese stats are showing, but if someone doesn't want to pay for healthcare then that should be their choice and they should live with the consequences, whether that be extra income from not having a bill every month or dying because they took a gamble and lost.

And before anyone jumps in about the supposed "plight of the poor," there is no right to free income in the Constitution. The progressives are getting around this little detail by cutting out money as the middle-man and handing out all the things that an income would give people:food, healthcare, housing, telecommunications, etc. It is sickening.

Welfare has been expanding at a rate faster than population growth. If it was supposed to help fight poverty it sure is doing a terrible job.

As to keeping health care costs down, get all the government regulations off of it and you will see costs come way down and doctors do a lot more pro bono care like they used to. That is the way to a truly better medical industry in the United States. And yes, that means ending all the crony capitalist deals with the government as well.

[ March 24, 2014, 01:16 PM: Message edited by: Seneca ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by Pyrtolin:
Should consumers have to bear athe direct financial burden for the baseline, or should the market be financed such that consumer decisions aren't limited by financial concerns.

Consumer decisions need to be limited by something.
Indeed- that's why we have trained professionals (ie: Doctors) to make the call on what services that consumers should actually be able to get access to or where it would be a waste of resources that others need to provide them.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Seneca:
The plan should be to embrace real liberty. Let people make their own choices and be responsible for them.

I agree. What do you think of the David Goldhill plan? Or plans similar to what they have in Singapore or Switzerland?
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
This comes down to the fear of liberty that progressives are pushing. They want people to be afraid to be responsible for their own needs and so want to cede ever more control to the government.
And yet it's progressives that are pushing for a system that allows people to be free to take responsibility for their health and procure the treatment they need, while you seem to be pushing for a system that uses personal financial assets as a tool to prevent people from taking responsibility or at least to defer care they need indefinitely, unless they can find someone that they can compel to serve them for free.
 
Posted by Grant (Member # 1925) on :
 
quote:
Originally posted by Pyrtolin:
Indeed- that's why we have trained professionals (ie: Doctors) to make the call on what services that consumers should actually be able to get access to or where it would be a waste of resources that others need to provide them.

Sounds like you have simply changed the name of the rooster guarding the henhouse. In a perfect world, doctors would only charge for what is needed. Not only are doctors incentivized to order services not needed, creating a conflict of interest, but doctors are trained by nature to utilize every tool in the toolbox. You have a tummy ache? Get a $50-$200 EKG, because there is a CHANCE that it could be an abnormally presenting MI. Doctors are trained not to take any chances. If we are going to reign in spending, we have to start making cost/risk assessments, and the only people I believe are qualified to do that are patients, advised by ethical doctors.
 
Posted by noel c. (Member # 6699) on :
 
"Please don't tell me that the solution is to get rid of President Obama. That's not an alternative plan."...

Actually, it is. I will go a step further; it is constitutionally mandated.

No enduring/viable market-based solution will be implemented while the "single-payer" grail entices socialist pilgrims to engage in a quest for health care Camelot.

Wait until 2016, and wring your hands in the interim if it makes you feel productive Grant.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
No enduring/viable market-based solution will be implemented while the "single-payer" grail entices socialist pilgrims to engage in a quest for health care Camelot.
No market based solution is possible without single payer, because financial wealth does not correlate to to need for service. Without a single payer model, the system cannot escape plutocratic control, which brings all the same faults as public control, but with even less public accountability.
 
Posted by noel c. (Member # 6699) on :
 
"No market based solution is possible without single payer... "...

See what I mean Grant? [Wink]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Grant:
quote:
Originally posted by Pyrtolin:
Indeed- that's why we have trained professionals (ie: Doctors) to make the call on what services that consumers should actually be able to get access to or where it would be a waste of resources that others need to provide them.

Sounds like you have simply changed the name of the rooster guarding the henhouse. In a perfect world, doctors would only charge for what is needed. Not only are doctors incentivized to order services not needed, creating a conflict of interest, but doctors are trained by nature to utilize every tool in the toolbox. You have a tummy ache? Get a $50-$200 EKG, because there is a CHANCE that it could be an abnormally presenting MI. Doctors are trained not to take any chances. If we are going to reign in spending, we have to start making cost/risk assessments, and the only people I believe are qualified to do that are patients, advised by ethical doctors.
Perhaps, but as long as they have the resources available to do so, why not?

Step back and think about it- if the EKG machine is sitting idle, that doesn't save potential ekgs for future use, it just means that the resource is idle and potential benefit from it is effectively wasted. So, what exactly is the problem of putting it to use to help build a better diagnosis for someone at that point?

On the other hand, if the EKG schedule is full of people who have a more direct and urgent need for it, then there's no motivation to put any one into the line who doesn't need to be there, and in fact, to ensure the best overall quality of care, the doctor now needs to apply their professional judgement to say who goes in and who can skip it and go on to be treated for what it's pretty clear is at play.
 
Posted by noel c. (Member # 6699) on :
 
"... if the EKG machine is sitting idle, that doesn't save potential ekgs for future use, it just means that the resource is idle and potential benefit from it is effectively wasted."...

I rest my case Grant. Go ahead, try to persuade Pyrtolin that EKG machines do not appear from ether.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by noel c.:
"No market based solution is possible without single payer... "...

See what I mean Grant? [Wink]

You are confusing money with market here.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by noel c.:
"... if the EKG machine is sitting idle, that doesn't save potential ekgs for future use, it just means that the resource is idle and potential benefit from it is effectively wasted."...

I rest my case Grant. Go ahead, try to persuade Pyrtolin that EKG machines do not appear from ether.

If you want to support a position argue that position, don't make up random arguments on my behalf and try to pretend they come from me.
 
Posted by Grant (Member # 1925) on :
 
quote:
Step back and think about it- if the EKG machine is sitting idle, that doesn't save potential ekgs for future use, it just means that the resource is idle and potential benefit from it is effectively wasted. So, what exactly is the problem of putting it to use to help build a better diagnosis for someone at that point?

On the other hand, if the EKG schedule is full of people who have a more direct and urgent need for it, then there's no motivation to put any one into the line who doesn't need to be there, and in fact, to ensure the best overall quality of care, the doctor now needs to apply their professional judgement to say who goes in and who can skip it and go on to be treated for what it's pretty clear is at play.

Think about it some more. If we say that we should give THIS individual with a tummy ache an EKG, then we should be giving ALL individuals with tummy aches an EKG. At this point it becomes a question of availability. Line for the EKG machine is too long? Buy another EKG machine and hire and train a new tech to run it. Don't need two EKG machines and two techs right now? Too bad, you have to keep both of them just in case you need both an hour from now, and that EKG tech needs to make a living. That's how costs become inflated by buying things we do not necessarily need but might. Now the hospital is taking a bigger chunk of the bill because it has to pay for two EKG machines and two techs.
 
Posted by noel c. (Member # 6699) on :
 
You might want to edit that post to clarify that it is from you, not me, Pyrtolin.

"If you want to support a position argue that position, don't make up random arguments on my behalf and try to pretend they come from me."...

Some positions are self-evident. Grant's response to you proves it... but I have no expectation that it will register with you. He has more patience than I do.

[ March 24, 2014, 01:57 PM: Message edited by: noel c. ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Grant:
quote:
Step back and think about it- if the EKG machine is sitting idle, that doesn't save potential ekgs for future use, it just means that the resource is idle and potential benefit from it is effectively wasted. So, what exactly is the problem of putting it to use to help build a better diagnosis for someone at that point?

On the other hand, if the EKG schedule is full of people who have a more direct and urgent need for it, then there's no motivation to put any one into the line who doesn't need to be there, and in fact, to ensure the best overall quality of care, the doctor now needs to apply their professional judgement to say who goes in and who can skip it and go on to be treated for what it's pretty clear is at play.

Think about it some more. If we say that we should give THIS individual with a tummy ache an EKG, then we should be giving ALL individuals with tummy aches an EKG.

On what basis? I don't think that logically follows at all. And how long would you keep going to a doctor that seemed to treat you more like a lab rat than a patient by prescribing completely bizarre tests without being able to help you understand why they were being done? This is precisely where the consumer end of the market does its work- people will seek out doctors that they feel treat them effectively without wasting their time, those who can't do that will get fewer patients (or at least patients that actually want what they're selling).

quote:
At this point it becomes a question of availability. Line for the EKG machine is too long? Buy another EKG machine and hire and train a new tech to run it.
Perhaps- but at that point making that call is fully within the sphere of exactly what we trust that a licensed professional should generally be able to make on a reliable basis. That's part of the point of having a licensing gateway and associated ethical standards to begin with.
quote:
Don't need two EKG machines and two techs right now? Too bad, you have to keep both of them just in case you need both an hour from now, and that EKG tech needs to make a living.
And that's how poor business sense will end up weeding out those that are competent to actually make good decisions.
quote:
That's how costs become inflated by buying things we do not necessarily need but might. Now the hospital is taking a bigger chunk of the bill because it has to pay for two EKG machines and two techs.
And that's where the hospital's motivation to manage resources more effectively comes from as well. IF they buy more equipment than they can effectively utilize, then they're going to put themselves out of business, because the cost of maintaining idle equipment and staff will eat away at them. If they send to many people to the machines uselessly- especially if the delay in treatment due to the tests ends up leading to worse overall outcomes- they're going to lose their patient base to facilities that are more efficient at providing care, and similarly chew away at their bottom line.
 
Posted by noel c. (Member # 6699) on :
 
"And that's how poor business sense will end up weeding out those that are competent to actually make good decisions."...

Finally, a morsel of reason.

Let physicians, and patients, not the UCA, dictate market strategy, and response. There is no market with a "single payer" no matter how contortional your reasoning becomes.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by noel c.:
"And that's how poor business sense will end up weeding out those that are competent to actually make good decisions."...

Finally, a morsel of reason.

Let physicians, and patients, not the UCA, dictate market strategy, and response. There is no market with a "single payer" no matter how contortional your reasoning becomes.

That's exactly what single payer does. Instead of letting personal wealth dictate the allocation of care, it makes it purely an interaction between physicians and consumers without letting personal finances of patients distort the decision making.
 
Posted by noel c. (Member # 6699) on :
 
- The physician supplies services

- The patient supplies money

- The UCA supplies... What?
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Pyrtolin:
What central planning? Right now we have a system that is effectively "centrally planned" by insurance company. The point of single payer is to discard that planning and instead let the market operate on direct patient/physician transactions.

Single payer = central planning, nothing more nothing less. In that game the only way costs are controlled is by the single payer paying less. It's decisions on what to pay (ie where to allocate its resources) are never as efficient as the multitude of decisions made by all the individual payers it replaces.
quote:
quote:
quote:
Originally posted by Pyrtolin:
In a single payer model, providers are freed to compete on efficiency of care, quality of service, and overall outcomes instead of, where health issues are concerned, the false arena of nominal price.

They can do that today.
Only if they're rich enough to have that luxury. The average person very often has to forgo needed care, not because their doctor says it's not necessary or others need it more, but because they don't have enough money to pay of it, which is an absurd way to prioritize need.
First you switched from providers to consumers, which doesn't respond to what either of us said.

Secondly, what's absurd about not allocating expensive products where they can't be afforded? Are you really arguing that everyone can get a million dollar surgery? Or do you recognize that at some level there will be resource constraints? What I know, is that there will always be constraints, and between capitalism and single payer/central planning/redistribution, only capitalism has a proven history of expanding the pool of availability and reducing the costs of expensive treatments. End of day the current system means that in 20 years everyone will get that million dollar surgery cause it'll only cost twenty thousand, in single payer, it'll only go to the friends of politicians.
quote:
quote:
However, in the single payer model they will only get paid by volume of payable events. That means nothing you just listed will be incentivized.
[/qb]No, that means that the things I listed, which would be the only way they could increase the volume of payable events over others that do better at them, will explicitly be what gets incentivized.
You're counter argument, is because you said so? Pay per event means the only thing that increases pay is more events. Unless you have a tremendous doctor oversupply, "consumer selection" isn't going to materially inpact that rate. Doctor oversupply doesn't exist today, and its a certainty that it's not going to get better with the economic model you're advocating.
quote:
Single payer actively removed the central planning aspect by putting control of the dispensation of service and resources directly in the control of the professionals that are trained to evaluate on the ground who is best served by receiving them. It explicitly removes central planning that is inherent to any individual payment system, whether enacted through insurance or personal wealth.
Central planning removes central planning? Seriously? Single payer like you suggest is some mythical thing where providers are free to charge the price they want? Cause what actually happens in the central planner sets the price they'll pay, and after that any treatment that isn't as profitable disappears from the medical professionals professional evaluation.
 
Posted by Seneca (Member # 6790) on :
 
It amazes me that people pushing SP ignore the current examples of medicaid and Medicare to see how the government would behave as a payer.

Though I have seen a few brutally honest socialists openly admit that the problem right now is that doctors can refuse to be paid pennies on the dollar from medicaid but under SP they'd have no choice but to swallow the low ball payments.

If you expand the myriad problems we have now with medicaid and medicare to the whole system by passing SP, be prepared to see the doctor shortage get exponentially worse.

[ March 24, 2014, 06:11 PM: Message edited by: Seneca ]
 
Posted by DonaldD (Member # 1052) on :
 
Doctors on the one hand are protected from the realities of market forces - artificial constraints on the number of doctors certified and controlled by doctors' associations themselves, the lack of freedom of movement of doctors outside the country to easily migrate into the country - whereas this artificial paucity of available doctors is then argued as a reason to jack up the prices of their services, because, well, free market!

If one is honestly concerned about doctor shortages - allow straightforward certification processes for qualified foreign doctors and allow them to immigrate.
 
Posted by Seneca (Member # 6790) on :
 
The AMA and state boards are what is stopping doctor immigration from other countries, really?

Also, even if you imported a lot of doctors and rammed through their certs, how would that not only be a temporary solution? If the government will only ever pass less than what healthcare costs, won't those new doctors just give up and quit also?

[ March 24, 2014, 07:13 PM: Message edited by: Seneca ]
 
Posted by NobleHunter (Member # 2450) on :
 
It amazes me that people condemning SP ignore current examples of actual single payer systems to see how the government would behave as a payer.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by NobleHunter:
It amazes me that people condemning SP ignore current examples of actual single payer systems to see how the government would behave as a payer.

No need to ignore them. One just has to look at the DIY tooth extraction kits in the UK or the various death panels in SP countries where the government decides when someone is worth saving and when it's time to schedule their euthanasia session.
 
Posted by NobleHunter (Member # 2450) on :
 
Death panels? Really?
 
Posted by Seneca (Member # 6790) on :
 
http://www.theglobaldispatch.com/canada-reveals-it-has-death-panels-slate-says-its-a-good-thing-to-play-god-50115/

http://www.express.co.uk/news/health/399032/Now-we-pull-out-our-own-teeth-Boom-in-DIY-dental-kits-as-patients-cannot-afford-NHS-fees
 
Posted by NobleHunter (Member # 2450) on :
 
You realize the "death panel" thing is about who has the ability to consent for patients who are unable to do so? That it exists to resolve conflicts between a doctor's duty of care and the wishes of the family. And its mandate is to act in the interests of the patient. Which is usually that the patient should keep breathing. The alternative would be judges parsing out the legal precedence.

You know there's a similar sort of process would happen in the US if there was a disagreement between doctors and the family?
 
Posted by Seneca (Member # 6790) on :
 
You ignored the main point about the court's secondary point.

quote:
In the same breath, however, the court also confirmed that, under the laws of Ontario, Canada’s most populous province, a group of government-appointed adjudicators could yet overrule the family’s choice. That tribunal, not the family or the doctors, has the ultimate power to pull the plug.”
No response on the DIY cavity kits eh?
 
Posted by NobleHunter (Member # 2450) on :
 
Well, yeah, what's the point on having a tribunal to settle disputes if it can't make the final decision? If it wasn't the tribunal, it'd be a judge.

I'm not familiar with the UK system, so I'll refrain from commenting.

[ March 24, 2014, 09:34 PM: Message edited by: NobleHunter ]
 
Posted by noel c. (Member # 6699) on :
 
DonaldD,

"Doctors on the one hand are protected from the realities of market forces - artificial constraints on the number of doctors certified and controlled by doctors' associations themselves, the lack of freedom of movement of doctors outside the country to easily migrate into the country - whereas this artificial paucity of available doctors is then argued as a reason to jack up the prices of their services, because, well, free market!

If one is honestly concerned about doctor shortages - allow straightforward certification processes for qualified foreign doctors and allow them to immigrate. "...

Totally agree.

The doctor certification structure is nothing more than a refined labor union.
 
Posted by TomDavidson (Member # 99) on :
 
Seneca, I'm curious why you're harping on the cavity kits. Surely you don't disapprove of the free market allowing people to pay extra for optional medical care?
 
Posted by DonaldD (Member # 1052) on :
 
quote:
Originally posted by Seneca:
The AMA and state boards are what is stopping doctor immigration from other countries, really?

How did you invent that from what I said?

People who can immigrate can immigrate, though doctors who are not able to work as doctors in the US are far less likely to do so.

Also, although the USA has liberalized trade agreements that facilitate the movement of industrial jobs away from the country, it has been quite successful in protecting domestic doctors and lawyers from international competition.

Or do you really think that the market for doctors is open to all comers? It's quite clear that there are large barriers against entry that artificially reduce the supply of doctors in the country, thus artificially supporting their wages to the detriment of consumers.
 
Posted by Seneca (Member # 6790) on :
 
Why bother even bringing them here? Don't you know all the latest rage is going to a doctor's appointment and having the nurse put you in a room with a computer monitor, camera and then get on a Skype call to your doctor overseas?

And if cavity DIY home kits are merely a market adaptation that have nothing to do with the government, why are they more prevalent in the UK than here if the NHS is so much better and more affordable?

[ March 24, 2014, 10:38 PM: Message edited by: Seneca ]
 
Posted by TomDavidson (Member # 99) on :
 
quote:
And if cavity DIY home kits are merely a market adaptation that have nothing to do with the government, why are they more prevalent in the UK than here if the NHS is so much better and more affordable?
May as well ask why Tim-Tams, man.
 
Posted by Seneca (Member # 6790) on :
 
Or there's the relevant answer which is that as bad as the US healthcare market is it isn't as bad as the UK's because we haven't gotten to he surgery kits as mass products yet.
 
Posted by TomDavidson (Member # 99) on :
 
So when people start supplementing public care with private care, that's how you know the market is bad?
 
Posted by noel c. (Member # 6699) on :
 
"So when people start supplementing public care with private care, that's how you know the market is bad?" ...

No, that is how you know the market has been butchered by public policy. Public care should be supplemental, not primary.
 
Posted by Greg Davidson (Member # 3377) on :
 
If there were evidence from multiple studies (using rigorous analytical methodologies) that demonstrate that the cost of American health care per patient is double that of the next closest nation, while the outcomes (both in terms of mortality as well as self-reported patient satisfaction) for the United States were below average for the top 40-50 industrialized countries, would that change anyone's mind? Would those facts - if substantiated - really matter?
 
Posted by Seneca (Member # 6790) on :
 
Guess it depends on how many biased studies from politically-involved organizations you can find, because I haven't seen anything but that in terms of trying to advocate SP or comparing the two and claiming SP systems are better.

Feel free to post some though and I'll take a look.
 
Posted by Seneca (Member # 6790) on :
 
quote:
Originally posted by noel c.:
"So when people start supplementing public care with private care, that's how you know the market is bad?" ...

No, that is how you know the market has been butchered by public policy. Public care should be supplemental, not primary.

Bingo!

A rising tide drowns all swimmers...
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Public care should be supplemental, not primary.
So if the standard was that everyone bought DIY tooth extraction kits, but only people who needed real dental surgery went to a publicly-provided doctor, that would be better?
 
Posted by noel c. (Member # 6699) on :
 
The standard is: buy your own catastrophic health care insurance, and use a tax-free health care savings fund to get that tooth extraction. If you decide against a savings account, go ahead and pay for it out of pocket, or buy exorbitantly priced insurance.

Only if none of those options are possible should a person draw from the public trough, but that should be available to all citizens who need it.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Only if none of those options are possible should a person draw from the public trough...
So I'm not sure what's wrong with home tooth extraction kits, then. Surely it's an efficient use of money?
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by DonaldD:
Doctors on the one hand are protected from the realities of market forces - artificial constraints on the number of doctors certified and controlled by doctors' associations themselves, the lack of freedom of movement of doctors outside the country to easily migrate into the country - whereas this artificial paucity of available doctors is then argued as a reason to jack up the prices of their services, because, well, free market!

There's definitely a balance that needs to be found between artificially limiting doctor supply and providing for appropriate quality controls. I see the argument that the control level is too high and is set artificially at a protectionist level. Yet at the same time, we still have a number of poor doctors, and I'm not sure I agree that changing the standard won't increase that percentage.

But on this whole idea of allowing foreign doctors to certify in, I must ask is it your view that there is an adequate supply of doctors on a world wide scale? Or do you think that taking doctors from other countries to supply US medical needs is okay, because it harms them, not us? One could easily argue that the harm you're trying to fix, ie providing care to the most disadvantaged Americans, should not be done by taking the care away from even more disadvantaged people worldwide.

It's interesting to me, that we seem to simultaneously believe everyone should be entitled to a top doctor (see the whole argument above about great doctors getting more business) and believe that the solution is to reduce (and it is a reduction, even its a fair reduction) the standard for certification and raid doctors from other poorer countries. I can't quite wrap my head around whether the goal is to help the worst off or not with that.
quote:
Originally posted by Noblehunter:
It amazes me that people condemning SP ignore current examples of actual single payer systems to see how the government would behave as a payer.

I think you need to provide more detail. I have spent quite a bit of time following up on various single payer examples on my own, and specifically when people hold them up as shining examples of how we should operate. I have yet to find one that does not make allocation decisions that deny treatment types to people based on cost. Virtually all of them ration or ban certain treatments, or direct medical decisions into less costly alternatives even where it impacts the outcomes or is not what the doctor would choose given all options. Additionally, most also seem to be premised on the mooching principal with respect to medical developments and drug production. Even those where there are "cutting" edge medical treatments available are often set up deliberately to draw international medical conglomerates to their shores with tax and fast tracking advantages - effectively letting them run trials on an expedited basis - with an ultimate goal of recouping costs in the US market after development.

If you really do switch the US to the same model, we're going to have to come up with a competely different driver of medical innovation and be willing to accept that the cost of giving everyone a mediocre standard of care today, is that it will delay how rapidly that standard moves upwards for everyone.

I'm not sure anyone's even legitimately established that American's weren't receiving care under the old model.
 
Posted by noel c. (Member # 6699) on :
 
"So I'm not sure what's wrong with home tooth extraction kits, then. Surely it's an efficient use of money?" ...

If you are a competent oral surgeon, have at it. I would not want to try digging out a broken root fragment... but then, I am just squeemish about blood, and bone, in unusual conditions.
 
Posted by NobleHunter (Member # 2450) on :
 
Seriati,

The circumstances I've heard of where decisions were based on cost have always been for exceptional cases with experimental treatments. The province isn't going to shell out a half million for an unproven treatment any more than an insurance company would. I haven't seen any evidence that the province directs accepted medical treatments based on cost.

Also worth pointing out that a person needing treatment that isn't covered is in no worse a situation than someone who's insurance denies coverage. The Canadian just didn't pay monthly premiums for the privilege.

Our doctors seem to have far more control over the care their patients receive than in the US. Where the US seems to have insurance people at every turn, our medical decisions are made solely between the patient and their doctor. Cost would be a factor for prescriptions, as they aren't covered for most people, so I guess not being able to afford the drugs is an issue. But if you need lab work, scans, or sugery you just get it; no awkward conversations about insurance. And no paying someone just to fill out forms to deal with the myriad insurance companies.

You may have a point about depending on the US for profitability. I don't know how our system interacts with the US one to be sure. There's a meme of rich people scurrying down to the US for queue jumping but I don't know if that's significant enough to affect outcomes.

ETA: The thing that gets me is that the insurance company is motivated to deny coverage to increase profits and they are implicated in every medical decision. The bureaucrat is motivated to keep their department out of the news and is only implicated in exceptional cases. Which system do think is going to adhere to medical advice more closely?

[ March 25, 2014, 10:45 AM: Message edited by: NobleHunter ]
 
Posted by noel c. (Member # 6699) on :
 
"There's a meme of rich people scurrying down to the US for queue jumping but I don't know if that's significant enough to affect outcomes. "...

My son-in-law is a Canadian who plays hockey professionally. They pull in a few million annually, and none of their health care needs are obtained in Canada. It is because your system is relatively primitive. The most advanced medical methods, and equipment are still the domain of American medicine, but Barry is changing that.
 
Posted by NobleHunter (Member # 2450) on :
 
Where do they live?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
If you are a competent oral surgeon, have at it. I would not want to try digging out a broken root fragment...
But surely you and Seneca would applaud those self-reliant people who take charge of their own oral care, no?
 
Posted by Seneca (Member # 6790) on :
 
Both SP and private systems have payers that ration care.

What is the difference?

If you are in a private system and a private insurer payer says no, you can go somewhere else and keep looking or even pay out of pocket.
I also contend that private insurers are a lot more vulnerable to PR media pressure, especially if they are watching their stock price, than an unelected government bureaucrat.

In a government SP system if the government says no then you are done. You have nowhere else to go. You can't even try to pay put of pocket because the government maintains a monopoly on not only doctors (who because they are constantly underpaid by the government can never take time to do pro bono care and due to restrictions from the government can't work on the side), but also on equipment and installations. So even if you found a doc you'd never be able to use any machines or ORs that you'd need to go with the doc.

[ March 25, 2014, 12:16 PM: Message edited by: Seneca ]
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Seneca:
What is the difference?

If you are in a private system and a private insurer payer says no, you can go somewhere else and keep looking or even pay out of pocket.

One significant addition to this analysis is that in a system where there are private payers acting in bad faith, the government can intervene to punish the private actors. Your power against a government actor is incredibly limited (convince your fellow citizens to elect a better government, if you can survive that long). And in many of these systems you have limited to no recourse for denial of care, for delays in care and often even for substandard care.
 
Posted by Seneca (Member # 6790) on :
 
Also a very good point Seriati. Thanks.
 
Posted by TomDavidson (Member # 99) on :
 
quote:

I also contend that private insurers are a lot more vulnerable to PR media pressure, especially if they are watching their stock price, than an unelected government bureaucrat.

We just saw conservatives on this site complaining about an unelected bureaucrat who bent the rules for a young girl after her father made a plea to the press.

--------

quote:
One significant addition to this analysis is that in a system where there are private payers acting in bad faith, the government can intervene to punish the private actors.
How often do you believe this happens?
 
Posted by NobleHunter (Member # 2450) on :
 
Or you have a single payer that lets you pay out of pocket? How do you think tourists' medical bills get paid? Or other non-residents?

Everybody knows private insurers deny coverage. It's practically their mandate. If they deny a hundred claims, then walk back one due to media scrutiny, they come out ahead. PR problem, what PR problem? If the bureaucrat denies one and it hits the media, he'll probably be fired unless he's got a lot of back up from doctors. The province does not want to deal with accusations that they're letting people die to save money. Even a single case can turn into a never-ending headache.
 
Posted by Pete at Home (Member # 429) on :
 
The vaccine injury compensation program is basically an insurance set up by the government in order to get care to the rare kids whose health has been ruined by a rare bad reaction to a vaccine. So far my son has been in the petition for nealy ten years. He is now stuck in foster care since his mom was committed. The government has gone back and forth saying that he's autistic, then admitting the encephalitis then saying autistic again, despite the MRI results. The judges have been changed four times. In my experience, government institutions set up to safeguard a funds are not less cold blooded than private corporations.
 
Posted by Seneca (Member # 6790) on :
 
quote:
In my experience, government institutions set up to safeguard a funds are not less cold blooded than private corporations.
Exactly. And it is much harder to fight the government than it is a private entity.
 
Posted by NobleHunter (Member # 2450) on :
 
I submit that Ontario's health insurance plan is not set up to safeguard a fund.

Seneca, that depends on your government. And amusingly, the thing that lets you fight the private entity is the government.
 
Posted by noel c. (Member # 6699) on :
 
NH,

"Where do they live? "...

He has (had?) a house in Surrey, plus a vacation house up there somewhere. They winter in the U.S. , and go "home" during summer.

I don't know for sure how many houses he still has here, but I know of one in Denver, and San Jose.

Why?
 
Posted by noel c. (Member # 6699) on :
 
Tom,

"But surely you and Seneca would applaud those self-reliant people who take charge of their own oral care, no? "...

Yes, do you brush your teeth every morning, and evening?... Good boy!
 
Posted by NobleHunter (Member # 2450) on :
 
I find it hard to believe there's a big enough difference in care to cross the border for every health care need. It just sounds too inconvenient. If they half live in the US it makes more sense, especially if they aren't here long enough to qualify for residency and thus health coverage.
 
Posted by noel c. (Member # 6699) on :
 
Do Canadian citizens need to qualify for health care?
 
Posted by NobleHunter (Member # 2450) on :
 
I believe so. The rules may vary by province, but I'm pretty sure you need to have residency in Canada to get coverage. I know people who moved back from the States and needed wait before being covered again.
 
Posted by noel c. (Member # 6699) on :
 
Interesting, evidently Canada is much more particular about residency that the U.S. . What are people supposed to do in an emergency, or if they just want to pay out of pocket for non-emergency services?
 
Posted by NobleHunter (Member # 2450) on :
 
http://www.health.gov.on.ca/en/public/programs/ohip/ohipfaq_mn.aspx

I couldn't find details but I assume you get a bill from the hospital if you aren't insured.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seriati:
Single payer = central planning, nothing more nothing less.


you seem to be confusing nationalized healthcare with single payer. Single payer implies no level of control over the interaction between providers and patients, only that the providers send their bills for the set of covered procedures to the paying authority instead of to the patient. there's no planning there.

quote:
In that game the only way costs are controlled is by the single payer paying less.
That's a false premise because it assumes that aggregate costs are relevant, never mind something that needs to be controlled. The point of single payer is to eliminate cost as a factor, and instead let need and professional judgement guide allocation of care. "Cost control" is only a meaningful factor if you're forcing the system to have to operate on private payments, despite the fact that individual need for service is completely irrelevant to ability to pay.

quote:
It's decisions on what to pay (ie where to allocate its resources) are never as efficient as the multitude of decisions made by all the individual payers it replaces.

And that's why the point of single payer is to let doctors decide how to allocate the resources without any central authority be able to second guess them, whether it be the government in a nationalized health care system or a plutocrat buying priority in a private payment system.


quote:
Secondly, what's absurd about not allocating expensive products where they can't be afforded? Are you really arguing that everyone can get a million dollar surgery?

I'm saying that, unless there's a shortage of ability to perform surgeries, then everyone who _needs_ a surgery should get one. And if there is a shortage, then they should be allocated based on professional evaluation of relative need, not based on personal wealth. It is insane and absurd to say that you should get a surgery that you don't really need because you have a million dollars on hand where someone who is too poor to afford that price line but is in critical need of surgical attention must go without.


quote:
Or do you recognize that at some level there will be resource constraints? What I know, is that there will always be constraints, and between capitalism and single payer/central planning/redistribution, only capitalism has a proven history of expanding the pool of availability and reducing the costs of expensive treatments.

You're creating false distinctions by completely mangling the meaning of terms. In a private payment system, access to the limited resources will be allocated based on who has the most cash on hand. In a single payer system, it will be allocated based on who the doctor feels has the most needs. Both of those are perfectly capitalistic; the doctor controls his practice and is working for personal profit, not taking political dictation from anyone.

You have some ground in an actually socialized system, like Britain's NHS, where the government is the service provider. But that's very distinct from a single payer system,l and I have yet to see anyone directly advocating here for a nationalized system to make it relevant to bring up at all.

quote:
End of day the current system means that in 20 years everyone will get that million dollar surgery cause it'll only cost twenty thousand, in single payer, it'll only go to the friends of politicians.
TEchnology will advance in either system bringing costs down. And the possibility that a surgery will cost a fraction of the amount (but still be completely unaffordable to the average person) in 20 years means very little to someone who urgently needs it now, but is being preempted by a plutocrat that doesn't need it as much (or, maybe even, worse who isn't getting it while the operating table sits completely empty, letting that potential surgery be completely wasted, since that idle time can never be recovered). And again, in your last bit, you seem to be confusing single payer with a nationalized system, since doctors, not politicians decide who gets treatment in a single payer system. The only thing politicians do is foot the bill as presented by the providers.

quote:
You're counter argument, is because you said so? Pay per event means the only thing that increases pay is more events.

Indeed- and the only way you can increase events is by attracting volume. If you drive away your customers, you lose volume. So now your motivation is to provide the best service possible to attract the highest volume of clients while finding the best way to keep your personal expenses under control to improve your overall margins. That helps both ensure that resources aren't being wasted by being idled and that the person most sensitive to the costs of services is someone with the best training to try to manage them.

quote:
Unless you have a tremendous doctor oversupply, "consumer selection" isn't going to materially inpact that rate. Doctor oversupply doesn't exist today, and its a certainty that it's not going to get better with the economic model you're advocating.

Supply of doctors is related directly to the cost of entry into the field and the availability of training resources. It's an important issue to be addressed, but completely tangential to the baseline payment model. Bring the barriers of entry down and the supply of doctors will more naturally adjust itself to meet the overall level of demand for service since as the balance between volume of patients for any given doctor and total number of doctors finds its way toward a generally profitable equilibrium.

quote:
quote:
Single payer actively removed the central planning aspect by putting control of the dispensation of service and resources directly in the control of the professionals that are trained to evaluate on the ground who is best served by receiving them. It explicitly removes central planning that is inherent to any individual payment system, whether enacted through insurance or personal wealth.
Central planning removes central planning?

No- single payer, not central planning. You're begging the question here by pretending that your assertion should be taken for granted.

quote:
Single payer like you suggest is some mythical thing where providers are free to charge the price they want? Cause what actually happens in the central planner sets the price they'll pay, and after that any treatment that isn't as profitable disappears from the medical professionals professional evaluation.
The government may work to negotiate the prices, but it it be absurd to have it just arbitrarily try to set them. The simple answer to your concern here is to not make stupid policy and work with providers to set profitable reimbursement rates that are mutually agreeable to all parties. Maryland already does this quite successfully as do other countries that use single payer systems. As a general rule the government should generally be accepting the prices that providers set so long as they're consistent and don't represent an unreasonable markup over the cost of providing them.
 
Posted by noel c. (Member # 6699) on :
 
NH,

"You may be out of the province for up to 212 days in any 12-month period and still maintain your Ontario health insurance coverage provided that you continue to make Ontario your primary place of residence. " (Ontario)

"If you spend part of every year outside B.C., to remain eligible for benefits you must be physically present in Canada at least six months in a calendar year and continue to maintain your home in British Columbia. Provided you remain eligible, you do not need to contact Health Insurance BC about your absence. " (British Columbia)

It looks as though they have the option of choosing without regard to residency for all practical purposes, and they still choose the U.S. for major medical services. They do have Stanford Medical Center in their backyard, so the choice is not a hard one.

[ March 25, 2014, 03:01 PM: Message edited by: noel c. ]
 
Posted by LetterRip (Member # 310) on :
 
Seriati,

quote:
There's definitely a balance that needs to be found between artificially limiting doctor supply and providing for appropriate quality controls. I see the argument that the control level is too high and is set artificially at a protectionist level. Yet at the same time, we still have a number of poor doctors, and I'm not sure I agree that changing the standard won't increase that percentage.
Like most professions, scarcity of practitioners leads to retaining even those who are low skilled. We have bad doctors because there isn't a sufficient supply that the bad ones can be driven out of the market.
 
Posted by noel c. (Member # 6699) on :
 
"Like most professions, scarcity of practitioners leads to retaining even those who are low skilled. We have bad doctors because there isn't a sufficient supply that the bad ones can be driven out of the market. "...

Once again, your conclusion does not follow from the premise. "Bad" doctors will be present without respect to their total numbers. If anything, the licensing agency raises performance standards. That is the usual argument given by organized labor for collectively bargained compensation contracts.
 
Posted by LetterRip (Member # 310) on :
 
Noel,

quote:
Once again, your conclusion does not follow from the premise. "Bad" doctors will be present without respect to their total numbers.
The demand can retain the poor performers when there isn't adequate supply. Just think of labor in general, as labor becomes scarce then employers begin to hire those who were previously deemed unemployable due to 'how bad' they are as employees.

This is true of both labor in general, but also any particular market segment. Ie programmers, mechanics, oil industry, etc. As supply increases, employers can be more choosy and all else being equal, the worst quality employees are dropped.

quote:
If anything, the licensing agency raises performance standards.
The supply constraint isn't due to quality control measures (ie licensing testing for specific knowledge and requiring specific experience/instruction), it is due to deliberate restrictions on supply (ie schools are only allowed to graduate a specific number of doctors each year and only a certain number of schools are allowed to exist).
 
Posted by noel c. (Member # 6699) on :
 
"As supply increases, employers can be more choosy and all else being equal, the worst quality employees are dropped. "...

... But "all else" is never equal. Lower skilled employees are cheaper, and employers utilize them because there is always a market for lower quality products. The "best" is often the enemy of "good enough". Markets operate on that principle in an efficient economy.

"The supply constraint isn't due to quality control measures (ie licensing testing for specific knowledge and requiring specific experience/instruction), it is due to deliberate restrictions on supply (ie schools are only allowed to graduate a specific number of doctors each year and only a certain number of schools are allowed to exist). "...

I agree with you, labor unions make precisely the same fallacious argument. Do we agree free choice by the consumer is the ideal to strive for?
 
Posted by Pyrtolin (Member # 2638) on :
 
Low skill is not the same as poor quality. Low skill can be used to fill gaps cheaply, certainly- but being outright bad costs the employer than they gain, no matter how low the price.
 
Posted by noel c. (Member # 6699) on :
 
I did not say "bad" quality, did I Pyrtolin? There is a point at which any product becomes useless if a certain standard is not met, but I am talking about standards that a pluralistic market will accept.
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by TomDavidson:
quote:
One significant addition to this analysis is that in a system where there are private payers acting in bad faith, the government can intervene to punish the private actors.
How often do you believe this happens?
Every day? What do you think using the courts for malpractice claims is? Or pursuing class actions against insurance companies or drug manufacturers? What about direct enforcement by state and federal officials on standards of care, loss of licenses and even criminal charges?
 
Posted by Seriati (Member # 2266) on :
 
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Seriati:
Single payer = central planning, nothing more nothing less.

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you seem to be confusing nationalized healthcare with single payer. Single payer implies no level of control over the interaction between providers and patients, only that the providers send their bills for the set of covered procedures to the paying authority instead of to the patient. there's no planning there.

Sure there is, the central planner sets the specific rates for procedure. If you want it to NOT be central planning, the providers need to be free to set their own billing rates. Since NO single payer system works that way your point really just fails.
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In that game the only way costs are controlled is by the single payer paying less.
That's a false premise because it assumes that aggregate costs are relevant, never mind something that needs to be controlled. The point of single payer is to eliminate cost as a factor, and instead let need and professional judgement guide allocation of care. "Cost control" is only a meaningful factor if you're forcing the system to have to operate on private payments, despite the fact that individual need for service is completely irrelevant to ability to pay.
Why would you think aggregate costs paid by the single payer are not relevant, when every single government that currently pays them does? Last I checked, those governments take cost containment very seriously. Please don't waste time putting forward a monetary theory answer that not one government apparently follows.
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Secondly, what's absurd about not allocating expensive products where they can't be afforded? Are you really arguing that everyone can get a million dollar surgery?
I'm saying that, unless there's a shortage of ability to perform surgeries, then everyone who _needs_ a surgery should get one. And if there is a shortage, then they should be allocated based on professional evaluation of relative need, not based on personal wealth. It is insane and absurd to say that you should get a surgery that you don't really need because you have a million dollars on hand where someone who is too poor to afford that price line but is in critical need of surgical attention must go without.
I think the more rationale answer is that the million dollar surgery not be generally available, particularly not when paid for by the state. If you want to have it covered in a private insurance context I have no problem with that, so long as the pool can set its price to account for it.
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Or do you recognize that at some level there will be resource constraints? What I know, is that there will always be constraints, and between capitalism and single payer/central planning/redistribution, only capitalism has a proven history of expanding the pool of availability and reducing the costs of expensive treatments.
You're creating false distinctions by completely mangling the meaning of terms. In a private payment system, access to the limited resources will be allocated based on who has the most cash on hand.
Or to those who rationally plan ahead by purchasing insurance that covers the procedures. You know the system we had in place prior to excessive government intervention, one where you buy health insurance, not health plans.
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In a single payer system, it will be allocated based on who the doctor feels has the most needs.
In a single payer, it will not be allocated based on a doctor's decision. When you have a thousand doctors rating their patient's need as moss pressing and only 100 treatment's available, it's going to be decided on some other basis. We see that in single payer systems all the time, waiting lists are common, as are special passes arranged by connected people.
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Both of those are perfectly capitalistic; the doctor controls his practice and is working for personal profit, not taking political dictation from anyone.
Lol. Single payer is not capitalistic, there's no economic decision in there. At best, the doctor has an incentive to obtain the care with the best reimbursement rate to himself.
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End of day the current system means that in 20 years everyone will get that million dollar surgery cause it'll only cost twenty thousand, in single payer, it'll only go to the friends of politicians.
TEchnology will advance in either system bringing costs down.
True, but the rate of advance is incredibly slower in the system you want.
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And the possibility that a surgery will cost a fraction of the amount (but still be completely unaffordable to the average person) in 20 years means very little to someone who urgently needs it now, but is being preempted by a plutocrat that doesn't need it as much (or, maybe even, worse who isn't getting it while the operating table sits completely empty, letting that potential surgery be completely wasted, since that idle time can never be recovered).
Noone is being pre-empted from million dollar surgery. What we have are early adopters willing to eat the up front costs out of their own pockets and the ability for the rest of us to gain down the road. You'd rather deny us that benefit.
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And again, in your last bit, you seem to be confusing single payer with a nationalized system, since doctors, not politicians decide who gets treatment in a single payer system. The only thing politicians do is foot the bill as presented by the providers.
You keep leaving out the biggest thing they do, ie FIX THE PRICES. No matter how much you pretend otherwise that represents a centrally planned allocation decision. The only difference nationalization has on that is it would free the doctors from the capricious decisions on what they should be paid made by the central planners, and free them to not have a preference among available treatments. In the single payer they have an incentive to prefer the best compensated treatments. And in both the available treatment options will be less than in a capitalistic model.
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You're counter argument, is because you said so? Pay per event means the only thing that increases pay is more events.
Indeed- and the only way you can increase events is by attracting volume.
I've addressed this several times, though you cut off when you respond. Without an oversupply of doctors there is no meaningfull consumer choice on this. Consumers have a choice between go to bad doctor, see no doctor. There is no incentive (other than personal ethics) to provide better slower care in your model. It's not like we haven't already seen the practice of medicine change to be volume oreinted, and this will only accelerate that trend. Ask any doctor how to make money on Medicare, if they are in any region where they don't have to take such patients they try not to, if they are it's volume, volume, volume. That's the truth of single payer.
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Supply of doctors is related directly to the cost of entry into the field and the availability of training resources. It's an important issue to be addressed, but completely tangential to the baseline payment model. Bring the barriers of entry down and the supply of doctors will more naturally adjust itself to meet the overall level of demand for service since as the balance between volume of patients for any given doctor and total number of doctors finds its way toward a generally profitable equilibrium.
We've had this talk before, I seem to recall, variables that can impact the model. Dropping quality for all can make the model "function". Though it means an overall worse outcome for the vast majority of medical consumers.

In any event, you're flat wrong about it being a tangential issue. The power of consumer choice to influence behavior requires an actual choice. We don't have such a thing in the majority of the country, adding a vast number of "new" patients is going to make it worse, and lowering the quality pool of doctors is going to make outcomes worse overall. Yay for victory!
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Single payer actively removed the central planning aspect by putting control of the dispensation of service and resources directly in the control of the professionals that are trained to evaluate on the ground who is best served by receiving them. It explicitly removes central planning that is inherent to any individual payment system, whether enacted through insurance or personal wealth.
Central planning removes central planning?
No- single payer, not central planning. You're begging the question here by pretending that your assertion should be taken for granted.
I'm not the begging the question, you're pretending that fix prices centrally and all the allocation decisions behind that isn't central planning. Without freedom to negotiate prices, it's central planning. Could there be even more central planning involved, sure.
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Single payer like you suggest is some mythical thing where providers are free to charge the price they want? Cause what actually happens in the central planner sets the price they'll pay, and after that any treatment that isn't as profitable disappears from the medical professionals professional evaluation.
The government may work to negotiate the prices, but it it be absurd to have it just arbitrarily try to set them. The simple answer to your concern here is to not make stupid policy and work with providers to set profitable reimbursement rates that are mutually agreeable to all parties. Maryland already does this quite successfully as do other countries that use single payer systems. As a general rule the government should generally be accepting the prices that providers set so long as they're consistent and don't represent an unreasonable markup over the cost of providing them.
Single payers fix prices in every system that exists, yet it would be absurd? Single payers refuse to pay for specific procedures in every system that exists, yet it's not a central decision?

I love how you claim they're negotiated but then throw in an "of course", as in "of course" they can't be an unreasonable markup [as determined by the state of course, nothing to see here, completely free negotiations, not central planning at all.]
 
Posted by LetterRip (Member # 310) on :
 
Seriati,

quote:
Single payers fix prices in every system that exists, yet it would be absurd? Single payers refuse to pay for specific procedures in every system that exists, yet it's not a central decision?
Some (most?) single payer are regionally negotiated prices, and the negotiated prices need only be offered during set times during set days.

In the US, insurance companies already negotiate with service providers, no reason that this couldn't take place with the government instead of the insurance companies.
 
Posted by Seneca (Member # 6790) on :
 
quote:
In the US, insurance companies already negotiate with service providers, no reason that this couldn't take place with the government instead of the insurance companies.
This already happens with medicaid and medicare.

Only, when you're dealing with the government, "negotiation" means the government dictates the terms and you simply accept them or walk away and eat the whole cost. This is why medicaid pays pennies on the dollar and ever-larger doctors are refusing it.

Once a universal SP system goes into effect and the government becomes the only game in town, this system of underpaying with no recourse will become the rule of the day and you'll see droves of doctors quit and go into other professions, and new potential doctors will study other fields.
 
Posted by NobleHunter (Member # 2450) on :
 
Yes, that has totally been the Canadian experience with health care.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
Guess it depends on how many biased studies from politically-involved organizations you can find, because I haven't seen anything but that in terms of trying to advocate SP or comparing the two and claiming SP systems are better.
Seneca, what constitutes a non-biased source, or a non-politically involved source? Is any source that disagrees with you biased? Or politically involved? For example, is any evidence collected by organizations like Harvard Medical School or the World Health Organization wrong just because of who they are?
 
Posted by Lyrhawn (Member # 3319) on :
 
quote:
Originally posted by Seneca:
quote:
In the US, insurance companies already negotiate with service providers, no reason that this couldn't take place with the government instead of the insurance companies.
This already happens with medicaid and medicare.

Only, when you're dealing with the government, "negotiation" means the government dictates the terms and you simply accept them or walk away and eat the whole cost. This is why medicaid pays pennies on the dollar and ever-larger doctors are refusing it.

Once a universal SP system goes into effect and the government becomes the only game in town, this system of underpaying with no recourse will become the rule of the day and you'll see droves of doctors quit and go into other professions, and new potential doctors will study other fields.

Studies have shown that most doctors spend more time filling out paperwork than they do treating patients, and that more doctors quit because of said paperwork than because of their job not paying well enough. I don't think this is a money issue.

I do however think the government should be incentivizing MD education, especially for those who go on to become GPs and PCPs rather than specialists. The current "free market" system does nothing to promote doctors becoming PCPs despite an overwhelming need for them. Salaries haven't gone up to make it more lucrative, only consumers have lost out because wait times have gone up. Paying more doesn't get you in faster.

I think we should reform who sees patients as well to allow well-trained nurses to see more patients and prescribe some medications. Free up doctors to only see the more troublesome cases, and free doctors from a mountain of paperwork.

That mountain of paperwork, by the way, is as much a problem from private insurance as from government sources, possibly more so. Thinning that process to a single kind of paperwork and a single system would dramatically change a doctor's workload and quality of life. It'd also allow them to see more patients and thus make more money.

[ March 25, 2014, 10:25 PM: Message edited by: Lyrhawn ]
 
Posted by noel c. (Member # 6699) on :
 
"That mountain of paperwork, by the way, is as much a problem from private insurance as from government sources, possibly more so. "...

That balance is about to change decisively.

"Thinning that process to a single kind of paperwork and a single system would dramatically change a doctor's workload and quality of life. "...

How about incentivizing patients to pay in cash from tax-free medical savings accounts?

"It'd also allow them to see more patients and thus make more money. "...

Under the UCA, one can only speculate if this would be true. It would be a rare exception to other government administrative track-records if it was.
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
That balance is about to change decisively.
I call BS on this assertion. Back in the good old days pre-ACA, when I took my son to clinic for three years getting treated for Leukemia, they had three oncologists on duty and one of them was on the phone the entire day every day we went to clinic talking with insurance companies. And this was for childhood cancer, the disease that usually got the best and fastest response from the insurance companies.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Seriati:
Sure there is, the central planner sets the specific rates for procedure. If you want it to NOT be central planning, the providers need to be free to set their own billing rates. Since NO single payer system works that way your point really just fails.


No, for it not be central planning producers and consumers need to be in charge of negotiating the disposition of services. Price is a signalling mechanism that facilitates markets where it's relevant, but it's not a relevant signal in a single payer health care system. Instead market signalling is accomplished based on capacity and quality of services with the nominal price of those services rendered irrelevant to the market. Central planning requires dictating what services are available and who gets them- single payer explicitly does not do that, it just picks up the tab for a baseline set of services regardless of who is getting them (and does not prevent other services from being offered directly at individual rates where they fall outside of that baseline scope of coverage). All the actual planning- the allotment of actual services performed is done at the doctor/patient or medical facility/patient level.


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Why would you think aggregate costs paid by the single payer are not relevant, when every single government that currently pays them does?
Ideally, because a little bit of price pressure can help drive innovation by helping increase the marginal reward for finding more cost effective ways to deliver care. Building in too high a default profit margin means that there is little marginal incentive to make small improvements.

More often than not it's because lawmakers are ignorant of the economic realities (though the Bank of England has officially make it harder to cop to such nonsense), driven by flawed ideology, or outright taking advantage of public ignorance for political expediency. In any case, it only works to limit the potential of their systems, though those system still manage to produce better overall outcomes across the entire population, as compared to ours, which provides exceptional outcomes for a select few and miserable results for everyone else.
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I think the more rationale answer is that the million dollar surgery not be generally available, particularly not when paid for by the state.
It should be available to those who need it. That's why we have trained professionals to make the call of who should get it and who shouldn't rather than simply letting it go to the highest bidder without regard for need (or go to no one, despite clear demonstration of need)
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Or to those who rationally plan ahead by purchasing insurance that covers the procedures. You know the system we had in place prior to excessive government intervention, one where you buy health insurance, not health plans.
The one that most people couldn't afford because the cost of insurance exceeded the average person's means, not to mention the entire nature of a for-profit insurance product is to work as hard to deny service regardless of actually need, or to actively take action to cancel a policy (by arbitrarily inflating the premiums to outrageous levels, if all else fails) if it ran out of options to deny costly services. The old insurance model existed directly to rob as many people of as much money as possible while providing the least possible amount of service. The ACA was needed to restrict such con games, but since the entire model was based on a fundamental fraud, the net effect will likely be floor falling out of the system as its fundamentally parasitic nature is actively revealed.
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In a single payer, it will not be allocated based on a doctor's decision. When you have a thousand doctors rating their patient's need as moss pressing and only 100 treatment's available, it's going to be decided on some other basis.
The doctor is the one delivering the care, so you're presenting a rather schizophrenic scenario. IF the doctor can only service 100 out of 1000 of his patients, then he will have to use professional judgement as to which 100 are most in need. In the meantime the other 900 provide a significant incentive fro 9 more doctors to move into the market and take up the rest of the slack.

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We see that in single payer systems all the time, waiting lists are common,
And yet, far, far less common that they are in ours, where people often end up waiting till they die because they can never afford to scrape together the cost of care, care that is actively sitting idle at that, in our personal cost system. The only reason that our waiting lists appear short is that most people can't afford to even get on them, never mind enjoying the comparative luxury of even having a place in line.
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Both of those are perfectly capitalistic; the doctor controls his practice and is working for personal profit, not taking political dictation from anyone.
Lol. Single payer is not capitalistic, there's no economic decision in there.
You don't seem to have a clue as to what an economic decision is. You're seem to keep trying to confuse financial decisions with economic decisions when financial decisions are only one small subset of economic choices. And you also don't seem to have a grasp on what capitalism is (private ownership of assets and the corresponding freedom to employ them for personal profit). Any choice of how or where to obtain a service or how to allocate ones resources is an economic decision, regardless of whether public money is used as a decision making tool in the process or not.

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True, but the rate of advance is incredibly slower in the system you want.
Why? Are you suggesting that somehow it will cause our level of investment in colleges, universities, and other research institutions, where most of the innovation comes from, to vanish overnight? It might lead to a refocusing on more generally productive research and less focus on high priced luxury services, since the marginal rewards improving the most widely needed services would increase significantly, but I don't see where you're getting the ideas that a process that operates mostly independently of the basic care delivery system will be affected to any great extent.
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Noone is being pre-empted from million dollar surgery.
Anyone who needs it and can't afford it is being pre-empted from it. In fact our current system makes it more likely that such a procedure will be mothballed and written of as not worth pursuing until we're lucky enough to have a significant number of wealthy people happen to come down with the corresponding condition to make it worth developing at all, whereas in a single payer system any number of people who need it will be able to get it and help build the experience levels and overall demand for service needed to refine it and invest in bringing down the overall cost.
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You keep leaving out the biggest thing they do, ie FIX THE PRICES.
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They negotiate the prices, sure, but that has nothing to do with planning the allocation of assets. It just removes price from the allocation process so that doctors and patients can allocate them based on more relevant criteria. In as much as central planning is relevant, it actively removes personal wealth as a tool for the rich to use to monopolize and plan the allocation of resource in their favor. Our current system is centrally planned by a handful of insurance companies and individuals wealthy enough to effectively dictate the allocation of resource based on what's most profitable to them. Single payer cuts them out and leaves the individual medical practitioners in direct control of resource allocation.

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No matter how much you pretend otherwise that represents a centrally planned allocation decision.
Allocation of what? Single payer doesn't dictate who gets care or what care can be given, at most it says that certain things are not public needs and so must be paid out of the pocket of the patient; that still doesn't constitute planning, it just creates a distinction between necessary service and luxury services, with all the real planning still being done at the practitioner/patient level.

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In the single payer they have an incentive to prefer the best compensated treatments.
Unless, of course, those methods are ineffective and would lead you to be unable to retain patients.

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And in both the available treatment options will be less than in a capitalistic model.
There's no difference in service availability between private payer and single payer models, the only difference is that individual financial means is rendered irrelevant for access to a certain subset of treatments that are designated as public needs as opposed to private luxuries, which single payer systems are as free to offer on an individual basis as a fully private payment model.
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I've addressed this several times, though you cut off when you respond. Without an oversupply of doctors there is no meaningful consumer choice on this.
Since right now we have too much overall slack in the system, it' not an immediately pressing issue, but as has been pointed out, the active factors at play are the cost of entry and the limited training resources. Put enough pressure on the current supply of doctors and the will to maintain those restrictions will collapse and help open the field for a more natural level of supply to come into play. (Not to mention the fact that a greater level of more prompt and effective care will likely reduce the overall load on the system which is mostly dealing with the costs of trying to fix issues long after they've been neglected to the point that they've become critical high cost treatments instead of while they're still cheap preventative maintenance items)

As has been noted a number of times in this thread, our system is directing a significant share of resources toward servicing wealthy foreigners with relatively low priority needs regardless of the relative need of domestic patients that can't afford to similarly preempt the system in their favor instead. The idea that we actually have a significant supply problems rings a bit false when we've apparently got enough slack that we import patients to help take it up.
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We've had this talk before, I seem to recall, variables that can impact the model. Dropping quality for all can make the model "function". Though it means an overall worse outcome for the vast majority of medical consumers.
Sure, there's no reason to drop standards- in fact there are good arguments to be made for better standards. But personal wealth has little relationship to ability to meet professional standards, as does deliberate quantity limitation on the number of people trained at any given time. Remove those arbitrary barriers and the number of qualified individuals that can be trained will increase dramatically, leading to higher overall quality along with greater quantity.

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In any event, you're flat wrong about it being a tangential issue. The power of consumer choice to influence behavior requires an actual choice. We don't have such a thing in the majority of the country, adding a vast number of "new" patients is going to make it worse, and lowering the quality pool of doctors is going to make outcomes worse overall.
Lowering quality is a nonsensical assertion on your part, since the barriers to entry have little to do with quality (and likely tend to filter quality out by favoring wealth and social connections over any actual quality metrics). On the other hand more patients (and, more specifically more reliable compensation at profitable levels for tending to those patients) will help keep more qualified professionals in the field as well as putting more pressure on the system to relax it's arbitrary barriers to entry.

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I'm not the begging the question, you're pretending that fix prices centrally and all the allocation decisions behind that isn't central planning.
Prices aren't allocation decisions. They're signals that can help make allocation decisions when they're communicated between producers and consumers, but the entire point of single payer is to negate that function; to render them irrelevant to allocation decisions because they have no relevance to the actual factors that should determine allocation.

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Without freedom to negotiate prices, it's central planning.
An the freedom to negotiate prices absolutely exists in single payer systems, however that negotiation occurs completely independently of the provision of care because it's not relevant to and of the actual factors that should determine the allocation of care.
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Single payers fix prices in every system that exists, yet it would be absurd? Single payers refuse to pay for specific procedures in every system that exists, yet it's not a central decision?
[/qb]Single payer systems negotiate prices with providers, they don't arbitrarily fix them. And sure they identify certain procedures as luxury services rather than needs, that does nothing to stop people who want that luxury for paying for them out of pocket at that point, which is perfectly fine because luxuries are explicitly resources that should be allocated based on personal wealth as critical need isn't, by definition, a factor.

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I love how you claim they're negotiated but then throw in an "of course", as in "of course" they can't be an unreasonable markup [as determined by the state of course, nothing to see here, completely free negotiations, not central planning at all.]
If the markup isn't sufficiently profitable, then there's no reason for doctors to work in the field, so the government can't arbitrarily settee prices; it has to negotiate a level that attracts a sufficient supply of professionals to the field to meet public needs. If we were forcing people to work as doctors, then you might have a point, but as long as they can choose to apply their skills and training elsewhere or even just choose not to take public reimbursements then the negotiations are absolutely free, as both sides can come to an overall mutually beneficial agreement without being able to significantly compel the other side to take unreasonable terms.
 
Posted by Lyrhawn (Member # 3319) on :
 
Noel -

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That balance is about to change decisively.
I don't really see why it would. Everyone signing up for Obamacare is still signing up for private insurance. Why would doctors need to call the government about a patient's private insurance plan?

The Medicaid expansion is much smaller than the expansion of people being covered by private insurance. I don't see the balance changing, and if it does, certainly not against government sources.

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How about incentivizing patients to pay in cash from tax-free medical savings accounts?
What do you think the benefits would be for the consumer in this? Given the expense of medical care in this country, I don't see how medical savings accounts could really be used for anything more than routine doctor's visits. But even then, unless employers are depositing into it, it still seems like an awfully large burden to place on a fairly powerless group of people.

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Under the UCA, one can only speculate if this would be true. It would be a rare exception to other government administrative track-records if it was.
From what I've read, most doctors don't have a problem with Medicare's payment system or paperwork. Their problem is with the actual payment amount. But the system itself is a breeze compared to many private insurance companies. Unifying payment and bureaucratic systems under the Medicare banner would simplify the system, save billions and save a ton of man hours.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by noel c.:
How about incentivizing patients to pay in cash from tax-free medical savings accounts?

With what cash. That's about as "let them eat cake" as you can get given that the fundamental problem is that the cost of needed care is completely unrelated to the ability of any given individual to actually earn, never mind save money.
 
Posted by Lyrhawn (Member # 3319) on :
 
Pyrtolin -

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And yet, far, far less common that they are in ours, where people often end up waiting till they die because they can never afford to scrape together the cost of care, care that is actively sitting idle at that, in our personal cost system. The only reason that our waiting lists appear short is that most people can't afford to even get on them, never mind enjoying the comparative luxury of even having a place in line.
Good point, and thanks for saying it. This always seems to get lost in the discussion whenever someone says that covering everyone will mean rationing care. The unasked question that SHOULD follow is "well wait a minute, if there would be waiting lines if everyone had access to care, who are all these people who don't get any care at all that make our lines so short?"

Right now we absolutely ration care, but we ration it along economic lines. Single payer would ration care along NEED lines. That's the difference between us and Canada. In Canada, if you need a knee replacement but you can wait, you have to wait, but if you REALLY need it, you get it sooner. In America, if you need a knee replacement, it doesn't matter how bad the need is. If you can afford it you get it quickly, if you can't afford it, you get it never.

A system where some people have to wait but everyone eventually gets care seems a lot more rational, compassionate and moral than a system where money is the only thing that matters and millions fall through the cracks.

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In the single payer they have an incentive to prefer the best compensated treatments.
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Unless, of course, those methods are ineffective and would lead you to be unable to retain patients.

Even more than that, that's ALREADY the system we have. One of the biggest criticisms of the American healthcare system is that it pays based on volume rather than quality of care. Doctors are incentivized to order as many tests and procedures as they can possibly justify because they're paid per action. Whether the patient needs those tests, or whether he lives or dies, or takes less or more time to get better, that's all irrelevant in the system we currently operate under. It's one of the biggest drivers of cost.

Hospitals would be incentivized to drive down costs if they were given lower fixed payments and told they could keep the balance if they could find a way to make patients better, faster, more cheaply, thereby making patient care the most important aspect of a hospital's business model.
 
Posted by noel c. (Member # 6699) on :
 
Lyrhawn,

"I don't really see why it would. Everyone signing up for Obamacare is still signing up for private insurance. " ...

Not really. If the insurance being provided was "private", companies would not be told what four flavors of coverage to offer, and then be told to recalculate actuarial tables on an extension of "existing policies" at a moments notice to supply political cover. What is the legal recourse to an insurance provider for compensation of costs resulting from four years of botched implementation of a flawed program?

"Why would doctors need to call the government about a patient's private insurance plan? " ...

How about governmental commitments for coverage? A large number of administration certified "enrollees" have not even paid their premium.

"The Medicaid expansion is much smaller than the expansion of people being covered by private insurance. "...

http://politicalticker.blogs.cnn.com/2014/02/05/study-puts-new-medicaid-enrollment-under-obamacare-at-fewer-than-2-million/

No, there is a net zero gain in people covered by "private" insurance when those being kicked off of their plans are factored in, and roughly 1\3 of new UCA "enrollees" have been placed on the Medicaid roll.

"I don't see the balance changing, and if it does, certainly not against government sources. "...

That is not our experience this far.

"What do you think the benefits would be for the consumer in this? Given the expense of medical care in this country, I don't see how medical savings accounts could really be used for anything more than routine doctor's visits. "...

Take "routine visit" coverage out of an insurance plan, and the policy price drops precipitously. Administrative costs are eliminated for all but catastrophic illness. Isn't that one of the benefits you are looking for?

"But even then, unless employers are depositing into it, it still seems like an awfully large burden to place on a fairly powerless group of people. "...

Paying your own bill for routine medical services is a "large burden"?

"From what I've read, most doctors don't have a problem with Medicare's payment system or paperwork. Their problem is with the actual payment amount. "...

There is a good reason that many physicians will not bother with the paperwork, which has to do with compensation. Try arguing for tests that the system does not approve. Is that a simplification you would like to expand?

"Unifying payment and bureaucratic systems under the Medicare banner would simplify the system, save billions and save a ton of man hours. "...

Just like the Model T, you can have any color you want as long as it is black.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Take "routine visit" coverage out of an insurance plan, and the policy price drops precipitously. Administrative costs are eliminated for all but catastrophic illness
No, it increases premiums dramatically, because the rate of catastrophic illnesses increases exponentially without baseline preventative care to head them off cheaply before they happen.
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Paying your own bill for routine medical services is a "large burden"?
It's an impossible burden for most people, just like having to grow all of your own daily food, generate all of your own electricity, or hand-make all of your own microchips would be.
 
Posted by noel c. (Member # 6699) on :
 
"No, it increases premiums dramatically, because the rate of catastrophic illnesses increases exponentially without baseline preventative care to head them off cheaply before they happen. "...

Sometimes I am forced to believe that you live in a propaganda bubble Pyrtolin. This statement is just insipid, and assumes your fellow humans have the initiative, and instinct for self-preservation, of a potted plant.

It is a fact that premiums for catastrophic coverage are much less than the cost of a plan which pays for visits to the General Practitioner for sniffles. It is impossible for me to take your long winded posts as anything more than cognitive clutter.

"It's an impossible burden for most people, just like having to grow all of your own daily food, generate all of your own electricity, or hand-make all of your own microchips would be. "...

I was raised in a middle class family. We were like "most people". My father paid for both routine medical, and dental, for four children out-of-pocket. Major problems were covered by insurance. You must have grown up in a card-board box shanty town. I am all for government subsidized care for people genuinely unable to manage their lives. I know they exist, but they do not constitute "most people".
 
Posted by Seneca (Member # 6790) on :
 
So now Holy Leader Reid, the same guy who admitted he helped set up Obamacare to fail in order to secretly push SP, has now blamed the need for Obamacare extensions on the American public's "internet ignorance." This even AFTER the government admitted the site was legitimately crashed for weeks on end.

Read it to believe it.

quote:
Senate Majority Leader Harry Reid tried to explain the Obama administration's latest decision to extend a key ObamaCare deadline by saying people just "are not educated on how to use the Internet."

The explanation, which glossed over the myriad technical problems HealthCare.gov had for weeks after its October launch, came as the administration faced Republican criticism for a late-breaking decision to extend a looming deadline for some. Open enrollment in the Affordable Care Act federal exchanges is set to end March 31, but the Department of Health and Human Services will let those who start the application process before that date have a bit more time to finish.

Reid, and the Obama administration, will not call the change a "delay."

"We have hundreds of thousands of people who tried to sign up and they didn't get through," Reid said during a press conference, before describing the difficulties people have with the Internet in general.

"There are some people who are not like my grandchildren who can handle everything so easily on the Internet, and these people need a little extra time. ... The example they gave us is a 63-year-old woman came into the store and said, 'I almost got it. Every time I just about got there, it would cut me off.' We have a lot of people just like this through no fault of the Internet, but [because] people are not educated on how to use the Internet," he said.

The administration has fixed many of the major issues with HealthCare.gov since its disastrous launch. But it continues to lag behind its enrollment goals. Giving people more time to sign up could boost those enrollment numbers.

Officials made clear, though, that they will rely on the honor system with this extension. Those who come to the site after April 1 will have to attest that they were in line before that date.

House Speaker John Boehner said Wednesday that the move has rendered another ObamaCare deadline "meaningless."

"The administration is now resorting to an honor system to enforce it. What the hell is this, a joke?" Boehner said Wednesday.

"The administration has now handed out so many waivers, special favors and exemptions to help Democrats out politically ... it's basically become the legal equivalent of Swiss cheese," said Senate Minority Leader Mitch McConnell, R-Ky.

The Health and Human Services Department Wednesday posted two documents that outline "special enrollment periods" for broad groups of people trying to access the new online health insurance markets.

Those who've started an application, but weren't able to finish before the March 31 open enrollment deadline, would get a limited amount of time to sign up for coverage that would take effect May 1.

Additionally, people with 10 general categories of "special" circumstances would also get extra time to apply -- up to 60 days. Categories include natural disasters, system errors related to immigration status, computer error messages due to technical difficulties, family situations involving domestic abuse, and other sorts of problems.

"We won't close the door on those who tried to get covered and were not able to do so through no fault of their own," Julie Bataille, communications director for the health care rollout, told reporters.

She deflected repeated questions on whether there is a hard deadline beyond which the administration won't take applications.

Special enrollment periods are allowed under the health law, and standard for workplace insurance. But they are mainly used to accommodate changes in life circumstances.

The administration announcement added to a perception of disarray that has dogged the health care overhaul from its early days. It also raised concerns about the potential for another round of technology problems like the ones that paralyzed HealthCare.gov after its Oct. 1 launch.

How long the extension will last seems to depend on individual circumstances. HHS said it will process paper applications received by April 7. Those applying online may have more time, until April 15, the same as the tax filing deadline. People who are due tax refunds may be willing to put some of that money toward health care premiums.


 
Posted by Lyrhawn (Member # 3319) on :
 
noel -

quote:
Not really. If the insurance being provided was "private", companies would not be told what four flavors of coverage to offer, and then be told to recalculate actuarial tables on an extension of "existing policies" at a moments notice to supply political cover. What is the legal recourse to an insurance provider for compensation of costs resulting from four years of botched implementation of a flawed program?
Is your car not sold from a private company because the government mandates fuel mileage standards and safety technologies?

quote:
How about governmental commitments for coverage? A large number of administration certified "enrollees" have not even paid their premium.
I repeat, why would doctors need to call anyone about this? If people aren't paying their premiums, it's between them and the insurance company. All of this happens off the doctor's radar.

quote:
No, there is a net zero gain in people covered by "private" insurance when those being kicked off of their plans are factored in, and roughly 1\3 of new UCA "enrollees" have been placed on the Medicaid roll.
You're going to have to provide a second link for that part then. Your first link doesn't talk about net gain or loss in private insurance.

quote:
Take "routine visit" coverage out of an insurance plan, and the policy price drops precipitously. Administrative costs are eliminated for all but catastrophic illness. Isn't that one of the benefits you are looking for?
I don't think this helps the way you think it does. You're still shifting a lot of cost to the consumer and away from insurance. That money has to come from somewhere. And how are you defining "catastrophic"? Does that count EVERYTHING other than regular checkups?

And yes, I do think it would constitute a large burden for a lot of people. Maybe if your insurance still lowers the overall cost by negotiating better rates with doctors but you still cover the full amount, but if you're just on your own for regular yearly checkups and prescriptions, you're talking about a pretty large extra cost that has to come out of people's pockets.

quote:
There is a good reason that many physicians will not bother with the paperwork, which has to do with compensation. Try arguing for tests that the system does not approve. Is that a simplification you would like to expand?
That's a much more complicated subject. More than half of ALL tests ordered in America are unnecessary. We're overtesting like crazy and it's costing a ton of money. But is that REALLY that much different than a private insurance bureaucracy designed to reject claims to save profit margins?

quote:
Just like the Model T, you can have any color you want as long as it is black
The Model T had the benefit of being cheap, affordable for the masses, and relatively reliable for a car at the time.

Doesn't really sound so bad when you apply that to healthcare. That might not have been the best comparison for your argument.

[ March 26, 2014, 05:40 PM: Message edited by: Lyrhawn ]
 
Posted by noel c. (Member # 6699) on :
 
"Is your car not sold from a private company because the government mandates fuel mileage standards and safety technologies? "...

No, it is sold by a private company because it was manufactured to their specifications, which were dictated by a market assessment. An accurate assessment is the basis upon which they compete, and profit.

Barry has turned health "insurance" companies into federal brokers of wealth redistribution.

"I repeat, why would doctors need to call anyone about this? If people aren't paying their premiums, it's between them and the insurance company. All of this happens off the doctor's radar. "...

How is a doctor to know if the premium was paid or not given the application system is so fraught with defects that Barry is now issuing verbal orders to "insurers" to provide coverage in violation of the UCA? If you had a patient at your front desk who insisted they had coverage, would you pick up the phone?

"I don't think this helps the way you think it does. You're still shifting a lot of cost to the consumer and away from insurance. That money has to come from somewhere. "...

Correct, do you think that adding a layer of bureaucracy somehow consumes less money?

"And how are you defining "catastrophic"? Does that count EVERYTHING other than regular checkups? "...

I would define "catastrophic" as the cost threshold beyond which I could not cover a medical emergency from savings. In a free market the consumer gets to set that number.

"... if you're just on your own for regular yearly checkups and prescriptions, you're talking about a pretty large extra cost that has to come out of people's pockets. "...

Was that a Freudian slip? The cost comes out of *your* pocket. Whose pocket would you like it to come out of?

"That's a much more complicated subject. More than half of ALL tests ordered in America are unnecessary. "...

The corollary is that half of the tests are necessary, if I accept your premise. Who do you want deciding that test is necessary? Tort reform is a better way to address your complaint.

"We're overtesting like crazy and it's costing a ton of money. But is that REALLY that much different than a private insurance bureaucracy designed to reject claims to save profit margins? "...

Where would you like the pushback to come from... rationing quotas?

"Doesn't really sound so bad when you apply that to healthcare. That might not have been the best comparison for your argument. "...

In a free market, you can choose the Model T... for yourself, not someone else. If that was Barry's goal, he should have sold it that way. How do you think that would have gone over?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
So now Holy Leader Reid, the same guy who admitted he helped set up Obamacare to fail in order to secretly push SP...
I should point out that a) Reid is neither a self-appointed "Holy Leader" nor declared by anyone else to be a "Holy Leader;" and b) Reid has admitted nothing of the kind.

----

quote:
it is sold by a private company because it was manufactured to their specifications...
And to the specifications of the government, no?

quote:
I would define "catastrophic" as the cost threshold beyond which I could not cover a medical emergency from savings. In a free market the consumer gets to set that number.
But we agree that when discussing "catastrophic coverage," the term "catastrophic" needs to be a broadly defined category that does not depend upon individual determination, yes?

quote:
Tort reform is a better way to address your complaint.
That's only if you believe that the primary driver of medical tests is the fear of malpractice suits, which study after study shows to not be the case.
 
Posted by TomDavidson (Member # 99) on :
 
On the other hand, clearly Seneca's nightmarish vision of British dental care is accurate:
http://cheezburger.com/59554049
 
Posted by noel c. (Member # 6699) on :
 
"And to the specifications of the government, no? "...

Show me a car designed by politicians, and I will show you my perpetual-motion machine.

"But we agree that when discussing "catastrophic coverage," the term "catastrophic" needs to be a broadly defined category that does not depend upon individual determination, yes? "...

No, implicit in my comment was the opposite assertion.

"That's only if you believe that the primary driver of medical tests is the fear of malpractice suits, which study after study shows to not be the case. "...

Show me an unbiased study that supports your statement.
 
Posted by Pete at Home (Member # 429) on :
 
quote:
Originally posted by TomDavidson:
On the other hand, clearly Seneca's nightmarish vision of British dental care is accurate:
http://cheezburger.com/59554049

In Sedaris' "me talk pretty one day" there's an hilarious description of the author's experiences with French medicine and dentistry. Very much defies the stereotypes.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Show me a car designed by politicians...
Are you contending that seatbelts, headlights, galvanized gas tanks, and 30+ MPG are all "market-driven" innovations? That while there's a great deal of private science which has gone into those things, it was government regulation which made them commonplace in the timeframe in which that happened?

quote:
No, implicit in my comment was the opposite assertion.
Okay, so your assertion here is that the word "catastrophic," even when part of the phrase "catastrophic coverage," can really only be defined by a given individual, and therefore the industry-standard term "catastrophic coverage" should lead with another word instead? By the same token, do you believe that the phrase "reasonable doubt" is useless unless all individuals involved in the dispute agree on what level of doubt is "reasonable?"

quote:
Show me an unbiased study that supports your statement.
I'd first like you to identify what -- beyond supporting my statement -- would classify a study as "biased."
 
Posted by noel c. (Member # 6699) on :
 
"Are you contending that seatbelts, headlights, galvanized gas tanks, and 30+ MPG are all "market-driven" innovations? That while there's a great deal of private science which has gone into those things, it was government regulation which made them commonplace in the timeframe in which that happened? "...

I contend that to the degree changes were ordered by government, they were peripheral to automotive design, and were implemented no faster than technological innovation made them possible (designer driven). I don't know why you think the government came up with the idea for headlights, they were common on horse drawn carriages, but take the 30 mpg number (which is not, and never was, a mandate). Why doesn't the government demand a 100 mpg 1-ton truck? Why doesn't it demand rear seat air-bags? How about low volatility fuel engines?

Some safety features are easy to sell, like laminated/tempered glass, shielded/galvanized brake lines, front air-bags, unibody crumple zones, armored polypropylene fuel tanks/ drive-train components, and automatic fuel shut-off valves. Consumers demand these things. Politicians usually go for the easy stuff like lap-belts, or play the me-to game on high technology. They are really pretty stupid, you give them way too much credit.

"Okay, so your assertion here is that the word 'catastrophic,' even when part of the phrase 'catastrophic coverage,' can really only be defined by a given individual, and therefore the industry-standard term 'catastrophic coverage' should lead with another word instead? "...

Give me your reference for the "industry standard term".

A dental abscess that is beyond the financial means of an individual to cover can be lethal.

"By the same token, do you believe that the phrase 'reasonable doubt' is useless unless all individuals involved in the dispute agree on what level of doubt is 'reasonable?' " ...

Apples, and oranges. "Catastrophic" medical situations are the nexus of a condition with potentially fatal consequences, and the individual's material inability to avoid it. My threshold need for catastrophic coverage is not the same as yours. It is completely subjective.

"Reasonable doubt" requires only the application of average analytical skill in determining probability of an event. I really have some trouble in seeing how you co-mingled the two concepts.

"I'd first like you to identify what -- beyond supporting my statement -- would classify a study as 'biased.' "

... A study produced by researchers that have no skin in the game, other than a desire to control costs to the patients benefit.

Here is a good one:

http://medicaleconomics.modernmedicine.com/medical-economics/news/who-benefits-tort-reform?page=full
 
Posted by TomDavidson (Member # 99) on :
 
Before we go on, which of the four studies mentioned in the linked bloggicle are "unbiased," and what is your basis for thinking so?
 
Posted by noel c. (Member # 6699) on :
 
Tom,

The synthesis by Baltic doesn't appear to demonstrate a need to pick, and choose. The journal itself did some of the original research. Reconcile the conclusions with this statement:

""That's only if you believe that the primary driver of medical tests is the fear of malpractice suits, which study after study shows to not be the case. "...
 
Posted by Greg Davidson (Member # 3377) on :
 
The theory that malpractice is a significant driver of medical costs is conclusively disproved by states such as Texas, which have essentially eliminated medical malpractice and yet which have no significant difference in medical costs
 
Posted by noel c. (Member # 6699) on :
 
"The theory that malpractice is a significant driver of medical costs is conclusively disproved by states such as Texas, which have essentially eliminated medical malpractice and yet which have no significant difference in medical costs" ...

It would seem you deny the entire premise that defensive medicine is a problem for consumers. I disagree based upon personal experience, and you should realize that you are in the minority if your experience conflicts. Read the linked article, and see if you want to modify your position.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by Greg Davidson:
The theory that malpractice is a significant driver of medical costs is conclusively disproved by states such as Texas, which have essentially eliminated medical malpractice and yet which have no significant difference in medical costs

To be clear- Texas hasn't eliminated malpractice. They've simply eliminated the ability of victims of it to be compensated for the damage done to them, lowering the price on it would tend to increase it rather than decrease it.

There are programs elsewhere being put into place to see if they can find more effective ways to reduce the actual rate of malpractice, but those focus on what it takes to help doctors not commit it in the first place, which is the only practical way to avoid it.
 
Posted by Pete at Home (Member # 429) on :
 
I think tort reform in Nevada was responsible for the Needle recycling HIV boom.
 
Posted by noel c. (Member # 6699) on :
 
"I think tort reform in Nevada was responsible for the Needle recycling HIV boom." ...

... Probably why Tom arrived at the realization that tooth extractions should not be performed at home.
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Reconcile the conclusions with this statement...
Again, before I do that, I want to know what you'll consider an unbiased source, and how I can recognize one that you'll consider unbiased before I start producing 'em.

--------

quote:
Probably why Tom arrived at the realization that tooth extractions should not be performed at home.
Um. In all seriousness, I've said nothing of the kind. I'm mocking Seneca for considering the idea horrific. [Smile]
 
Posted by Seneca (Member # 6790) on :
 
Pulling teeth out and sticking in glue at home, what could go wrong?
 
Posted by noel c. (Member # 6699) on :
 
Tom,

"Again, before I do that, I want to know what you'll consider an unbiased source, and how I can recognize one that you'll consider unbiased before I start producing 'em. "...

Already gave you that :

"... A study produced by researchers that have no skin in the game, other than a desire to control costs to the patients benefit."
 
Posted by TomDavidson (Member # 99) on :
 
quote:
A study produced by researchers that have no skin in the game, other than a desire to control costs to the patients benefit.
Yes, and I'm curious which of the four studies cited in the blog article provided fall into that category, in your opinion. Quantifying what you consider an appreciable amount of "skin in the game" is the tricky part of the identification, after all.
 
Posted by noel c. (Member # 6699) on :
 
Tom,

Can you just bring yourself to say you made an overstatement?
 
Posted by TomDavidson (Member # 99) on :
 
Not in this case, no. I just know your M.O. by now. And frankly, given the whole Obama's grandma thing, I think that's the pot calling the kettle black. Have you owned up to that one yet, years later?
 
Posted by noel c. (Member # 6699) on :
 
Tom,

"Not in this case, no. I just know your M.O. by now. "...

So, the overwhelming consensus for this claim; "That's only if you believe that the primary driver of medical tests is the fear of malpractice suits, which study after study shows to not be the case.", is not something that you are particularly confident supporting.

Yup, that's my MO.

"... And frankly, given the whole Obama's grandma thing, I think that's the pot calling the kettle black. Have you owned up to that one yet, years later? "...

... I am not sure what you are objecting to. Is there something about Barry's grandmother that you would like to interject?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
So, the overwhelming consensus for this claim; "That's only if you believe that the primary driver of medical tests is the fear of malpractice suits, which study after study shows to not be the case.", is not something that you are particularly confident supporting.
No. It's not something that I believe you will admit I have proven unless I can first nail your feet to the floor with a definition of a valid source. Because otherwise you will attack every source I pull out for some manufactured reason or another and will wiggle endlessly over ridiculous minutae. I don't actually believe that you'll abide by your own definition of a trustworthy source once confronted by some, but I think it'll be amusing to watch you come up with reasons that they meet your criteria but still aren't trustworthy (or, for that matter, watching you come up with criteria that are so impossibly narrow that they exclude all but your favorite sources.)

But if you're willing to say, right now, that academics doing a study are by definition unbiased -- which is the only criteria consistent among the four studies mentioned in that article -- I can run with that. [Wink]
 
Posted by noel c. (Member # 6699) on :
 
"But if you're willing to say, right now, that academics doing a study are by definition unbiased -- which is the only criteria consistent among the four studies mentioned in that article -- I can run with that. "...

Does this mean you are abandoning the "study after study" standard, and adoption the "my academics are unbiased" standard?

Would you have as much difficulty if you were attempting to substantiate a less ambitious claim?
 
Posted by TomDavidson (Member # 99) on :
 
quote:
Does this mean you are abandoning the "study after study" standard, and adoption the "my academics are unbiased" standard?
God, no. *rolls eyes*
It means exactly what it says.
I know you're going to wiggle like a desperate little worm to avoid acknowledging reality. I know that, to pin you down, I will need to get you to lay out criteria for an "acceptable" source, because otherwise you will first attempt to wiggle by pre-emptively dismissing the source. And I'm being up-front about this because I was stupid enough not to realize that being up-front about this would just make you feel the need to get all sweaty and wiggly earlier than usual.

Tom: Please see your email.

[ March 28, 2014, 01:10 PM: Message edited by: OrneryMod ]
 
Posted by noel c. (Member # 6699) on :
 
"It means exactly what it says. "...

What it "says" is vacuous.

"I know you're going to wiggle like a desperate little worm to avoid acknowledging reality. "...

How endearing... what "reality"?

"I know that, to pin you down, I will need to get you to lay out criteria for an 'acceptable' source,... "...

More than that; you will have to lay out a *generally accepted* source to meet your "study after study" criteria.

"... because otherwise you will first attempt to wiggle by pre-emptively dismissing the source. "...

Come on Tom... dazzle me!

"And I'm being up-front about this because I was stupid enough not to realize that being up-front about this would just make you feel the need to get all sweaty and wiggly earlier than usual. "...

I already showed you mine... Your turn. [Wink]
 
Posted by TomDavidson (Member # 99) on :
 
quote:

More than that; you will have to lay out a *generally accepted* source to meet your "study after study" criteria.

No, see, I know better than that. In fact, you've already demonstrated that this isn't the case -- because, just as an example, climatologists doing climatology studies are "generally accepted," but we know you don't consider them to be acceptably unbiased sources even though they're academics who do not directly profit from climate change theories. Something, then, presumably distinguishes the four studies loosely cited by the article you read from climatology studies conducted by otherwise equivalently unbiased academics. And presumably you won't say that it's simply that those studies support your existing opinions.
 
Posted by noel c. (Member # 6699) on :
 
"And presumably you won't say that it's simply that those studies support your existing opinions. "...

... Then make things simple for yourself;

Rather than relying upon an anonymous appeal to authority, employ your formidable powers of analysis, and argumentation. After all, you do not need a meteorological degree to understand the psychology of risk aversion. It is a universally common human trait, and if you had not inherited it, you would probably not have lived long enough to reproduce.

Make your case that physicians do not order unnecessary testing to cover their professional reputations from the negative effects of malpractice suits.

Like I said; "dazzle me".
 
Posted by Greg Davidson (Member # 3377) on :
 
quote:
Make your case that physicians do not order unnecessary testing to cover their professional reputations from the negative effects of malpractice suits
Your hypothesis is that the root cause of excessive medical testing is fear of malpractice suits. If we have a state where the risk of malpractice suits is significantly lower than average, because state law has essentially precluded such lawsuits, then your hypothesis would predict that the amount of excessive medical testing would decline significantly. Texas provides an excellent test of your hypothesis - and guess what, medical costs in Texas are not significantly different from the rest of the country (see this extended discussion