Affordable Care Act / ObamaCare

[HuskerNMO]

Then why is it not "necessary" for any other program to be viable, just health care coverage? The fiscal insolvency of Medicare, Medicaid, Social Security, etc. don't seem to have the same people arguing that costs must be controlled to keep them viable.

 

Because in this instance there are three parties that came to an agreement based on the inclusion the individual mandate.

 

The government wanted to expand coverage, alter regulation of insurance (issuance, caps, etc.), and lower cost in part by reducing reimbursement rates.

Insurers agreed because the individual mandate will expand their risk pool.

Health care providers agreed because the individual mandate will reduce losses incurred from treating those will no ability pay (i.e. the uninsured).

 

If the individual mandate is removed from health care reform, the whole thing necessarily falls apart; all the good aspects that enjoy wide bipartisan support go away. I understand that many of the opponents that find the mandate particularly egregious are standing on a principle of the scope of government, but essentially, it seems insane to me that their argument boils down to wanting to protect the theoretical person who has the ability to obtain health insurance but doesn't want to. Also, it is conveniently ignored that this theoretical person is suddenly in the market for health care the moment they have a health emergency, which quickly becomes the financial burden of the insured in the per-reform system.

 

Lowering costs by reimbursing less is a myth, private companies require a certain level of profit to maintain operations, if you lower their income they will have to make up for it in some way, either reduced quality, staffing or reduction in services. A big part of the problem is the reduction of reimbursements, less dollars from the government for the same services means that the charitable care that many health systems do will be reduced or eliminated.

[carlfense]

No, what is strange is the left looking over my shoulder and determining if I have been using too much salt. Forcing a restaurant to change their menu because they view it to be hazardous to my health. That is what is really strange.

What's strange is that you sound concerned about salt regulations . . . but not about government ordered rape.

 

Put another way, you sound concerned about the left looking over your shoulder but unconcerned about the right ramming instruments into your orifices.

 

Why is that? Tribalism?

 

I will be sure and inform rape victims that I meet that the government telling me to buy something is equal to their physical assault. Great choice of words.

Where did I say that? I think you may have missed the point. It wasn't about the ACA at all. Yikes.

[johnnyrodgers20]

Banning salt in NYC was not done by right wingers, forcing Cos. to shrink fries sizes is not done by right wingers. While both fringes are whacko, the lefties try to micro manage your life for your own good. I think that is the point!!

How about requiring the insertion of wands into vaginas? Nah. That's not nearly as invasive as shrinking the size of fries, right?

 

 

You know Carl that is my point!! Why does the left worry about such trivial things when have so many huge issues that need to be solved!!

[carlfense]

You know Carl that is my point!! Why does the left worry about such trivial things when have so many huge issues that need to be solved!!

What?

[knapplc]

The thing you miss about the regulation is the cost of regulation, tell a small rural hospital that they have to abandon their paper based methods, buy and implement electronic medical records, develop systems to maintain HIPAA compliance, have to convert to a new coding standard over the next few years which will require system changes, staff training and changes and they simply can't afford the changes so they sell out to a larger company. I work for a regional health system and we just finished integration with one such hospital, are looking at a second, and have 3 others within an hour of us that have sold out to our competitor in town in the past 2 years.

 

The changes in regulation on healthcare aren't creating competition other than for the large companies to swallow the smaller ones.

 

And when you talk about the other industrialized countries and their affordable health care, go compare the income tax rates of said countries to the US, most are between 35-50% compared to the US which is between 28-30 depending on where you look. I'm sure if I gave an extra 5% of my income along with everyone else we could funnel it to healthcare and create the appearance that it has become affordable, but yet I now take home less so I can't afford the stuff that I really need to spend my money on. You can call it "affordable" all you want, but the truth is you want subsidized healthcare.

 

Cost is the key thing, and that's a great point to bring up. Yes, healthcare costs a lot. But that doesn't mean that those needing healthcare are to be punished. It means that costs need to be controlled.

 

That, to me, is the largest swing-and-miss of Obamacare. Most everyone agrees that some reform was needed because costs of healthcare are outstripping consumers' abilities to pay for it, but instead of figuring out a way to help rein in costs, Obamacare simply says, "You have to cover everyone." That's nice, but it doesn't fix the problem.

 

I'll be the first to admit I don't have the answer to healthcare costs. But the current political battle is no more likely to solve the problem than Obamacare did. And meanwhile, we live in the most prosperous nation on earth, yet a huge chunk of our population cannot afford the basic healthcare offered by countries half as wealthy as us.

[krill]

Lowering costs by reimbursing less is a myth, private companies require a certain level of profit to maintain operations, if you lower their income they will have to make up for it in some way, either reduced quality, staffing or reduction in services. A big part of the problem is the reduction of reimbursements, less dollars from the government for the same services means that the charitable care that many health systems do will be reduced or eliminated.

 

There are few absolutes in health care, or any economic activity. Yes, cutting reimbursements will in some instances cause providers to drop out of Medicare and Medicaid, pass on the cost to others, or lower the quality of care below what is acceptable. In other instances, and more realistically using an example like Japan where reimbursement rates are set at a fixed rate for all health care providers with an eye for savings, the real cost of delivering health care can be lowered, sometimes dramatically. An MRI for instance cost about $160 in Japan while the same exam can easily cost ten times that in the US because rate cuts in Japan forced providers and device manufactures to find a way to lower the cost.

 

If the federal government doesn't step in with incentives to lower cost, who will? Insurance companies have more incentive to deny care than lower delivery cost. Individuals do not have the collective influence necessary to change the market because refusing consumption (which would cause a market change in actual capitalism) means serious illness or death, so in effect there is no choice.

 

This is all beside the point though in regard to the original comments.

[HuskerNMO]

The thing you miss about the regulation is the cost of regulation, tell a small rural hospital that they have to abandon their paper based methods, buy and implement electronic medical records, develop systems to maintain HIPAA compliance, have to convert to a new coding standard over the next few years which will require system changes, staff training and changes and they simply can't afford the changes so they sell out to a larger company. I work for a regional health system and we just finished integration with one such hospital, are looking at a second, and have 3 others within an hour of us that have sold out to our competitor in town in the past 2 years.

 

The changes in regulation on healthcare aren't creating competition other than for the large companies to swallow the smaller ones.

 

And when you talk about the other industrialized countries and their affordable health care, go compare the income tax rates of said countries to the US, most are between 35-50% compared to the US which is between 28-30 depending on where you look. I'm sure if I gave an extra 5% of my income along with everyone else we could funnel it to healthcare and create the appearance that it has become affordable, but yet I now take home less so I can't afford the stuff that I really need to spend my money on. You can call it "affordable" all you want, but the truth is you want subsidized healthcare.

 

Cost is the key thing, and that's a great point to bring up. Yes, healthcare costs a lot. But that doesn't mean that those needing healthcare are to be punished. It means that costs need to be controlled.

 

That, to me, is the largest swing-and-miss of Obamacare. Most everyone agrees that some reform was needed because costs of healthcare are outstripping consumers' abilities to pay for it, but instead of figuring out a way to help rein in costs, Obamacare simply says, "You have to cover everyone." That's nice, but it doesn't fix the problem.

 

I'll be the first to admit I don't have the answer to healthcare costs. But the current political battle is no more likely to solve the problem than Obamacare did. And meanwhile, we live in the most prosperous nation on earth, yet a huge chunk of our population cannot afford the basic healthcare offered by countries half as wealthy as us.

 

The theory is that if you reduce the revenue streams then the hospitals will be forced to adapt and reduce costs on their own accord, which they will do, but I think it will have the opposite effect that the American public really desires. It will lead to further crowding of ER's, increased wait times for PCP's and the further consolodation of the industry as a whole into large corporations that don't have the pulse or intrests of the local community at mind when making decisions.

 

We do agree that there is NO simple answer, and there probably won't even be a correct answer. As long as America continues to live our fast paced, unhealthy lifestyle health care costs will continue to rise in turn. Poverty is not a new issue in America, why is health care suddenly such a hot topic for everyone? Why is it suddenly such a fundamental right? Because American's work too much, are too stressed and take poor care of themselves.

 

I hate to stereotype, but how many people complaining about the cost of healthcare own multiple newer vehicles, are overweight, choose to smoke or whatever cliche you want to use to describe people? Why does our tax system and welfare system encourage and reward individuals to have multiple children with tax incentives and increased welfare?

 

To me it's a worse injustice to bring a child into a poor house where you can't afford to take care of them than to have healthcare cost more than people can "afford".

 

The unfortunate truth is we, as a society, are getting exactly what we put into our collective existance, we pour greed in by wanting a bigger house, nicer cars, the newest TV or whatever else and rack up significant debt, become overweight or over-stressed which lowers our quality of life and increases our reliance upon healthcare and other subsidized services.

 

Until there is a fundamental change upon the philosophy and actions of the average American in a large quantity these issues will only become worse and worse.

[carlfense]

The thing you miss about the regulation is the cost of regulation, tell a small rural hospital that they have to abandon their paper based methods, buy and implement electronic medical records, develop systems to maintain HIPAA compliance, have to convert to a new coding standard over the next few years which will require system changes, staff training and changes and they simply can't afford the changes so they sell out to a larger company. I work for a regional health system and we just finished integration with one such hospital, are looking at a second, and have 3 others within an hour of us that have sold out to our competitor in town in the past 2 years.

 

The changes in regulation on healthcare aren't creating competition other than for the large companies to swallow the smaller ones.

 

And when you talk about the other industrialized countries and their affordable health care, go compare the income tax rates of said countries to the US, most are between 35-50% compared to the US which is between 28-30 depending on where you look. I'm sure if I gave an extra 5% of my income along with everyone else we could funnel it to healthcare and create the appearance that it has become affordable, but yet I now take home less so I can't afford the stuff that I really need to spend my money on. You can call it "affordable" all you want, but the truth is you want subsidized healthcare.

 

Cost is the key thing, and that's a great point to bring up. Yes, healthcare costs a lot. But that doesn't mean that those needing healthcare are to be punished. It means that costs need to be controlled.

 

That, to me, is the largest swing-and-miss of Obamacare. Most everyone agrees that some reform was needed because costs of healthcare are outstripping consumers' abilities to pay for it, but instead of figuring out a way to help rein in costs, Obamacare simply says, "You have to cover everyone." That's nice, but it doesn't fix the problem.

 

I'll be the first to admit I don't have the answer to healthcare costs. But the current political battle is no more likely to solve the problem than Obamacare did. And meanwhile, we live in the most prosperous nation on earth, yet a huge chunk of our population cannot afford the basic healthcare offered by countries half as wealthy as us.

 

The theory is that if you reduce the revenue streams then the hospitals will be forced to adapt and reduce costs on their own accord, which they will do, but I think it will have the opposite effect that the American public really desires. It will lead to further crowding of ER's, increased wait times for PCP's and the further consolodation of the industry as a whole into large corporations that don't have the pulse or intrests of the local community at mind when making decisions.

 

We do agree that there is NO simple answer, and there probably won't even be a correct answer. As long as America continues to live our fast paced, unhealthy lifestyle health care costs will continue to rise in turn. Poverty is not a new issue in America, why is health care suddenly such a hot topic for everyone? Why is it suddenly such a fundamental right? Because American's work too much, are too stressed and take poor care of themselves.

 

I hate to stereotype, but how many people complaining about the cost of healthcare own multiple newer vehicles, are overweight, choose to smoke or whatever cliche you want to use to describe people? Why does our tax system and welfare system encourage and reward individuals to have multiple children with tax incentives and increased welfare?

 

To me it's a worse injustice to bring a child into a poor house where you can't afford to take care of them than to have healthcare cost more than people can "afford".

 

The unfortunate truth is we, as a society, are getting exactly what we put into our collective existance, we pour greed in by wanting a bigger house, nicer cars, the newest TV or whatever else and rack up significant debt, become overweight or over-stressed which lowers our quality of life and increases our reliance upon healthcare and other subsidized services.

 

Until there is a fundamental change upon the philosophy and actions of the average American in a large quantity these issues will only become worse and worse.

This is why:

 

Also, I'm pretty sure that I fall into the category opposite your stereotype. I think healthcare costs are too high and drive a 9 year old car, am not overweight, and don't smoke. Further, I benefit directly from high health care costs. I still think that they are out of control.

[krill]

We do agree that there is NO simple answer, and there probably won't even be a correct answer. As long as America continues to live our fast paced, unhealthy lifestyle health care costs will continue to rise in turn. Poverty is not a new issue in America, why is health care suddenly such a hot topic for everyone? Why is it suddenly such a fundamental right? Because American's work too much, are too stressed and take poor care of themselves.

 

I hate to stereotype, but how many people complaining about the cost of healthcare own multiple newer vehicles, are overweight, choose to smoke or whatever cliche you want to use to describe people? Why does our tax system and welfare system encourage and reward individuals to have multiple children with tax incentives and increased welfare?

 

To me it's a worse injustice to bring a child into a poor house where you can't afford to take care of them than to have healthcare cost more than people can "afford".

 

The unfortunate truth is we, as a society, are getting exactly what we put into our collective existance, we pour greed in by wanting a bigger house, nicer cars, the newest TV or whatever else and rack up significant debt, become overweight or over-stressed which lowers our quality of life and increases our reliance upon healthcare and other subsidized services.

 

Until there is a fundamental change upon the philosophy and actions of the average American in a large quantity these issues will only become worse and worse.

 

I think you make a lot of good points here about personal health choices, social factors that are antithetical to good health, and backwards priorities some people have. There are moral hazard questions with insurance and government guarantees that cannot be ignored and should have been more prominent in the debate over health care. However, I do see Democrats trying to make a difference in some small way, like trying to introduce better school lunches and nutrition education in public schools, but even those common measures are roundly ridiculed and caught in the crossfire of special interest (e.g. processed food industry selling crap to schools).

 

The least we can do is take off our exceptionalism hats for a brief moment and analyze health care around the globe to see what works and what doesn't work. It's not that hard when you accept that what we had was definitely not working.

[HuskerNMO]

But what do we define as healthcare and what needs reformed?

 

People attack the insurance industries as the big bullies of healthcare, they on average make about 2.2% profit margin. The median operating margin for hospitals that had 200+ beds was -.7%, some do make a lot of money, but most operate on razor thin budgets. The profit and hole of healthcare in in the research arms of the drug companies and medical device industry, these guys are raking in 20%+ profit margins, we pay for the innovations here in the United States and those with the money to pay for it are going to places like the Mayo Clinic to get bleeding edge treatment and paying the cost of it.

 

Of course other countries piggyback on the medical research done in the United States and spend less on research which lowers their cost, while still having the benefit of what we provide.

 

The US has the most advanced systems in the world, and the best care for those that can afford it, it's the American way.

 

The only real solution to drastically altering the cost model is to have better pricing control across the board, but that could ultimately gut the profitiblity of the research arms which will slow innovation and ultimately lead to reduced quality of care and curing of diseases.

 

Health care costs are not a bubble, if you put an action into part A there will be a reaction somewhere else along the chain that could cause a larger problem than the one we started out with.

[Mavric]

Krill gave a good summary above. Basically it's because there is a third party payer for the ACA after the GOP absolutely rejected a single payer system. The programs that you listed aren't the best examples because those are government provided. What I find interesting is that no one argues that the government can require me to pay X numbers of dollars in taxes and in return provides me X dollars of health care. However, if the government were to cut itself out of the equation and say pay those same X dollars directly to a provider/insurer . . . all hell breaks loose. Interesting stuff. Financially speaking, those two simplified examples are identical.

 

I wasn't so much comparing the programs as I was your argument for justifying the Constitutionality of the programs. Seems to me that citing the "Necessary" clause as including financial matters in this case but not for other programs is just trying to grasp at straws to find a justification that no one cares about otherwise. Doesn't hold a lot of water for me.

 

I guess you'll have to enlighten me on your second point - to what government-provided health care are you referring?

[Mavric]

This is why:

 

It is worth noting that the CPI measures health care cost, not health insurance costs. Thus, it is pretty obvious that the main driver of increasing health insurance premiums is the cost of the health care itself. Changing the rules on how health insurance is handled may make some small difference in the overall cost of health insurance but it will not seem like much in the big picture.

[carlfense]

I guess you'll have to enlighten me on your second point - to what government-provided health care are you referring?

Medicare or Medicaid for starters. Everyone seems to agree that the federal government can force citizens to pay into a program that in turn pays providers to give care to some citizens. The ACA (in part) cut the government out and required citizens to pay that money to a private insurer who then paid providers. I'm a terrible accountant . . . but how are those different from a financial perspective?

[johnnyrodgers20]

I guess you'll have to enlighten me on your second point - to what government-provided health care are you referring?

Medicare or Medicaid for starters. Everyone seems to agree that the federal government can force citizens to pay into a program that in turn pays providers to give care to some citizens. The ACA (in part) cut the government out and required citizens to pay that money to a private insurer who then paid providers. I'm a terrible accountant . . . but how are those different from a financial perspective?

 

 

And that is one reason that MC,MCAID, and SS are going bankrupt and need to be changed! Adding another govt. program that can't sustain itself is sheer madness and I can't believe intelligent people are actually falling for this. It is another nail in the US bankruptcy coffin, and it is coming, no bones about it. We are Greece just ten years ago. I was watching a show, I can't remember where and I don't have the stats but we have the same financial numbers that Greece had a decade ago. I know everyone will come on here and say we aren't Greece and no one will remember this silly thread in ten years. But I want all of you to remember that you were arguing about the debt and how you stood up for all the entitlements.

[knapplc]

And that is one reason that MC,MCAID, and SS are going bankrupt and need to be changed! Adding another govt. program that can't sustain itself is sheer madness and I can't believe intelligent people are actually falling for this. It is another nail in the US bankruptcy coffin, and it is coming, no bones about it. We are Greece just ten years ago. I was watching a show, I can't remember where and I don't have the stats but we have the same financial numbers that Greece had a decade ago. I know everyone will come on here and say we aren't Greece and no one will remember this silly thread in ten years. But I want all of you to remember that you were arguing about the debt and how you stood up for all the entitlements.

 

That is so weird! I can't remember where I read it and I don't have the numbers on hand at the moment, but I was watching a show that said exactly the opposite of that.

 

What are the odds?