Good news for us re: Obamacare/ACA

[JJ Husker]

Why are you so intent on keeping/making this a partisan issue? I (and most people with a heartbeat) agree, something needed/needs to be done with healthcare. Many parts of the ACA are components of what repubs wanted to do. Yes, the jagoffs on Capital Hill are playing political football with this issue to their death. But, that does not mean it is all sunshine and roses and there are no problems whatsoever with their intended fix. I've said this a thousand times so I guess one more time won't hurt; They did not fix the single biggest problem but rather sped it up and made it worse. If you really think they've got this issue on lock down, well good for you. I'm going to have to see the improvement before I believe.

^^^again . . . the bold. heh.

 

I've never said that it's all sunshine and roses. I have said that it's far better than the status quo. Despite the "repeal and replace" slogan the GOP has not proposed a workable alternative. They've voted what? 40+ times? to repeal Obamacare. How many alternatives have they voted on? How many times have they voted to improve the law? Then again . . . I forget . . . I'm making this a partisan issue.

 

Can't speak for carlfense, but one of the reasons this is remaining such a politically divided topic is the 40 votes to repeal Obamacare. I can see one, two - maybe several such if there's new legal standing to the repeal, but 40 is absurd. And passing only 15 bills before ending sessions while this country faces real problems and needs real leadership doesn't help, and that's entirely a partisan issue.

 

I am not offering any excuses for the obstructionist repubs. They suck and are doing us exactly zero favors. However, I am trying to express real concerns I have about this bill, regardless of who/which party advanced it. Just because the numbnuts in Washington can't get together to change a light bulb doesn't mean we have to follow in their footsteps and cheerlead bad parts of the bill. That's what I was getting at when I said Carl was making this a partisan issue. I understand that it is one anyway, I just don't think we have to fall into those roles when we're discussing it. If and when we do, we get exactly as far with it as the folks in DC.

[carlfense]

I am not offering any excuses for the obstructionist repubs. They suck and are doing us exactly zero favors. However, I am trying to express real concerns I have about this bill, regardless of who/which party advanced it. Just because the numbnuts in Washington can't get together to change a light bulb doesn't mean we have to follow in their footsteps and cheerlead bad parts of the bill. That's what I was getting at when I said Carl was making this a partisan issue. I understand that it is one anyway, I just don't think we have to fall into those roles when we're discussing it. If and when we do, we get exactly as far with it as the folks in DC.

Sure. Let's talk about fixing the parts of the law that need improvement.

 

I'd start with getting rid of the employer mandate entirely. It's unnecessary and might carry some significant consequences for around 1% of the workforce.

[JJ Husker]

I am not offering any excuses for the obstructionist repubs. They suck and are doing us exactly zero favors. However, I am trying to express real concerns I have about this bill, regardless of who/which party advanced it. Just because the numbnuts in Washington can't get together to change a light bulb doesn't mean we have to follow in their footsteps and cheerlead bad parts of the bill. That's what I was getting at when I said Carl was making this a partisan issue. I understand that it is one anyway, I just don't think we have to fall into those roles when we're discussing it. If and when we do, we get exactly as far with it as the folks in DC.

Sure. Let's talk about fixing the parts of the law that need improvement.

 

I'd start with getting rid of the employer mandate entirely. It's unnecessary and might carry some significant consequences for around 1% of the workforce.

 

To be honest, I have not thought a whole lot about the employer mandate. I have been too focused on the impact on my small business which is not subject to the mandate. My guess is that, without the employer mandate, they will have trouble paying for everything involved so, at this point with the way it is setup, they probably need it to make it appear viable. I do know what is going to happen with smaller employers though, they will be bailing out of company sponsored plans left and right. This will lead to more and more people having to go directly to the exchanges to get their health insurance. And, this quite naturally leads to an eventual one payer, government run healthcare system. this will likely be somewhat better for the poor and those who historically have not had coverage. It will be decidedly worse for those of us who have maintained reasonable health care coverage. When the government gets involved with deciding what we do or don't need and what they're willing to pay for, individual care will suffer.

 

I still maintain that the much bigger problem is runaway care and premium costs. I've thought about it a lot and I haven't come up with any magic bullets. Any fix/aid I see also leads to lower quality care and less control for the average person and provider. It's a real excrement sandwich.

[topekahusker]

We now get a one year reprieve on the mandatory lower out-of-pocket maximums until 2015. So, another delay that postpones one of the drivers of the increases in premiums that are starting to get reported state by state.

[knapplc]

I still maintain that the much bigger problem is runaway care and premium costs.

 

Definitely agree, and this is the single biggest area where Obamacare missed the mark. We need to curb those costs more than anything else. Curb those costs and mandatory healthcare becomes a much smaller problem.

 

Healthcare costs in other first-world countries are much lower, and the standard of care is no worse, and often better. We pay too much for the care we receive.

[carlfense]

Healthcare costs in other first-world countries are much lower, and the standard of care is no worse, and often better. We pay too much for the care we receive.

There's a reason why the critics of single payer systems tend to focus on inane issues like waiting room times . . .

[carlfense]

My guess is that, without the employer mandate, they will have trouble paying for everything involved so, at this point with the way it is setup, they probably need it to make it appear viable.

Not really. The employer mandate doesn't apply to ~95% of companies and the vast majority of companies who fell into the mandate already offer insurance.

 

And, this quite naturally leads to an eventual one payer, government run healthcare system.

If we're lucky.

 

It will be decidedly worse for those of us who have maintained reasonable health care coverage. When the government gets involved with deciding what we do or don't need and what they're willing to pay for, individual care will suffer.

Why? It works elsewhere, as knapplc noted.

 

I still maintain that the much bigger problem is runaway care and premium costs. I've thought about it a lot and I haven't come up with any magic bullets. Any fix/aid I see also leads to lower quality care and less control for the average person and provider. It's a real excrement sandwich.

That curve has been bending downwards lately. Maybe it's just a coincidence. Maybe not. We'll see.

[sd'sker]

It will be decidedly worse for those of us who have maintained reasonable health care coverage. When the government gets involved with deciding what we do or don't need and what they're willing to pay for, individual care will suffer.

should not be any worse than having insurance companies making those decisions.

[JJ Husker]

It will be decidedly worse for those of us who have maintained reasonable health care coverage. When the government gets involved with deciding what we do or don't need and what they're willing to pay for, individual care will suffer.

should not be any worse than having insurance companies making those decisions.

 

Color me skeptical. Yeah, there are the occasional horror stories coming out of the private system but "government run" just plain gives me the willies. The only thing our government has ever done half way efficiently is wage war. Post Office, Social Security, Medicare, Medicaid.......need I say more. It should be a big clue that our lawmakers exempt themselves from all of these programs.

[sd'sker]

the post office is a public service, it should not have to be profitable. also, if they just let the post office run itself, it would probably be a lot better.

social security, in and of itself, works just fine. the problem is that congress saw it as their own personal piggy bank. even so, i could be fixed with a few minor tweaks.

and as far as i can tell, people are quite satisfied with medicare and medicaid.

 

the problem is with the price of care, as you have mentioned, and the many, general, problems of insurance companies.

[JJ Husker]

My guess is that, without the employer mandate, they will have trouble paying for everything involved so, at this point with the way it is setup, they probably need it to make it appear viable.

Not really. The employer mandate doesn't apply to ~95% of companies and the vast majority of companies who fell into the mandate already offer insurance.

 

And, this quite naturally leads to an eventual one payer, government run healthcare system.

If we're lucky.

 

It will be decidedly worse for those of us who have maintained reasonable health care coverage. When the government gets involved with deciding what we do or don't need and what they're willing to pay for, individual care will suffer.

Why? It works elsewhere, as knapplc noted.

 

I still maintain that the much bigger problem is runaway care and premium costs. I've thought about it a lot and I haven't come up with any magic bullets. Any fix/aid I see also leads to lower quality care and less control for the average person and provider. It's a real excrement sandwich.

That curve has been bending downwards lately. Maybe it's just a coincidence. Maybe not. We'll see.

 

Other than escalating costs for the past ten years or so, I have generally been pretty darned happy with my health insurance and the care I have received. I just don't see any scenario where the care gets better and the costs go down. Heck, I don't see how the care will get better with increasing costs. I hope I'm wrong and it all turns out beautifully. Like I've said though, I'll have to see it to believe it.

 

My biggest hesitation is that I believe, for them to get costs under control, they are going to have to get very heavy handed in controlling what providers, drug makers, insurers, etc. can charge. And, as soon as they do that, those industries and occupations are going to be a lot less desirable. Pretty soon we'll have under educated disgruntled health system workers with longer wait times and meddling bureaucrats. Sorry, but that's how I see it playing out. Hope I'm wrong.

[carlfense]

Color me skeptical. Yeah, there are the occasional horror stories coming out of the private system but "government run" just plain gives me the willies. The only thing our government has ever done half way efficiently is wage war. Post Office, Social Security, Medicare, Medicaid.......need I say more. It should be a big clue that our lawmakers exempt themselves from all of these programs.

.8%, 1-2%, and <7%.

[carlfense]

My biggest hesitation is that I believe, for them to get costs under control, they are going to have to get very heavy handed in controlling what providers, drug makers, insurers, etc. can charge. And, as soon as they do that, those industries and occupations are going to be a lot less desirable. Pretty soon we'll have under educated disgruntled health system workers with longer wait times and meddling bureaucrats.

Could be. Personally, I'm a lot more concerned about costs and outcomes than "wait times." I think that's quite the red herring.

 

It's quite possible that if our medical professionals weren't so lavishly compensated (yes, lavishly.) it would result in disgruntled workers. Most of the health system workers that I know are already pretty disgruntled . . . even though they are all very well compensated.

[JJ Husker]

My biggest hesitation is that I believe, for them to get costs under control, they are going to have to get very heavy handed in controlling what providers, drug makers, insurers, etc. can charge. And, as soon as they do that, those industries and occupations are going to be a lot less desirable. Pretty soon we'll have under educated disgruntled health system workers with longer wait times and meddling bureaucrats.

Could be. Personally, I'm a lot more concerned about costs and outcomes than "wait times." I think that's quite the red herring.

 

It's quite possible that if our medical professionals weren't so lavishly compensated (yes, lavishly.) it would result in disgruntled workers. Most of the health system workers that I know are already pretty disgruntled . . . even though they are all very well compensated.

 

I think you are probably a lot more familiar with health system workers than I am. I would agree that many of them are lavishly compensated. But, I believe a good portion of that lavish pay is driven by all that extra schooling, on going education, and excessive malpractice insurance costs. Add in all the cover your ass paper pushing and testing and lab work they have to do and pretty soon you'll have some runaway conditions. I know some in the system myself and, as you say, they are generally disgruntled with the system even though they are profiting greatly from it. But, they also tend to take more days off, vacation more exotically, and live at a higher level than most other occupations.

 

I did not mean to imply that lower pay alone would cause them to be disgruntled but, it sure can't help. I would guess that all the red tape and redundant BS would grate on a person much worse than having to simply do your job on a lower pay scale. I know our family physician is retiring early primarily so he does not have to deal any longer with the changing nature of the system. It would be nice if that decision was as simple for the rest of us.

[krill]

My biggest hesitation is that I believe, for them to get costs under control, they are going to have to get very heavy handed in controlling what providers, drug makers, insurers, etc. can charge. And, as soon as they do that, those industries and occupations are going to be a lot less desirable. Pretty soon we'll have under educated disgruntled health system workers with longer wait times and meddling bureaucrats. Sorry, but that's how I see it playing out. Hope I'm wrong.

 

Why would you be at all concerned when these three groups played a major role in crafting the bill? If they wanted it stopped, any one of these groups has the clout to make changes.

 

It's not like the bill did anything radical like say, increasing the number of primary care residency slots, aggressively pursing reimbursement rates to decrease unnecessary and expensive procedures, granting government more power to negotiate prices for drugs they are paying for, or introducing a public health care option to compete with the private insurers. None of that happened, and none of major players (AMA, providers, insurers, pharma) are throwing lobbying dollars at stopping implementation.