Good news for us re: Obamacare/ACA

[rawhide]

I think that he needs to lead.

 

He should quit being so divisive. He's the most divisive president in American history, you know.

Abe Lincoln was pretty divisive

but back then everything was black and white.

And the democrats hated him too.(Lincoln)

[carlfense]

And the democrats hated him too.(Lincoln)

Lincoln, the Republican.

[KJ.]

 

You all may have seen this already but Dave Ramsey breaks down the math of Obamacare and explains how it doesn't work. Well worth your 10 minutes

Yikes. For a guy that says "mathematically" about 43 times and claims insurance pricing to be on the level of an 8th grade math class, he's completely clueless. It's sad that this buffoon spouts out oversimplified and inaccurate details on insurance/social security and some people run with it thinking "the math doesn't work!".

[tschu]

I think that he needs to lead.

 

He should quit being so divisive. He's the most divisive president in American history, you know.

Often the best leaders are the ones who make the difficult decisions despite knowing that they will face criticism.

[suigeneris]

People who had high deductible catastrophic policies (which worked well for many) were always going to be "screwed" under the ACA in the sense that they have to buy more coverage than they want. They have to subsidize the policies of people who were previously priced out of the system when insurers could exercise their underwriting prerogative. That's kind of the whole point of the ACA's reform of the individual market. Except for states that previously had a ridiculously bad market for individual policies (e.g., New York) or those that can leverage their population to bargain with insurers (e.g., California), the exchanges aren't going to usher in new era of cost competition among insurers.

 

The biggest failure of the ACA is that it doesn't do much to lower the cost of the medical services themselves (as distinguished from just shifting the cost around). The pipe dream is that the actual cost of services rendered will somehow be reduced through efficiency gains and greater information sharing. Of course, if access to medical services is increased, it stands to reason that demand may increase as well.

 

That's why the best part of the ACA is the Medicaid expansion. Per beneficiary costs for services is about 20% cheaper under Medicaid than for private insurance. Medicaid reimburses providers at lower rates and has lower administrative costs. I hope that a couple decades from now, we'll be able to say that the ACA got the ball rolling toward a single-payer system. Death panel gibberish aside, we need the cold, clammy hands of bureaucrats holding the purse strings. Our domestic experience and the experience of other developed countries strongly suggests it's cheaper.

[tschu]

Unfortunately, republican states refused to implement the Medicaid expansion because apparently they believed that making a big rah-rah political fuss was more important than giving millions of poor people free (and amazingly cheap) health coverage. One of those states is Nebraska. Oh what a world we live in!

[suigeneris]

Unfortunately, republican states refused to implement the Medicaid expansion because apparently they believed that making a big rah-rah political fuss was more important than giving millions of poor people free (and amazingly cheap) health coverage. One of those states is Nebraska. Oh what a world we live in!

 

Since people in Nebraska still pay federal taxes, the Unicameral's decision is best viewed as an act of generosity to the states that did accept the expansion. I guess states will eventually be on the hook for 10% of the cost and people in the expanded Medicaid bracket don't pay much in the way of taxes.

 

I hope Medicaid eventually expands to include middle income taxpayers, so that there is a genuine tradeoff between paying higher taxes instead of paying health insurance premiums. In its current form, the ACA leaves the middle class twisting in the wind, buffeted by health care inflation and burdened with paying for the Medicaid expansion. It's great that we're helping more people have access to health care, but there needs to be a serious effort to control the cost of services.

 

Having the government pay for everything isn't a winning strategy, but a monopsony can be a very powerful tool to arrest inflation in a market as dysfunctional as the market for medical services.

[tschu]

there needs to be a serious effort to control the cost of services.

 

again, this, along with getting more people coverage, is exactly the purpose of obamacare

[suigeneris]

there needs to be a serious effort to control the cost of services.

 

again, this, along with getting more people coverage, is exactly the purpose of obamacare

 

The ACA is aimed much more at getting more people insured than controlling costs. As to the former, I think it will be successful. But it only nibbles at the edges of controlling costs.

 

What I was referring to above wasn't the change in the price of premiums due to establishing minimum coverage levels, prohibiting underwriting, and expanding the pool of insureds. I'm talking about whether the ACA will reduce, or slow the growth of, the cost of an appendectomy. To that end, the ACA provisions (competition among insurers through the exchanges, taxes on "Cadillac" policies, requirements that insurers spend a certain percentage of premiums on care, incentivizing preventive care, greater access to information, etc.) are of doubtful efficacy.

 

As it stands, the ACA is a good deal for people with pre-existing conditions and those within the expanded Medicaid bracket (in those states that accepted federal money) but you should be skeptical whether it will be a better deal for everyone else.

[tschu]

I'm talking about whether the ACA will reduce, or slow the growth of, the cost of an appendectomy.

I know.

[tschu]

If I must expand, there are requirements introduced on the amount insurers must spend on patients, tax penalties for both hospitals and insurance companies, tax penalties on "cadillac plans" so that people don't go nuts with them. There is the requirement for preventative care that will reduce future costs on more serious health problems. And of course the fact that the whole thing sets up a system of much more intense price competition between insurers and between providers. Costs won't be lower initially (as I've said time and time again) due to the system shock of a complete overhaul where everyone will hedge on the more expensive side. But as competition increases and the mandate takes full effect, costs probably won't go down, but should at least not increase at such an insane rate.

[BigRedBuster]

Wow...sucks to be her.

 

LINK

 

(CNN) - Jessica Sanford, the Washington State woman cited by President Barack Obama as an Obamacare success story, received more bad news Tuesday. Officials with the state's health exchange checked on her case and said she will not qualify for assistance in buying insurance.

 

Sanford had written the White House last month after purchasing what she thought was affordable health care coverage on the Washington state insurance exchange.

 

Part of her message was read by the President at a Rose Garden event at the a White House on October 21.

 

But in the days that followed that presidential shout-out, Sanford received letters from Washington state's insurance exchange, notifying her she did not qualify for a tax credit she was originally told she would be getting.

[carlfense]

Wow...sucks to be her.

 

LINK

 

(CNN) - Jessica Sanford, the Washington State woman cited by President Barack Obama as an Obamacare success story, received more bad news Tuesday. Officials with the state's health exchange checked on her case and said she will not qualify for assistance in buying insurance.

 

Sanford had written the White House last month after purchasing what she thought was affordable health care coverage on the Washington state insurance exchange.

 

Part of her message was read by the President at a Rose Garden event at the a White House on October 21.

 

But in the days that followed that presidential shout-out, Sanford received letters from Washington state's insurance exchange, notifying her she did not qualify for a tax credit she was originally told she would be getting.

Sad story. Sounds like she was in a bad spot before and she could be in a worse spot now.

[suigeneris]

If I must expand, there are requirements introduced on the amount insurers must spend on patients, tax penalties for both hospitals and insurance companies, tax penalties on "cadillac plans" so that people don't go nuts with them. There is the requirement for preventative care that will reduce future costs on more serious health problems. And of course the fact that the whole thing sets up a system of much more intense price competition between insurers and between providers. Costs won't be lower initially (as I've said time and time again) due to the system shock of a complete overhaul where everyone will hedge on the more expensive side. But as competition increases and the mandate takes full effect, costs probably won't go down, but should at least not increase at such an insane rate.

 

It seems we agree on what the ACA tries do and just disagree somewhat as to whether those measures are aggressive enough and how successful they will be. I think it is really hard to predict how these things will play out, since there are so many interrelated parts and there will surely be unintended consequences. For example, some people argue that limiting Medicaid and Medicare administrative costs to a certain percentage has actually disincentivized cost-savings. If you get to keep 1% of expenditures for overhead and salaries, a hospital administrator has an incentive to spend more to make that 1% bigger. The same concern may apply to limits on health insurers' administrative costs.

 

I'll admit that my opinion is based on a very rudimentary understanding of the economics of the health care market and the mechanics of the ACA. Needless to say, this stuff is complicated and it will be interesting to see how it plays out.

[Junior]

http://www.texasobserver.org/a-galveston-med-student-describes-life-and-death-in-the-safety-net/

 

Depressing read on a Friday night about those on the fringes of medical care.

 

The Affordable Care Act, better known as Obamacare, could have been a huge relief. However, Gov. Rick Perry rejected billions of dollars in federal funding to expand Medicaid, funding that should have brought access to more than a million Texans, including many St. Vincent’s patients.

 

Perry’s refusal is catastrophic health policy. For patients, it means that seeking medical care will still require risking bankruptcy, and may lead nowhere. For doctors, the message was not only that our patients’ lives don’t matter, but also that medicine—our old profession, so full of people who genuinely want to help others—will continue to be part of the economic machine that entrenches poverty. When the poor seek our help, they often wind up with crippling debt.

....

 

Among those consequences are the deaths of the poor. As Howard Brody, director of the Institute for the Medical Humanities, has shown, 9,000 Texans per year will die needlessly as a result of our failure to expand Medicaid. However, because dying patients are often too sick, exhausted and wracked with pain to protest, UTMB and states like Texas aren’t forced to reckon with the consequences of their policy decisions.

....

 

 

Vanessa’s request for UTMB funding wasn’t approved. She has received a $17,000 bill from UTMB for the visit when Jimmy went through the ER, and a $327,000 preliminary bill from the Houston hospital.

If the Affordable Care Act had been in effect last year, they would have been able to afford insurance, get treatment early and avoid bankruptcy. I use stories like theirs—cancer stories—when I am encouraging my patients to check out the insurance exchanges.

....

 

When one of our St. Vincent’s patients gets a bad diagnosis, we start sending faxes: to UTMB, to MD Anderson, to anywhere that might have funds to help them. Sometimes it works out, but often it doesn’t. Sometimes I think of it as “sending faxes into the abyss.” And sometimes I think of it as the slow, diligent, technical way that I have of insisting that these lives matter.