The Sad Case of the Patient Protection and Affordable Care Act

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

"Most pathologies in the current system are creatures of previous laws and regulations. " Pure opinion, no evidence that this is actually happening.

wrong, big time. WWII Wage Price controls led directly to employer-provided health insurance which is now identified as one of the key factors in the current mess. Also, state mandates require everyone to pay for coverage that not everyone wants or uses. There is plenty of evidence for an empiricist.

"Instead of these mandates, at least allow people to buy insurance that only covers the big expenses. " - This makes zero sense.

it makes great sense as an option; it would not make sense if it were the only option.

Basically people should be charged full price for regular exams and birth control

that already happens in existing insurance plans. It is "pre-paid spending" that is already baked into the premium. For people who want it, they can elect to purchase these plans; for those who prefer "unbundled" coverage, they can elect to pay for these services out of pocket.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The easiest thing to do is look at car insurance. You are essentially part of the overall group that the entire company insures. What keeps costs down is other insurance companies competing for your business. Your personal risk is factored in, but you certainly aren't out there on an island. Its also true insurance. They don't pay for your oil changes. If we were to get rid of the mandates and go back to true "insurance" there would be plans that would be very affordable and more likely to keep costs down going forward.

And for the first retort I know is coming. There are already laws on the books that insurance companies can't drop you just because you get sick as long as you are current in your payments.

My first thought was you can luck out and get good drivers who never use the $ they put in. Humans all die and most of them also utilize health care before they do. This may not be related to how much they take care of themselves. You have guaranteed risk when you pick up a client for health insurance.

..."But the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse. " Some #'s would be nice, because indigent care is pretty expenses. Regardless, regulations aren't the problem. Its the way Medicare is paid out (by procedure instead of based on the total care of the patient). Some state that already has universal coverage is going down this road since they've already solved problem #1, that of everybody having coverage.
"If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what's offered today that we would likely not even need the mandate." - yes it would be cheaper for insurance because it wouldn't cover much and you'd be paying the rest out of pocket or just skipping doctors visits until you reached a crisis point. However, health care costs would be unaffected.

Anything else?

Many people over use the system. Anyone who reads my posts has at some time seen me whine about the people who have a cough or sore throat and insist on being seen (it is their RIGHT!!!!!) for stupid stuff. People truly seem to have lost the ability to problem solve the simplest things like try home remedies or maybe wait to see if the kid is going to vomit again before you call in a panic and insist we check the kid out. You capitate rather than pay for service and those people are a massive drain but we still have to see them or we get slapped by the insurance companies. If we refuse they hie themselves off to the ER (which they do anyways sometimes) and we get slapped for that.

Start with the current law (Obamacare). Everybody gets insurance, plus exchanges are set up in each state to shop around.

First, crack down on fraud. In fact, I would enlist the private sector on this. Simply put, govt hires fraud detection service to sniff out hucksters and pays out a % of the savings once recovered. Solves the problem of people screaming about govt getting too big if they had to bring on more people to do it themselves.

Next, as Mass is now doing, incentivize care on patient basis instead of paying per procedure.

After that, yes tort reform ought to be part of the package. Dems/libs/whatever aren't against this, but correctly argued that this wasn't the magical solution righties made it out to be.

Lastly, I also think the advent of the so called "minute clinics" in CVS for example are an important and cheaper way to get people routine car and ease wait times to see medical professionals. This also needs to be encouraged or better yet restrictions preventing it happening need to be cleared (for example high school dropout Boston mayor was against this practice for a time and threatened to ban them from the city).

With the problem of access to insurance solved, the cost of delivery and the ease of getting care can now be focused on.

The theory for seeing people on incentive is great. The practice is absolutely killing primary care. See previous posts. Unless you are going to reimburse the 'gatekeeper' at a reasonable rate the primary care system is bankrupted and unable to function. Locally we have 50% less independent practices for primary care now than we did even 5 yrs ago. They can't stay afloat with all the requirements to prove they have met incentives and the need to chase patients to be compliant- all of which are not reimbursed except then you get full payment for the services you have rendered. Otherwise they withhold a chunk of change. THe larger practices currently have a person dedicated to proving the patients have met incentives and calling/sending letters/setting up appts for those who have not. This is not because the practice is inefficent. The incentive requirements are ridiculously cumbersome and are different for every insurance. The smaller practices are bleeding $ that they could capture if they could afford to have someone chase like the larger practices. This is a very scary trend.

If we were single payer then this type of thing might work a bit better. We are not. The primary care system in Mass is in shambles with the insurance companies making out like bandits and changing the incentives/rules so often you can't even plan defensively.

Minute clinics are a great place if you have something simple but fragment care. We get a note every time someone goes to one. >75% of those visits were not needed and were during our office hours. (idng- we lose money and the system pays for a useless visit) The insurance co are waking up and refusing to pay if we were open at that time and weren't called first. More work for us. People are PO's that they can't just go where ever for free. Guess who is responsible for educating them about why they can't have a referral. Yep- primary care. Andno, we don't get reimbursed for talking to anyone on the phone.

If we were reimbursed like lawyers for every bit of work we do I would have my second house and a yacht.

PS Can anyone tell I just got home from work after seeing patients for 3 hours and charting, chasing and generally having to clean up muck that I will not be reimbursed for because of the stupid insurance companies??!!
I didn't think so.

PPS I know I can't spell or type and the grammar horse will be at my door.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I haven't read Ryan's Plan (didn't even know it existed), but speaking as a Gen-Y, I'm sure you could understand why people should be responsible for their own bills. Forcing me to pay for your health care because you couldn't prepare on your own is not only asinine, but whiny on your part. Given FreshFish's description of Ryan's plan, it doesn't sound like too bad of an idea.

Earlier, I posted the Democratic response to the Ryan plan, the video in which a Ryan look-alike pushes a wheelchair bound older woman over the edge of a cliff. President Obama piled on more of the same yesterday:

Did you hear about the GOP's red-in-tooth-and-claw plan for Medicare? Grandma and Gramps are going to be drafted for the Hunger Games.

Mr. Obama has been working Mediscare for the last year, but he is also debuting some new material, each layer thicker than the last. Modern Republicans are so radical that they oppose research and care for Alzheimer's, cancer, AIDS, autism and Down Syndrome, even as they want to deny education and food to children and their mothers. They want to pave over Yellowstone and backfill the Grand Canyon. But few tourists could get there anyway, because Republicans plan to shut down air traffic control too.

Because Republicans have criticized the Administration's torrent of costly new rules across the entire economy, therefore they favor returning to a state of regulatory nature, with no rules at all. Because Republicans oppose high-speed rail, therefore they would have opposed industrialization in the 19th century. They do plan to build a wayback machine to the Gilded Age, however, by handing a $150,000 check to every American millionaire, a million-dollar check to every billionaire, and a billion-dollar check to every trillionaire.

"This is not conjecture," Mr. Obama said. "I am not exaggerating. These are facts." Lest you think we exaggerate, read the transcript.

Equal time for a proponent:

Mr. Ryan's "premium support" reform for Medicare ... has been endorsed by Oregon Democrat Ron Wyden. It was advanced in the 1990s by President Clinton's Medicare commission led by Democrat John Breaux. It mirrors the insurance system that lets millions of federal workers choose from a myriad of insurance plans with a government subsidy

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

President Obama piled on more of the same yesterday

I'm sure you didn't mean to, but you missed his point. Here is the full context. Just trying to help out.

But here's the solution proposed by the Republicans in Washington, and embraced by most of their candidates for president: Instead of being enrolled in Medicare when they turn 65, seniors who retire a decade from now would get a voucher that equals the cost of the second cheapest health care plan in their area. If Medicare is more expensive than that private plan, they'll have to pay more if they want to enroll in traditional Medicare. If health care costs rise faster than the amount of the voucher -- as, by the way, they've been doing for decades -- that's too bad. Seniors bear the risk. If the voucher isn't enough to buy a private plan with the specific doctors and care that you need, that's too bad.

"So most experts will tell you the way this voucher plan encourages savings is not through better care at cheaper cost. The way these private insurance companies save money is by designing and marketing plans to attract the youngest and healthiest seniors -- cherry-picking -- leaving the older and sicker seniors in traditional Medicare, where they have access to a wide range of doctors and guaranteed care. But that, of course, makes the traditional Medicare program even more expensive, and raise premiums even further.

"The net result is that our country will end up spending more on health care, and the only reason the government will save any money -- it won't be on our books -- is because we've shifted it to seniors. They'll bear more of the costs themselves. It's a bad idea, and it will ultimately end Medicare as we know it.

"Now, the proponents of this budget will tell us we have to make all these draconian cuts because our deficit is so large; this is an existential crisis, we have to think about future generations, so on and so on. And that argument might have a shred of credibility were it not for their proposal to also spend $4.6 trillion over the next decade on lower tax rates.

"We're told that these tax cuts will supposedly be paid for by closing loopholes and eliminating wasteful deductions. But the Republicans in Congress refuse to list a single tax loophole they are willing to close. Not one. And by the way, there is no way to get even close to $4.6 trillion in savings without dramatically reducing all kinds of tax breaks that go to middle-class families -- tax breaks for health care, tax breaks for retirement, tax breaks for homeownership.

"Meanwhile, these proposed tax breaks would come on top of more than a trillion dollars in tax giveaways for people making more than $250,000 a year. That's an average of at least $150,000 for every millionaire in this country -- $150,000.

"Let's just step back for a second and look at what $150,000 pays for: A year's worth of prescription drug coverage for a senior citizen. Plus a new school computer lab. Plus a year of medical care for a returning veteran. Plus a medical research grant for a chronic disease. Plus a year's salary for a firefighter or police officer. Plus a tax credit to make a year of college more affordable. Plus a year's worth of financial aid. One hundred fifty thousand dollars could pay for all of these things combined -- investments in education and research that are essential to economic growth that benefits all of us. For $150,000, that would be going to each millionaire and billionaire in this country. This budget says we'd be better off as a country if that's how we spend it.

This is supposed to be about paying down our deficit? It's laughable.

The bipartisan Simpson-Bowles commission that I created -- which the Republicans originally were for until I was for it -- that was about paying down the deficit. And I didn't agree with all the details. I proposed about $600 billion more in revenue and $600 billion -- I'm sorry -- it proposed about $600 billion more in revenue and about $600 billion more in defense cuts than I proposed in my own budget. But Bowles-Simpson was a serious, honest, balanced effort between Democrats and Republicans to bring down the deficit. That's why, although it differs in some ways, my budget takes a similarly balanced approach: Cuts in discretionary spending, cuts in mandatory spending, increased revenue.

"This congressional Republican budget is something different altogether. It is a Trojan Horse. Disguised as deficit reduction plans, it is really an attempt to impose a radical vision on our country. It is thinly veiled social Darwinism. It is antithetical to our entire history as a land of opportunity and upward mobility for everybody who's willing to work for it; a place where prosperity doesn't trickle down from the top, but grows outward from the heart of the middle class. And by gutting the very things we need to grow an economy that's built to last -- education and training, research and development, our infrastructure -- it is a prescription for decline.

All of which is completely reasonable.

Voters tried a radical experiment beginning in 1980, reversing 50 years of American values and trusting in the beneficence of the wealthy and the wisdom of the market. It didn't work and the country has been spiraling downwards ever since. The sooner we repair the damage the better.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I'm sure you didn't mean to, but you missed his point. Here is the full context. Just trying to help out.



All of which is completely reasonable.

Voters tried a radical experiment beginning in 1980, reversing 50 years of American values and trusting in the beneficence of the wealthy and the wisdom of the market. It didn't work and the country has been spiraling downwards ever since. The sooner we repair the damage the better.

The reason we'd want to get rid of those programs is because not only can we not afford them anymore, but they are being abused by the various administrations. Look at how both Clinton AND Dubya used Social Security to bring the budget closer to a balance. What's not to say that a future Congress or administration will do the same with Medicare, Obummercare, or whatever future theft program comes to fruition?

If the government wants to get involved in providing health care, there's a very easy way to do it without having to go through all of this mandate crud: create a competitive insurance plan! Also, instead of stealing from the taxpayers that won't ever qualify in order to fund it, base it upon the amount of money that each citizen that chooses to use the program has already contributed to Medicare, and if people wish to choose to plan for using this program in the future, they will also be able to contribute. If someone wishes to opt out, they can do so under the known risk that they will not be covered should the need arise for the plan.

Ever since FDR, the government has become a fascist oligarchy, and to promote the land of the free, we need to come up with solutions to preserve the balance of life, liberty, and the pursuit of happiness.

[Bob Gray]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I'm sure you didn't mean to, but you missed his point. Here is the full context. Just trying to help out.

All of which is completely reasonable.

Voters tried a radical experiment beginning in 1980, reversing 50 years of American values and trusting in the beneficence of the wealthy and the wisdom of the market. It didn't work and the country has been spiraling downwards ever since. The sooner we repair the damage the better.

It's campaigning tripe. Nothing more.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

It's campaigning tripe. Nothing more.

The Ryan Plan? I agree, but I'm a little surprised you do.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I'm sure you didn't mean to, but you missed his point. Here is the full context. Just trying to help out.



All of which is completely reasonable.

Voters tried a radical experiment beginning in 1980, reversing 50 years of American values and trusting in the beneficence of the wealthy and the wisdom of the market. It didn't work and the country has been spiraling downwards ever since. The sooner we repair the damage the better.

Fishy by name, Fishy by trade. Agree completely with Barry O. A devastating indictment of GOP priorities, essentually a massive wealth transfer to older wealthy Republican voters at the expense of everybody else. I especially love the part about how if this is to reform the system, what's up with the billions of dollars of tax breaks for GOP campaign contributors? How much do the Kock brothers and Sheldon Alderson get from The Ryan Kickback?

The funniest part is Mittens now owns this. He's on board completely so he can't run away from it. Have fun telling everybody under 55 (the very people who had the power to put Obama in the White House in the first place) that they get to pay yet again for the Whiniest Generation to live like kings. I'm sure that'll go over real well....

Will the last knuckledragger who thinks Romney is our next President please raise your hand.

EDIT: Les, always appreciate the "insiders" view.

[Bob Gray]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The Ryan Plan? I agree, but I'm a little surprised you do.

You'd do well working for your favority media outlets.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I have never quite understood why the alternative isn't to have the provision of free medical care for people who can't pay for it..... But we as a country never seem to be able to wrap out heads around the concept of a pure welfare system,.....

I suppose you know that nothing is "free", and you mean something like "people who can afford to pay more are taxed to provide for people who can't afford to pay."


There is a tradition of "social reciprocity" that goes back centuries in this country, preceding the formation of the US. Every adult is expected to contribute "something of value" to society. Unfortunately, there is a despicable class of cynical career politicians that maintains "the only thing you need to contribute is your vote every two years; once you do that, we'll make sure you receive everything else you need in return." (did you notice that Rosa DeLauro now wants the government to provide "free" diapers to people "in need"?) The idea of receiving things "for free" from the rest of us while contributing nothing of value in return bothers a lot of people.

Seriously, how much of your income do you want directed to someone who does absolutely nothing, ever, in return?

Myself, I willingly donate time money and skills to people who need temporary assistance in recovering from a tough time, and I also recognize that, due to chronic health problems, some people are physically or mentally not able to contribute "much" in the way of reciprocal value. However, can we agree that these are special cases and represent a small percentage of those where the tension and frustration lie?

I have not made up my mind yet on this issue: I do understand and empathize with people on both sides. I don't like being used and taken advantage of, and I also empathize with suffering and need.

What complicates the situation tremendously is we now have multiple generations who have been taught it is "okay" to do nothing other than collect benefits; any transition would be really hard on them. A social worker I knew had a 28-year old grandmother among her caseload, for example. After having been consigned to that life, what can she do now? Really tough question.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The reason we'd want to get rid of those programs is because not only can we not afford them anymore, but they are being abused by the various administrations. Look at how both Clinton AND Dubya used Social Security to bring the budget closer to a balance. What's not to say that a future Congress or administration will do the same with Medicare, Obummercare, or whatever future theft program comes to fruition?

If the government wants to get involved in providing health care, there's a very easy way to do it without having to go through all of this mandate crud: create a competitive insurance plan! Also, instead of stealing from the taxpayers that won't ever qualify in order to fund it, base it upon the amount of money that each citizen that chooses to use the program has already contributed to Medicare, and if people wish to choose to plan for using this program in the future, they will also be able to contribute. If someone wishes to opt out, they can do so under the known risk that they will not be covered should the need arise for the plan.
Ever since FDR, the government has become a fascist oligarchy, and to promote the land of the free, we need to come up with solutions to preserve the balance of life, liberty, and the pursuit of happiness.

They do that now only we have to pay for them when they show up in duress. I keep pounding on this but it doesn't get addressed. Until we have the right to NOT treat people (which will never happen) there is no impetus to for the people with an immortality complex or the disease of denial to cover themselves. They get a free ride from the rest of us through our increased rates and they sink their families if they have anything to fork over

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

They do that now only we have to pay for them when they show up in duress. I keep pounding on this but it doesn't get addressed. Until we have the right to NOT treat people (which will never happen) there is no impetus to for the people with an immortality complex or the disease of denial to cover themselves. They get a free ride from the rest of us through our increased rates and they sink their families if they have anything to fork over

Then repeal the law that forces that sort of treatment. It sounds like a good trade-off to me.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I suppose you know that nothing is "free", and you mean something like "people who can afford to pay more are taxed to provide for people who can't afford to pay."


There is a tradition of "social reciprocity" that goes back centuries in this country, preceding the formation of the US. Every adult is expected to contribute "something of value" to society. Unfortunately, there is a despicable class of cynical career politicians that maintains "the only thing you need to contribute is your vote every two years; once you do that, we'll make sure you receive everything else you need in return." (did you notice that Rosa DeLauro now wants the government to provide "free" diapers to people "in need"?) The idea of receiving things "for free" from the rest of us while contributing nothing of value in return bothers a lot of people.

Seriously, how much of your income do you want directed to someone who does absolutely nothing, ever, in return?

Myself, I willingly donate time money and skills to people who need temporary assistance in recovering from a tough time, and I also recognize that, due to chronic health problems, some people are physically or mentally not able to contribute "much" in the way of reciprocal value. However, can we agree that these are special cases and represent a small percentage of those where the tension and frustration lie?

I have not made up my mind yet on this issue: I do understand and empathize with people on both sides. I don't like being used and taken advantage of, and I also empathize with suffering and need.

What complicates the situation tremendously is we now have multiple generations who have been taught it is "okay" to do nothing other than collect benefits; any transition would be really hard on them. A social worker I knew had a 28-year old grandmother among her caseload, for example. After having been consigned to that life, what can she do now? Really tough question.

I agree with much of this. The Dems don't seem to like to acknowledge there are grifters in the system and the GOP wants to throw the baby our with the bathwater because there are some.

I would really like some sort of program where the people getting asst should have to give back. They have some food bank programs that work on this principle. In order to get food you do community service. One of my family members used to clean an elderly lady's house and do her shopping and then get a voucher fro the food bank.

I definitely agree there is a culture of those who are in the system and have very little exposure to those successful out of it. You would think that they can absorb the 'right' culture in school/ church, whatever but it is so foreign to them it would be like me going to Russia, not speaking the language and missing all but the most blatant cultural rules. Even if they do see they should be doing something different they are going without a road map. The best thing is a mentor who has gotten out of that lifestyle but it isn't easy to find one. Add to that the lack of daycare (if you work for min wage the going rate for day care around here for an infant is more than you make in a week) and you have a recipe for failure even in a motivated person.

This is going to sound weird but the lack of Home Ec classes and IT classes something that really misses an opportunity. When I was a kid we had Home Ec and learned how to price shop, what a nutritious meal consisted of and various other basic housewifey things. Both Boys and girls had to take it. We had to make a budget and were assigned things like going to the grocery store to see what we could buy for meals on our budget. These seem like basic skills but you would be absolutely shocked how many people we have who are in financial distress and we teach them this stuff at the Dr's office. They are unaware of basic nutrition and a lot of the money saving things that the previous generations took for granted.

[MinnFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

They do that now only we have to pay for them when they show up in duress. I keep pounding on this but it doesn't get addressed. Until we have the right to NOT treat people (which will never happen) there is no impetus to for the people with an immortality complex or the disease of denial to cover themselves. They get a free ride from the rest of us through our increased rates and they sink their families if they have anything to fork over

Along similar lines I thought the bill pushed a couple years ago that required a $50 copay (I would probably do $20) for every ER patient was a good idea. Ideally it would keep some of the most frivolous cases out of there. If someone was truly needy I'm sure there would be charities that would reimburse them for it.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

This is going to sound weird but the lack of Home Ec classes and IT classes something that really misses an opportunity. When I was a kid we had Home Ec and learned how to price shop, what a nutritious meal consisted of and various other basic housewifey things. Both Boys and girls had to take it. We had to make a budget and were assigned things like going to the grocery store to see what we could buy for meals on our budget. These seem like basic skills but you would be absolutely shocked how many people we have who are in financial distress and we teach them this stuff at the Dr's office. They are unaware of basic nutrition and a lot of the money saving things that the previous generations took for granted.

This is one of the most sensible things I've seen, at least on this page. You wouldn't believe how many times I get into arguments with people over this sort of thing, and I find it to be common sense. Of course, many schools cut these programs in order to fill budget holes (gosh knows you can't touch that soccer budget; we didn't have football where I went to K-12 school). Even if you have community activists willing to spread this sort of message (of course the teachers' unions wouldn't allow for that) would do a great deal of good.