The Sad Case of the Patient Protection and Affordable Care Act

[Carter]

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

There is one way to avoid the high cost of Health Care in your later years. Die.

Working on it.

[Farce Poobah]

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

There is one way to avoid the high cost of Health Care in your later years. Die.

Another way is to appoint Samurai Actuary to enforce the mortality tables.

[FreshFish]

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

Interview with Aetna's CEO in today's WSJ:

http://online.wsj.com/article/SB1000...ections_health

They have shifted their market position to collaborate with physician groups and hospitals to coordinate information on best practices and new payment models.

Mr. Bertolini: People assume that what's in the bill is what we are implementing. But what happens is the bill is sort of like an airplane model kit. You've got these directions that come with all these parts. You start putting it together and you go, 'You know what? I'm not going to do it that way. I'm going to do it this way.' [Laughs.] In regulation you actually get a chance to fix it. I think this is what we are seeing. So, I would argue, on the Supreme Court case specifically, that the individual-coverage requirement, the guaranteed issue and community rating [provisions that require insurers to sell plans to consumers regardless of pre-existing health conditions and not peg premiums to health status], are all things that needed to be fixed in regulation anyway. As they were structured, they were unworkable or weren't going to work the way they were intended.

The Supreme Court case, from my perspective, is important in its constitutional role, but has far less impact on the Affordable Care Act than I think the American public and the political blogosphere is giving it.

lots of other nuggets there as well. not sure if this is a subscriber only article or a general public article.

[FlagDUDE08]

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

lots of other nuggets there as well. not sure if this is a subscriber only article or a general public article.

It's subscriber content.

[FreshFish]

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

Wow! I never expected Karl Rove to offer genuine sympathy for Obama, yet....

A New York Times/CBS News poll earlier this month [found] that 34% of Americans support ObamaCare (18% strongly) while 48% disapprove (36% strongly). Only 24% want to keep the entire law while 27% want the individual mandate gone and 41% want the entire law struck down.

If the court moves to invalidate part or all of the Affordable Care Act, what matters most politically is Mr. Obama's response.

The president could pivot to the center and regain some of the high ground he occupied in his 2008 campaign. He could say that while he disagreed with the court's decision, the justices had the responsibility under our system to decide whether the law was constitutional. Everyone needs to respect and accept the verdict.

He could then add that a big problem remains: Tens of millions of our fellow citizens lack affordable health insurance. Now it is the responsibility of Republicans and Democrats, liberals and conservatives to come together and provide access to coverage. And the president could offer proposals to do that.

Voters would then see Mr. Obama more as he appeared in 2008—reasonable and practical, open to dialogue and discussion, committed to bipartisan answers.

[5mn_Major]

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

Wow! I never expected Karl Rove to offer genuine sympathy for Obama, yet....

The chances of sincerity are about zero...and no, don't expect Obama to take that grizzly bait.

[leswp1]

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

Mass going forward with Medical home legislation. One of the articles from the local paper- http://www.lowellsun.com/ci_20855393....lowellsun.com

Made my blood boil. We do not bring people in for uneeded appointments to make money. Most of the visits we chase people for are required by insurance to do things that may or may not be appropriate but are required to regain the withhold they keep back until patients meet measures (that are not patient specific and may be inappropriate for pt). They think we aren't going to have as many visits.

Flat rate for patients means if the patients come in 15-20 times a yr for imagined maladies, because they are lonely or because they don't like to think for themselves they cost way more than they bring in. Trying to decrease their usage doesn't work. They call the insurance co and complain if you try to give advice over the phone that is completely appropriate.

They tried this model about 20-25 yrs ago here. They had to recind after practices were jettisoning the all the high maintenance patients because they could not afford to keep them and stay afloat. It wasn't ethical but small practices were going under. The legislature actually passed stuff to keep the insurance co from capitated plans because it became a crisis.

[joecct]

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

Wow! I never expected Karl Rove to offer genuine sympathy for Obama, yet....

Remember where you can find sympathy in the dictionary......

And Les, sometimes I wonder if Massachusetts is for it, the rest of us should run the other way...

[leswp1]

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

Remember where you can find sympathy in the dictionary......

And Les, sometimes I wonder if Massachusetts is for it, the rest of us should run the other way...

So frustrating that no one asks the people in the trenches what to do at either the local or Fed level. When the Fed law was first floated it looked pretty good conceptually. THe GOP gutted much of it which really confused me because alot of it was cut and paste from different GOP proposals before. Equally disgusted with the useless Dems who couldn't get it together, the GOP who would rather focus on beating a president than caring for the needs of the country and the populace who was stupid enough to believe the utterly silly nonsense floated about death panels, and all the other falsehoods that were spewed about. If this were a family with a parent of any intelligence, the parent would have slapped everyone silly and pointed out that no one wins when you don't work together.

The Primary care folks are the brunt of everything because the specialists are majority on any of the committees that make decisions. We get more and more responsibilities with less and less reimbursement. If I was in med school there is nothing that would entice me to go into primary care without a serious overhall. Contrary to popular belief there is absolutely no money in it and there is way more stress. The incentives they are talking about aren't really going to be enough to get anyone who really looks to enter into primary care. The work load is enormous and not comensurate with the amount of recompense they are offering. It might help for the first bit of your career but the long term outlook is not rosy.

The way they are doing this they are making it more and more difficult to succeed. THe patient has NO responsibility or consequence for being noncompliant but there are plenty of consequences for me. At some point the practice will have to let the complex or non-compliant patients go. No way to survive otherwise and that does not sit well either ethically or morally. Been there before. The practice I was in hung in for awhile but the numbers were so bad we had to take action. It was an awful feeling to know you can't take care of someone because the system forces that decision on you.

end rant/

Bad attitude right now. Bad week at work. Charted about 9 hours more than what I am paid for (still not caught up and having neck issues from all the time on the computer), dealt with a 'few' recalcitrant patients who are costing me an arm and a leg because they aren't meeting the measures the insurance company requires, had to deal with a 'few more' who have been absent because they couldn't afford the meds or the follow up, and more than a few more who insisted on being seen because they had insignificant problems but should be able to see someone because they pay for insurance. Not all weeks are like this but this was particularly bad. Sometimes I think I should be more like a former colleague who just wanted the paycheck but could have cared less. so much easier.

[FreshFish]

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

Well, while a majority of the Supreme Court ruled that PPACA was indeed unconstitutional under the Commerce clause, as widely expected, the law nevertheless was allowed to stand anyway, on a technicality.

Chief Justice Roberts made no secret of what he thought about the content of the law itself:

Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.”

[hat's off to joecct for the link from which I lifted this quote]

somewhere else he made an even more direct derogatory quote, which I'll track down later and update.

Still a bad law, still forces the healthy young to subsidize the mediocre middle-aged, still has enormous pricing distortions, still is a very costly overhang that is a significant contributory force in slow hiring, now we know we can be taxed if we don't own insurance, just like we are taxed if we buy cigarettes or cigars or whiskey or beer.

[unofan]

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

[hat's off to joecct for the link from which I lifted this quote]

You know, I realize it's 180 or so pages including the concurrance, the dissent, and Thomas's two page footnote, but is it too much to ask you read the actual opinion and quote it yourself? Judges do write those things for a reason...

Also, I read that as a rebuke of the GOP challenges as much as the law itself. It's essentially "stop bringing your political quarrels here"

[dxmnkd316]

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

You know, I realize it's 180 or so pages including the concurrance, the dissent, and Thomas's two page footnote, but is it too much to ask you read the actual opinion and quote it yourself? Judges do write those things for a reason...

I read Roberts opinion and I'm working my way through the opinion of the court. I find I'm actually enjoying reading it.

[unofan]

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

I read Roberts opinion and I'm working my way through the opinion of the court. I find I'm actually enjoying reading it.

Whatever else people say about Roberts, he (and his clerks, though he doubtless wrote much of this opinion himself) is a **** fine legal writer. Way better than Kennedy, whose opinions tend to ramble and lose sight of the finish line.

[FreshFish]

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

You know, I realize it's 180 or so pages including the concurrance, the dissent, and Thomas's two page footnote, but is it too much to ask you read the actual opinion and quote it yourself? Judges do write those things for a reason...

Also, I read that as a rebuke of the GOP challenges as much as the law itself. It's essentially "stop bringing your political quarrels here"

weekend reading, perhaps, i still work for a living and have to make do with the Readers' Digest Condensed edition in the meantime.

I read the first 15 or 20 pages, marvelous writer, very clear and cogent.

[FlagDUDE08]

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

Well, while a majority of the Supreme Court ruled that PPACA was indeed unconstitutional under the Commerce clause, as widely expected, the law nevertheless was allowed to stand anyway, on a technicality.

Chief Justice Roberts made no secret of what he thought about the content of the law itself:

[hat's off to joecct for the link from which I lifted this quote]

somewhere else he made an even more direct derogatory quote, which I'll track down later and update.

Still a bad law, still forces the healthy young to subsidize the mediocre middle-aged, still has enormous pricing distortions, still is a very costly overhang that is a significant contributory force in slow hiring, now we know we can be taxed if we don't own insurance, just like we are taxed if we buy cigarettes or cigars or whiskey or beer.

That's why I like the selection of Roberts. He did his job. He didn't do a bunch of partisan codswallop, like the others. I disagree with the ruling, but the process must be respected, and as the Chief Justice said, there are other ways to repeal the law, such as Congressional action.