The Sad Case of the Patient Protection and Affordable Care Act

[LynahFan]

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

However, as long as being a doctor is more lucrative than the typical profession, if you grow the supply of care recipients there will be more openings for doctors at providers, and where there are openings there will be applicants.

I think the quality argument is a much better one against caps -- you will no longer attract the best and the brightest if they are paid less relative to law, business, academia, etc. Call it the Schoolteacher Dilemma.

Except that the potential pool of applicants we're talking about are "people who have passed their medical boards." Once people are through med school, they still have to choose to go into primary care rather than specializing or going into concierge care, so the reward for primary care has to be higher relative to those other medical career choices, not just higher than law, business, etc.

I certainly agree that keeping the pay higher than law and business will improve the quality of the med school applicant pool, but that does no good if none of them choose primary care post graduation.

[Kepler]

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

Then why do we not see similar progression in even the present?

We do. Compare the 85+ to 80-84 for 1900, 1950, and 2000. 85+ goes from a tiny fraction of 80-84 in 1900 to being a larger absolute value than 80-84 by 2000.

They should have added the additional cohorts to the chart to make it more obvious. As it is the chart is correct but misleading, because the "+" of the top cohort makes it far more years than the 5 years of every other cohort.

[FlagDUDE08]

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

Because the chart is also elongating. That 85+ includes 85-89, 90-94, 95-99, 100-104, etc...

Nobody within a given 5 year cohort will be larger than 80-84, but the number of cohorts are increasing.

Then why do we not see similar progression in even the present?

[Kepler]

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

Only if the price can float higher so that there is a higher reward for investment. We already know how many doctors will be produced at today's prices; the only mechanism (in a free market) which would produce a greater supply than we have today is a greater price. If the price is capped (and with a larger and larger proportion of health care being performed at Medicare rates, this is increasingly the case), then there's no reason to expect that there will be more doctors.

However, as long as being a doctor is more lucrative than the typical profession, if you grow the supply of care recipients there will be more openings for doctors at providers, and where there are openings there will be applicants.

I think the quality argument is a much better one against caps -- you will attract fewer of the best and the brightest if they are paid less relative to law, business, academia, etc. Call it the Schoolteacher Dilemma.

[LynahFan]

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

This is contrary to how supply and demands actually works. Capital looks for a ready market.

Only if the price can float higher so that there is a higher reward for investment. We already know how many doctors will be produced at today's prices; the only mechanism (in a free market) which would produce a greater supply than we have today is a greater price. If the price is capped (and with a larger and larger proportion of health care being performed at Medicare rates, this is increasingly the case), then there's no reason to expect that there will be more doctors.

[Kepler]

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

Another unintended consequence of PPACA: it greatly increases the demand for healthcare services yet includes clauses that likely will restrict supply.

This is contrary to how supply and demands actually works. Capital looks for a ready market.

[Kepler]

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

I'm skeptical, because this seems like the global warming hockey stick. Why do they think 85+ is going to shoot up so far when you compare the sizes of 75-84?

Because the chart is also elongating. That 85+ includes 85-89, 90-94, 95-99, 100-104, etc...

Nobody within a given 5 year cohort will be larger than 80-84, but the number of cohorts are increasing.

[FlagDUDE08]

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

A nice illustration of this in one figure:

*****http://thesocietypages.org/socimages/files/2010/03/FeatureAgingFigure1.png******

I'm skeptical, because this seems like the global warming hockey stick. Why do they think 85+ is going to shoot up so far when you compare the sizes of 75-84?

[FreshFish]

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

Another unintended consequence of PPACA: it greatly increases the demand for healthcare services yet includes clauses that likely will restrict supply. If the goal was to provide access to healthcare for all, the effect likely will be to create a two-tier healthcare system, one for the well-off; and one for everyone else.

Since this imbalance cannot be reconciled through price, it will most likely be reconciled through time.

We've seen a preview in Massachusetts; waiting times to see primary care physicians have been getting longer.

The full sad details are here.

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

[FreshFish]

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

A nice illustration of this in one figure:

*****http://thesocietypages.org/socimages/files/2010/03/FeatureAgingFigure1.png******

thanks, that's a great image.

[Kepler]

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

It appears that you misunderstand life expectancy.

Life expectancy is different at different ages (and also is different depending upon which mortality table you use...). The life expectancy of someone in their 40s is to a later age than the life expectancy of someone in their 20s because some of those 20-year olds have died along the way to 40.

According to the IRS life expectancy table used to calculate required minimum distributions from retirement plans, the life expectancy of a 65-year old is 20 years. The life expectancy of a 75-year old is 12.5 years (IRS Table V).

That table is probably a bit out of date these days. I read an article recently that asserted that the fastest-growing age cohort in the US is ages 90-99. The news shows used to make a big deal over people turning age 100; they've stopped because so many people are living past 100, it's no longer newsworthy.

A nice illustration of this in one figure:

*****http://thesocietypages.org/socimages/files/2010/03/FeatureAgingFigure1.png******

[FreshFish]

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

Given the current system's making, you have to live until at least 85, about 5-10 years beyond the country's life expectancy, to break even, according to an AP study. http://www.foxnews.com/politics/2012...king-historic/

It appears that you misunderstand life expectancy.

Life expectancy is different at different ages (and also is different depending upon which mortality table you use...). The life expectancy of someone in their 40s is to a later age than the life expectancy of someone in their 20s because some of those 20-year olds have died along the way to 40.

According to the IRS life expectancy table used to calculate required minimum distributions from retirement plans, the life expectancy of a 65-year old is 20 years. The life expectancy of a 75-year old is 12.5 years (IRS Table V).

That table is probably a bit out of date these days. I read an article recently that asserted that the fastest-growing age cohort in the US is ages 90-99. The news shows used to make a big deal over people turning age 100; they've stopped because so many people are living past 100, it's no longer newsworthy.

[FlagDUDE08]

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

Great, so I get to lose out on about 15 years of interest? What a wonderful plan...

Given the current system's making, you have to live until at least 85, about 5-10 years beyond the country's life expectancy, to break even, according to an AP study. http://www.foxnews.com/politics/2012...king-historic/

[dxmnkd316]

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

The Eurozone as a whole isn't doing too badly - Greece and Spain greatly skew their overall unemployment numbers, and there are far greater issues than universal health care causing their issues like trying to have a unified currency without a unified government backing it. Greece and Spain are hurting because they can't devalue their currency and the other countries don't want to bail them out. It's not unlike what would happen in, say, Mississippi if the Federal government didn't send money to it. Besides, for every Greece, Spain and Italy you have, I can point to a Norway, Germany, or Austria.

Ireland, Greece, Spain, Portugal, Italy, Cyprus, France (to an extent), and Iceland if we're including countries not in the Eurozone in the Eurozone (Norway???)... I don't know, I'd say only two have decent to good economies (Germany and I'll assume Austria based on your post). So we're talking six or seven that are deep in the red and two in the black. That's not a very good sign for the Eurozone.

All have had massive problems as of late.

[unofan]

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

That Eurozone is humming right along like a well-tuned Lambo, isn't it? Nope, no problems at all. NONE.

The Eurozone as a whole isn't doing too badly - Greece and Spain greatly skew their overall unemployment numbers, and there are far greater issues than universal health care causing their issues like trying to have a unified currency without a unified government backing it. Greece and Spain are hurting because they can't devalue their currency and the other countries don't want to bail them out. It's not unlike what would happen in, say, Mississippi if the Federal government didn't send money to it. Besides, for every Greece, Spain and Italy you have, I can point to a Norway, Germany, or Austria.

Um....I think you missed something along the way somewhere. I asked you for your solution and you consistently refuse to give one. I say I would use techniques that parents use on wayward children and you turn it into something grotesque.

If I had a teenager who ran up a credit card debt on the emergency credit card, I'd cut up the credit card in front of him and tell him he's on his own until he pays me back (in fairness, I wouldn't give a credit card to any kid not in college - so my assumption is the kid should be somewhat self-sufficient anyway). I can only assume by your analogy, you'd cut up the wasteful person's health insurance card and tell him he's on his own when it comes to health care. It was your analogy, afterall.

You still have not said how you would address this problem.

Universal health care to cover all basic medical care just like virtually every other westernized society, paid for by taxes. We already do this for the elderly, poor children, and indirectly to anyone else who shows up at an ER without the ability to pay. Might as well cover the rest of the 18-65 crowd, too, since they'd actually lower the overall per capita cost of the system. If people want to pay extra for things above and beyond what the the single payer system covers, they'd be free to do so.

My guess is that you have no answer at all, and that enrages you, and so you throw a tantrum by demonizing something reasonable by exaggerating it beyond all recognition, all to hide your [gratuitious insult, subsequently redacted].

I get annoyed at people who took Economics 101 or maybe even Intro to Microeconomics, heard "the free market rules," and then conveniently ignore the chapters on externalities, natural monopolies, imperfect markets, and market failures. As I've said on here before, the free market is a means to an end, not an end in and of itself. One of the necessary conditions required for a free market to provide an optimum distribution of goods is an assumption that everyone is acting rationally. As I'm sure everyone here knows from personal experience, pretty much nobody acts rationally all of the time, and there are plenty of people who act irrationally the majority of the time. While experience tells us the free market is generally better at rationing resources for a lot of things, even the vast majority of things, that doesn't mean it's better for everything all of the time. Sometimes the market can be wrong.

You can incentivize all the choices you want (though I find it amusing you will rail against incentives found in the tax code in the very next breath), there are going to be people who don't follow them, even if it makes no logical sense. Do we simply let them slip through the cracks because it's their own **** fault? That sounds great in theory. Less so when you have to walk past them on your way to work in this imperfect real world of ours.