The Sad Case of the Patient Protection and Affordable Care Act

[FreshFish]

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

Sounds like Fishy and Flaggy are advocating a single payer system!

Do you lialways bop in and unload your bombast without paying any attention to the ongoing thoughtful conversations among the regulars?


The Federal Government Employees Insurance Program (see joecct he knows much more than I do) has had a single-payor system for a long time. You get a premium budget and then you get to pick which insurance company to spend that budget on.

Paul Ryan also proposed a single-payor system for Medicare, in case you weren't paying attention: seniors would get a premium budget and a list of insurance companies, including existing Medicare if desired, to pick which one to spend that budget on.

We were having a related conversation last night at dinner. There were people from different states, and we were comparing cable television service. Universally, everyone noticed that, as soon as competition was introduced to an area, the incumbent's service magically became much better and their pricing increases magically slowed, just like that.

Single-payor plus multiple provider could work very well. You need the threat of taking your business elsewhere to keep a service provider honest. Once you allow a monopolist to have unrestrained pricing power, you inevitably get inferior service and higher costs. that's just how life is.

It's funny how you progressives rave about anti-trust legislation in all other areas while yearning to cede to the government monopoly power over our most precious asset. Makes no sense at all to a logical mind. I guess you are programmed so that your rampant cheerfleading exclusively for one side impairs your ability to think clearly outside of a partisan box??

[FlagDUDE08]

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

It's funny how you progressives rave about anti-trust legislation in all other areas while yearning to cede to the government monopoly power over our most precious asset.

Careful, you use a term like "government monopoly", and they'll mistaken you for me!

Also, I'm still trying to find where I petitioned for a single payer system...

[Rover]

Do you lialways bop in and unload your bombast without paying any attention to the ongoing thoughtful conversations among the regulars?


The Federal Government Employees Insurance Program (see joecct he knows much more than I do) has had a single-payor system for a long time. You get a premium budget and then you get to pick which insurance company to spend that budget on.

Paul Ryan also proposed a single-payor system for Medicare, in case you weren't paying attention: seniors would get a premium budget and a list of insurance companies, including existing Medicare if desired, to pick which one to spend that budget on.

We were having a related conversation last night at dinner. There were people from different states, and we were comparing cable television service. Universally, everyone noticed that, as soon as competition was introduced to an area, the incumbent's service magically became much better and their pricing increases magically slowed, just like that.

Single-payor plus multiple provider could work very well. You need the threat of taking your business elsewhere to keep a service provider honest. Once you allow a monopolist to have unrestrained pricing power, you inevitably get inferior service and higher costs. that's just how life is.

It's funny how you progressives rave about anti-trust legislation in all other areas while yearning to cede to the government monopoly power over our most precious asset. Makes no sense at all to a logical mind. I guess you are programmed so that your rampant cheerfleading exclusively for one side impairs your ability to think clearly outside of a partisan box??

Fishy, the next thoughful conversation that you're part of will be the first one. You seem butthurt over the fact that your party got humiliated and your ideology is going the way of the dinosaur. Neither of these are my fault, so kindly drop the anger.

The idea behind single payer, which I'm open to, is that as the government is technically a non-profit entity they can operate cheaper, and can achieve some economies of scale. Show me a proposal and I can get behind it. Ryan's plan was stupid, and has been thoroughly rejected by the American people. His block grant was fixed while healthcare costs will rise by some amount over time, thus reaming those people who coincidentally don't vote Republican while asking for no changes out of the people currently bankrupting the system. Willfully omitting key points like that destroys your credibility. Just ask Paul Ryan...

[DrDemento]

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

a question for our in resident medical specialists.

my doc tells me he gets (numbers are rough - I cant remember exactly) 80 cents on the dollar from Blue Cross, 45 from TriCare (military coverage) and 20 cents from medicare. do doctors screen their patients by what insurance coverage they have? do patients with better insurance get better, quicker service?

as an aside, wow, this system is really broken.

My office never asked anyone about insurance ever before an appointment was made. But that was years and years ago. We just did not care what coverage a patient had-we adapted to whatever situation the patient was in and if they truly had nothing-they paid nothing. One of the reasons i closed the office and just do consulting work was exactly what you indicate-coverage can determine care. I cannot abide by that. I did not go into medicine to be employed by an insurance company or the government. But from what I have seen-and remember, Jenny and I are patients also-every office asks as their first question what insurance do you have? We are not even asked what the problem is or is it emergent. Just how will you be covered for payment. I never thought I would ever say this-but I am glad we are no longer practicing in an office environment.

[DrDemento]

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

Which to a sensible person means you actually have a plan for how to integrate them, no?



yes, very much so, yet look at what happens when we try to introduce some incentives.

The carrot: our health insurance plan gives people $100 every six months if they go to they gym three times a week. that works pretty well.

the stick: people who engage in unhealthy habits should pay more. It's common practice for smokers to have higher rates than non-smokers, for example, yet try to have the obese pay a higher premium or lose weight and listen to the outrage! in CT the governor wanted to implement a plan by which people who work for the state actually take the prescription drugs for 4 common conditions or else pay more for their health coverage and it was a huge controversy. (the conditions were high cholesterol, high blood pressure, COPD, and diabetes). It's my understanding that all of these conditions are well-controlled with medication; physicians who presumably have on-going contact with their patients prescribe them, yet people resist taking them anyway? Why shouldn't they pay more when they don't?

FF: I normally agree with you for the most part. But on the point of forcing people to take medications or else they would pay more for coverage. If you force a patient to take a medication-for example Lipitor or another statin-and they get rhabomyolysis and are incapacitated or die from protein overload shutting down their kidneys (and trust me it does happen and we have seen it)-who gets sued and for how much and who pays? After all, perhaps the doctor felt it really wasn't indicated but had to give the medication because it was mandated by someone.

[FreshFish]

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

FF: I normally agree with you for the most part. But on the point of forcing people to take medications or else they would pay more for coverage. If you force a patient to take a medication-for example Lipitor or another statin-and they get rhabomyolysis and are incapacitated or die from protein overload shutting down their kidneys (and trust me it does happen and we have seen it)-who gets sued and for how much and who pays? After all, perhaps the doctor felt it really wasn't indicated but had to give the medication because it was mandated by someone.

I can certainly understand that on a case-by-case basis; the widespread antipathy however cannot all be chalked up to a few exceptions. Something else clearly was going on in this particular situation.

BTW, I'm not for "forced" anything. It would be easy enough to include a waiver if the doctor was closely monitoring the situation and had misgivings.

I do think unhealthy lifestyle choices should bear more consequences than they do. You want to be 5'10" and weigh 320#? okay, but don't ask all the rest of us to chip in for the extra costs your condition entails; bear those incremental costs yourself.

I am always annoyed at those news stories about people who become too big to fit through the door of their apartment and can no longer get out. They got in, didn't they?

[DrDemento]

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

I can certainly understand that on a case-by-case basis; the widespread antipathy however cannot all be chalked up to a few exceptions. Something else clearly was going on in this particular situation.

BTW, I'm not for "forced" anything. It would be easy enough to include a waiver if the doctor was closely monitoring the situation and had misgivings.

I do think unhealthy lifestyle choices should bear more consequences than they do. You want to be 5'10" and weigh 320#? okay, but don't ask all the rest of us to chip in for the extra costs your condition entails; bear those incremental costs yourself.

I am always annoyed at those news stories about people who become too big to fit through the door of their apartment and can no longer get out. They got in, didn't they?

As always we are pretty much agreed. But i love playing the other side. In my career i have seen quite a few very obese (morbidly so) people who do not get that way voluntarily. There a several metabolic syndromes (some inherited, some gene mutations, some not otherwise specified) that lead to some patients having to be weighed down at the meat packing company. Years ago we had one lady who was about 565 pounds and strictly adhered to a 1200 calorie diet. Where do these people fit in this schematic? Granted they are the distinct minority of obese people.

[DrDemento]

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

I do think unhealthy lifestyle choices should bear more consequences than they do. You want to be 5'10" and weigh 320#? okay, but don't ask all the rest of us to chip in for the extra costs your condition entails; bear those incremental costs yourself.

Just a thought-why should you and I (assuming you are a safe driver) be charged to subsidize all those other morons who are out there driving irresponsibly? Sure they get charged more-if they decide to pay for insurance, since many just drive anyway without it. But my auto insurance has gone up virtually every year as long as i can remember, even with older cars-and neither Jen or I have had an accident in over 30 years each of driving.

I fully agree with you-people who make poor or dangerous choices should pay a penalty for them. But how do we implement that system for healthcare effectively. how do we decide exactly what unhealthy decisions are? And who makes these decisions? Insurance companies? The US Government? Hard to draw lines in this-is eating one Big Mac bad for you? Two? 300 per year? I like the concept but i cannot wrap myself around how this could be accomplished easily.

[Rover]

Just a thought-why should you and I (assuming you are a safe driver) be charged to subsidize all those other morons who are out there driving irresponsibly? Sure they get charged more-if they decide to pay for insurance, since many just drive anyway without it. But my auto insurance has gone up virtually every year as long as i can remember, even with older cars-and neither Jen or I have had an accident in over 30 years each of driving.

I fully agree with you-people who make poor or dangerous choices should pay a penalty for them. But how do we implement that system for healthcare effectively. how do we decide exactly what unhealthy decisions are? And who makes these decisions? Insurance companies? The US Government? Hard to draw lines in this-is eating one Big Mac bad for you? Two? 300 per year? I like the concept but i cannot wrap myself around how this could be accomplished easily.

It can't be accomplished at all except for the low hanging fruit (smokers, for example or drug users). Offensive linemen in the NFL are obese by body mass standards but are in pretty good shape. You'd also never get away with charging old people extra.

The point of pooling resources seems to me to be that you take the good with the bad but hopefully it all evens out in the end. What I find is people want to set up a system that revolves around them while not realizing that isn't possible.

Besides, cracking down on fraud would possibly be a lot more lucrative to the long term health of the system.

[ScoobyDoo]

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

Just remember, if you're employed you can afford Health Care if they offer it. Otherwise forget it. And that's the perfect solution.

[DrDemento]

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

It can't be accomplished at all except for the low hanging fruit (smokers, for example or drug users). Offensive linemen in the NFL are obese by body mass standards but are in pretty good shape. You'd also never get away with charging old people extra.

The point of pooling resources seems to me to be that you take the good with the bad but hopefully it all evens out in the end. What I find is people want to set up a system that revolves around them while not realizing that isn't possible.

Besides, cracking down on fraud would possibly be a lot more lucrative to the long term health of the system.

Rover-I may have disagreed with some of what you have posted in the past-but you just hit a home run here. I agree totally. What we have here in the US is a population that cannot be compared to any other industrialized nation-what works in Japan or Sweden does not mean it can work here. Most important is that everyone has to realize that for every action there is a chain of reactions down the line. Some of the rules, laws, controls put into effect only create incredible problems later on.

[FreshFish]

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

Most important is that everyone has to realize that for every action there is a chain of reactions down the line. Some of the rules, laws, controls put into effect only create incredible problems later on.

Emphasis added!

[DrDemento]

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

Emphasis added!

Emphasis accepted. I have spent virtually my entire adult life in medicine-several fields and several aspects of it. I have come to the conclusion that where we now reached is intolerable, but where we are going is even more so. Hopefully there is an answer but as of now I just do not see it.

[ScoobyDoo]

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

Just remember. Dying solves your Health Care issues.

[goldy_331]

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

Just remember. Dying solves your Health Care issues.

You first.