The PPACA - Implementation Phase I

[SteveP]

Re: The PPACA - Implementation Phase I

Perspective? Perspective is every other westernized country had socialized medicine that works. We have socialized medicine for retirees that works. Yet You want me to accept that medically caused bankruptcies are okay because at least the person isn't dead? Fark that.

Having grown up and lived under Canada's socialized health care system for 41 years, I can tell you that it doesn't always work. And it wasn't/isn't free. Universal health care is funded by federal and provincial income taxes that took almost half of my pay cheques (going back to the Queen's English )

People are literally dying waiting for treatment. Don't believe me? Then take a look at this essay from 2007. And our friends and family back home (including our best friend who is a doctor) would tell you that nothing has changed since the author wrote it in 2007.

What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

[FreshFish]

Re: The PPACA - Implementation Phase I

FF: I've said it before and will just reiterate it here-if everyone had to make some sort of small copayment(not sure what that amount should be, but I would bet as little as $2 would do it) for every medical visit of any sort-doctor or hospital or ER-the result might surprise a whole bunch of folks. When people have to reach into their wallet and pull out something-it often makes them a bit hesitant. No insurance coverage for the small fee, no credit card accepted, just plain old cash. Your post about catastrophic medical coverage is spot on. That is pretty much what i and my wife have carried all along-you just have to sit down and figure out what deductible you can live with comfortably. We do it with car insurance, home owners insurance, disability insurance, flood insurance, etc-so why should it be such a far stretch to do it with health insurance? This should not be misconstrued as the answer to all our problems-but why would it not be of some help in taming the rapidly expanding medical costs in this country?

I guess that's the main difference between experience and opinion, Doc. Knowing what works because it's actually been done compared to speculation about what might work if only people are virtuous enough.

One addendum I'd make to your suggestion is that everyone always be shown the entire bill. Under our current plan, I go to the doctor for a routine check up, I get billed for a $10 co-pay, and that's the only bill I see. I have to go well out of my way to find out how much the doctor billed the insurance company for the same visit.

The doctor I had for the past 11 years retired at the end of last year, explicitly to avoid the PPPACA mandates. He was very sorry to be forced to leave private practice, as he truly enjoyed working with his patients. The replacement is unsatisfactory: he doesn't deal with people, he only deals with symptoms. You are just another case study or a set of statistics to him.

[FreshFish]

Re: The PPACA - Implementation Phase I

So these subsidized insurance plans, how many people are in for a rude awakening when their $200/month premium is actually more like $400/month and that it only becomes $200/month after you file your annual taxes? How many people are planning their monthly cash outlays/budgets for one number only to find out that they'll really need much more? See, when you sign the insurance contract, it specifically states that insured person owes the full premium, that the government money is more of an annual reimbursement/tax credit. 2014 and up through the 2015 tax filings should be an interesting and sad event.

You must spread some Reputation around before giving it to St. Clown again.

[LynahFan]

Re: The PPACA - Implementation Phase I

Having grown up and lived under Canada's socialized health care system for 41 years, I can tell you that it doesn't always work. And it wasn't/isn't free. Universal health care is funded by federal and provincial income taxes that took almost half of my pay cheques (going back to the Queen's English )

People are literally dying waiting for treatment. Don't believe me? Then take a look at this essay from 2007. And our friends and family back home (including our best friend who is a doctor) would tell you that nothing has changed since the author wrote it in 2007.

Very similar to my experience living in the UK for 3 years. Long delays for appointments is just another form of rationing, which is unavoidable in a resource-limited environment. The US's current (previous?) system simply rations by ability to pay or obtain health insurance. It's not entirely clear what will end up being the "rationing" factor under Obamacare (but there will be one, or more) - long delays will probably be a part of it, as fewer people choose to become doctors due to the decreased profitability and increased regulation.

[DrDemento]

Re: The PPACA - Implementation Phase I

I guess that's the main difference between experience and opinion, Doc. Knowing what works because it's actually been done compared to speculation about what might work if only people are virtuous enough.

One addendum I'd make to your suggestion is that everyone always be shown the entire bill. Under our current plan, I go to the doctor for a routine check up, I get billed for a $10 co-pay, and that's the only bill I see. I have to go well out of my way to find out how much the doctor billed the insurance company for the same visit.

The doctor I had for the past 11 years retired at the end of last year, explicitly to avoid the PPPACA mandates. He was very sorry to be forced to leave private practice, as he truly enjoyed working with his patients. The replacement is unsatisfactory: he doesn't deal with people, he only deals with symptoms. You are just another case study or a set of statistics to him.

Jen and i decided some years ago to do a similar thing. We closed the office and now I limit myself to consulting work only-virtually all of it pro bono. I loved practicing as a physician-but saw the handwriting on the wall. I am not, and will not be a provider. And i will not and never have taken orders from the government or any insurer or allow them to influence what was my best clinical judgement for my patients. It just became too frustrating.

[DrDemento]

Re: The PPACA - Implementation Phase I

Very similar to my experience living in the UK for 3 years. Long delays for appointments is just another form of rationing, which is unavoidable in a resource-limited environment. The US's current (previous?) system simply rations by ability to pay or obtain health insurance. It's not entirely clear what will end up being the "rationing" factor under Obamacare (but there will be one, or more) - long delays will probably be a part of it, as fewer people choose to become doctors due to the decreased profitability and increased regulation.

Correct-and the government's answer to the last part of your post will be to allow non qualified people to practice as if they were doctors and provide what they (the government) feels is what you need as care. Funny thing, when the government does this, is it not practicing medicine without a license?

[goldy_331]

Re: The PPACA - Implementation Phase I

Perspective? Perspective is every other westernized country had socialized medicine that works. We have socialized medicine for retirees that works. Yet You want me to accept that medically caused bankruptcies are okay because at least the person isn't dead? Fark that.

So much better to be solvent but dead? Like Canadians.

[unofan]

So much better to be solvent but dead? Like Canadians.

Cause no one in America has ever died due to lack of treatment caused by an inability to pay or an insurance company screwing them over.

[unofan]

Correct-and the government's answer to the last part of your post will be to allow non qualified people to practice as if they were doctors and provide what they (the government) feels is what you need as care. Funny thing, when the government does this, is it not practicing medicine without a license?

Maybe if the ama encouraged more medical schools rather than shoring up their monopoly, I'd be sympathetic. But since med schools, unlike law schools, are not money makers for colleges, the shortage is not lack of qualified people but lack of placement opportunities. I have no problem with nurse practitioners taking over more duties.

[FreshFish]

Re: The PPACA - Implementation Phase I

Here's a non-partisan, non-sectarian plan that would work for many people and not for everyone.

It seems to me that we would be far better off segmenting the delivery system so that we use what works best for each group, rather than force everyone into an inferior result that doesn't work at all for anyone.

Two basic concepts:

-- the risk premium that people pay is proportionate to their risk profile.
-- we pay attention to what already works well

So, for people with high-risk conditions, they are segregated into a high-risk pool and receive supplemental support from some other source, be it charity or government (I'd prefer the former over the latter but let's not get distracted over that detail for now).


The basic design of life insurance works very well. People are going to die someday, that's a given. The risk of dying increases as one gets older, with only a few exceptions. Therefore, a well-designed life insurance policy works as follows:
-- at the outset, the premium is higher than is needed to cover the pure risk. A relatively small portion of the premium covers the pure risk, the rest goes to "self-insurance" in the form of policy reserves.
-- the second year, only the difference between the insurance benefit and the cash value is the risk amount. In other words, the risk amount has gone down slightly. At the same time, the cost to insure the risk, per unit, has gone up. The difference between the risk premium and the total premium adds to the "self-insurance" in the form of higher policy reserves.
-- every year, the process repeats in a virtuous circle. The risk amount declines as the risk premium for unit of risk increases, the "self-insurance" in the form of policy cash values keeps growing, until eventually the policy is almost all cash value and very little pure risk. The premium has remained level and affordable throughout the entire life cycle of the policy.


For health insurance, you break the linkage between employment and coverage, and open up the marketplace to association-sponsored insurance, so that people can pool risk into categories, just like it works with life insurance: smokers pay more than non-smokers, etc.

You start with a relatively low deductible and the premium exceeds the pure risk profile so that the excess builds up in a cash reserve that you carry forward on a tax-deferred basis year after year. As the cash reserve ("self-insurance") builds up, you increase the deductible proportionately, so that the risk premium per unit of risk declines commensurately.

It's beyond the scope of a few paragraphs to outline all the technical details (for example, in a life insurance policy, the self-insurance portion is allocated by policy; in the group health program, the self-insurance portion is allocated proportionately across the covered group, since some people never submit claims while others submit claims more than once in their lifetimes). This plan might also break our reliance on Medicare to insure all people over 65; instead people would get an option (you also can program a life insurance policy to last a lifetime or to last for a limited number of years).



The main issue of PPACA was never about helping people, it is only about controlling people, making sure everyone behaves as Our Great Leader dictates. That should be obvious by now.

[LynahFan]

Re: The PPACA - Implementation Phase I

Cause no one in America has ever died due to lack of treatment caused by an inability to pay or an insurance company screwing them over.

Yep, I'm sure one has died under such circumstances. That totally justifies a massive. un-read, poorly thought out, more poorly implemented, partisan overhaul of the entire system

[unofan]

, partisan overhaul of the entire system

A plan based on a heritage foundation proposal in response to HillaryCare and first implemented by a republican governor is partisan alright. Just not the way you think.

[Tiggsy]

Re: The PPACA - Implementation Phase I

That did wonders for the millions of uninsured and the 3 out of 5 bankruptcies that occur due to Health Care. Try again.

So does that mean you think this, at this very moment, is better than had we done nothing? I'm not so sure you'll find a whole lot of agreement on that one.

[ScoobyDoo]

Re: The PPACA - Implementation Phase I

So does that mean you think this, at this very moment, is better than had we done nothing? I'm not so sure you'll find a whole lot of agreement on that one.

At this very moment nothings happened. Policies don't even end till Jan. 1.

And given that the kids till 26 and can't lose insurance for pre-existing is already in place I'd have to say yes, we are better off at this very moment.

[FreshFish]

Re: The PPACA - Implementation Phase I

From the Huffington Post:

The document, obtained by The Associated Press, shows that administration officials at the Centers for Medicare and Medicaid Services were concerned that a lack of testing posed a potentially "high" security risk for the HealthCare.gov website serving 36 states. It was granted a temporary security certificate so it could operate.

Security issues are a new concern for the troubled HealthCare.gov website. If they cannot be resolved, they could prove to be more serious than the long list of technical problems the administration is trying to address.