The PPACA Thread Part III - Let's have a healthy debate!

[William Blake]

Maybe the best solution is not a federal solution??

It's funny be because in Colorado, those opposed to tge Colorado Care amendment say "it shouldn't be a state solution, it should be done at the federal level"

I guess both just sound like excuses for not trying to fix anything.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The way the policies are currently constructed, you can't afford to have a major medical expense. Not with super high deductibles.

Stupid statement on several levels. If you have insurance, even with high deductibles, by law your maximum out of pocket expense is 10K. That's it. Now, 10K is a lot of money for a lot of people. I realize that. However, in the pre-ACA world, your medical costs could be UNLIMITED. That's how people were getting buried in bankruptcy due to medical bills.

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The way the old policies were constructed you wouldn't have medical insurance and it would bankrupt you financially.

For some reason in this country it's ok to charge 1000 dollars for a pill that costs 1 dollar to make while at the same time saying we can't reduce costs and cover everybody. The entire system is broken. The system was broken before. It's still broken.

And here's the beauty of it. There are a lot of powerful people making a lot of money off the broken system. And they are way more powerful than the average American who needs Health Care.

We have an ethics crisis in this country.

You keep bemoaning the $1000 hepatitis C pill, but have you looked at how that pill treatment cost in relation to the old method of treatment? Take some time, put in the small bit of effort, and you'll find that taking the course of pills is still far cheaper and easier than the old method of treatment. Politicians like to make hay on that cost of that pill while insurance companies and medical professionals are ecstatic that it exists.

[SJHovey]

Re: The PPACA Thread Part III - Let's have a healthy debate!

That is an awesome soundbyte...problem is it means nothing. People had the same issues under the old system (google the stats on bankruptcies due to health issues) so in reality it is just an empty platitude. That is all the Right has about this...a bunch of rhetoric but zero solutions. That is why their repeals go nowhere...

Again I dislike ObamaCare as much the next guy but I will still rip the GOP for their ridiculousness on this subject until they prove it is more than just hollow words said to make a few bucks. Problem is, almost every day that party gives people reason to believe they dont give two craps about them so why should anyone trust them on this issue? Add in that they have no idea what they want to do to make sure people have access to good rates and coverage (and dont you dare say Market Forces because that is what got us here in the first place...bad health care at high prices cause of Market Forces) and they look like fools.

This is not a Republican/Democrat issue. Obamacare is, because that's political. But fixing of healthcare issues is an issue between the public (which is disorganized and underfunded) and large, wealthy corporations in either the medical field or health insurance field. There have been opportunities for the Dems to fix this, most notably during the first two years of Bill Clinton's administration, and they failed miserably.

Here is the conundrum as I see it.

First, we got off on the wrong foot. The insurance model really only works if you are insuring unexpected, reasonably rare events, like car accidents or tornadoes or fires. It doesn't work well for something you might use tens or hundreds of days a year. That would be like buying insurance to cover you in case you need to buy food.

But, until someone invents the time machine, it's a very bad system in which we find ourselves. The problem of Obamacare is that it simply pours gasoline on a dumpster fire that already exists. Putting more money into the insurance model is not the way we should be going. Instead, we should be trying to wean ourselves from the insurance model.

The slow, painful way is to change it so the only insurance you buy covers things like major, unexpected medical events. Basically something like an extremely high deductible plan. People will pull back from some care they might otherwise have sought (every single sniffle), and the medical providers will have to start doing some serious pricing analysis. The problem is, that creates pain for insurers, health care providers and the public, and it would take a long time to correct things.

The better solution is to simply rip the band aid off and go to a single payer plan. However, doing so is impeded by at least three large roadblocks. First, there is the general public mistrust of a single payer plan, even though most find Medicare generally acceptable. To push the single payer plan past the public, we basically would just have to say, "ok, medicare starts when you are born (or at conception to gain even more political support) not when you hit your mid-60's." That might help us get past roadblock number 1.

More difficult is the medical community. We've built a medical industrial complex that is, in some instances at least, a for profit model. Going to the single payer plan is essentially nationalizing our healthcare providers. People who you willingly allow to stick a camera up your anus are extremely effective lobbyists, and I don't think they want to be government employees.

The final hurdle is probably the most difficult. To go to a single payer plan is to effectively kill a huge industry. I have no idea how many people are employed in the health insurance industry, and related businesses, but to tell them that they're just going to have to go out and start trying to sell universal life policies or something instead isn't going to happen without an extremely bloody fight. I don't think the country wins that fight. We saw that in '92.

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

You keep bemoaning the $1000 hepatitis C pill, but have you looked at how that pill treatment cost in relation to the old method of treatment? Take some time, put in the small bit of effort, and you'll find that taking the course of pills is still far cheaper and easier than the old method of treatment. Politicians like to make hay on that cost of that pill while insurance companies and medical professionals are ecstatic that it exists.

It's systemic. Look at epi-pen for example then. Costs usually go down over time. The cost of that is going up. Value based pricing for Health Care is ethically and morally wrong.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Two things:

1) I see no good reason to ditch employer based insurance. That's where most adults get their coverage. Not a perfect system but what is?

2) Regarding implementation of single payer you can do a couple of things fairly easily. Expanded Medicaid for starters to the remaining hold out states is an easy one. Next you could have a buy in for both people approaching Medicare age (say the 55 and older crowd) as well as Medicaid for people just over the poverty line, or as an option for people not happy with their ACA exchange options. However, what doesn't change is everybody must have insurance or pay a penalty. Also insurance for only catastrophic events is stupid. Putting off routine care means higher expenses down the road.

[unofan]

Maybe the best solution is not a federal solution??

Because poor people in red states don't deserve to be cared for by virtue of being born in a bad place?

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It's systemic. Look at epi-pen for example then. Costs usually go down over time. The cost of that is going up. Value based pricing for Health Care is ethically and morally wrong.

The epi-pen situation is entirely separate, in no way analogous. The Hep-C pill (Daklinza) can't follow the same pricing model as the Epi-pen at all as the Hep-C pill price has eith. The Hep-C pill is a limited course, a 12-week treatment of taking one pill per day to eradicate the illness from your body, effective in 89% of patients in one test study and up to 100% in another (limited to certain genotypes). That makes for an $84,000 total treatment cost. The Epi-pen is to treat a reoccurring chronic issue that will only treat the symptom as there is no cure. The Epi-pen makers have a market for life and are digging their own corporate graves for when the patent expires or someone releases a similar medication delivery system and undercuts the Epi-pen.

FYI, the old Hep-C treatments that were replaced by Daklinza were six-figures in total cost. The pill is cheaper.

[SJHovey]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Two things:

1) I see no good reason to ditch employer based insurance. That's where most adults get their coverage. Not a perfect system but what is?

2) Regarding implementation of single payer you can do a couple of things fairly easily. Expanded Medicaid for starters to the remaining hold out states is an easy one. Next you could have a buy in for both people approaching Medicare age (say the 55 and older crowd) as well as Medicaid for people just over the poverty line, or as an option for people not happy with their ACA exchange options. However, what doesn't change is everybody must have insurance or pay a penalty. Also insurance for only catastrophic events is stupid. Putting off routine care means higher expenses down the road.

No. What is stupid is the system you endorse.

A needs to buy services from B.

A works for C, who in partial exchange pays money to D, who then pays money to E to help manage the A/B relationship, while at the same time A and C pay money to Government Agency (GA), and then some combination of D/E/GA pay B for A's services.

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The epi-pen situation is entirely separate, in no way analogous. The Hep-C pill (Daklinza) can't follow the same pricing model as the Epi-pen at all as the Hep-C pill price has eith. The Hep-C pill is a limited course, a 12-week treatment of taking one pill per day to eradicate the illness from your body, effective in 89% of patients in one test study and up to 100% in another (limited to certain genotypes). That makes for an $84,000 total treatment cost. The Epi-pen is to treat a reoccurring chronic issue that will only treat the symptom as there is no cure. The Epi-pen makers have a market for life and are digging their own corporate graves for when the patent expires or someone releases a similar medication delivery system and undercuts the Epi-pen.

FYI, the old Hep-C treatments that were replaced by Daklinza were six-figures in total cost. The pill is cheaper.

That's fantastic news on the HEP-C treatment. It's still wrong to charge one thousand dollars for a 1 dollar pill. However, admittedly I don't know what the research costs were and what the recoup rate is at the thousand dollar price tag.

Either way I posted an article a while ago on how Epi-Pen (Mylan) and other Medical device and pharma companies are applying value based pricing to their products. That's ethically and morally wrong and it will bankrupt them and us.

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

That's fantastic news on the HEP-C treatment. It's still wrong to charge one thousand dollars for a 1 dollar pill. However, admittedly I don't know what the research costs were and what the recoup rate is at the thousand dollar price tag.

Either way I posted an article a while ago on how Epi-Pen (Mylan) and other Medical device and pharma companies are applying value based pricing to their products. That's ethically and morally wrong and it will bankrupt them and us.

It's the old line, "The next pill costs $1 to make. The first pill cost $400,000,000 to make." Also, how many people do you know who've had Hep-C? The market size for that cure is far more limited than most drugs we see in our day-to-day lives. It's going to take a long time for Bristol Meyers Squibb to recoup their R&D costs on Daklinza.

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It's the old line, "The next pill costs $1 to make. The first pill cost $400,000,000 to make." Also, how many people do you know who've had Hep-C? The market size for that cure is far more limited than most drugs we see in our day-to-day lives. It's going to take a long time for Bristol Meyers Squibb to recoup their R&D costs on Daklinza.

Then you would be correct that it's a horrible example and the thousand dollars is justified. However, just imagine how easy that would have been to explain without the Skirelli and Epi-Pen examples?

And thus there's the problem. And thus there's the failure of insurance companies, and government.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

No. What is stupid is the system you endorse.

A needs to buy services from B.

A works for C, who in partial exchange pays money to D, who then pays money to E to help manage the A/B relationship, while at the same time A and C pay money to Government Agency (GA), and then some combination of D/E/GA pay B for A's services.

Your explanation is nonsense.

[Jimjamesak]

Two things:

1) I see no good reason to ditch employer based insurance. That's where most adults get their coverage. Not a perfect system but what is?

No. No. It's a terrible system for those us in the actual working class. When you have to depend upon your employer for something so basic and necessary, your employer has you by the balls. Even for unionized workers the biggest fight at CBA time is health care. Even my employer doesn't do health care anymore, they shifted it all to the union.

It's even worse for most working class people because there's very few options for jobs so employers have all the leverage. Costs going up? Time to double the rates! And that's even if your employer offers it in the first place. Most places just bump your pay slightly and tell you to hit the marketplace.

[ScoobyDoo]

No. No. It's a terrible system for those us in the actual working class. When you have to depend upon your employer for something so basic and necessary, your employer has you by the balls. Even for unionized workers the biggest fight at CBA time is health care. Even my employer doesn't do health care anymore, they shifted it all to the union.

It's even worse for most working class people because there's very few options for jobs so employers have all the leverage. Costs going up? Time to double the rates! And that's even if your employer offers it in the first place. Most places just bump your pay slightly and tell you to hit the marketplace.

Correct. Consumer/worker has zero power in relationship.