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The Sad Case of the Patient Protection and Affordable Care Act

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

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases. Then the hard luck cases have no insurance. Then we all get burdened with higher medical costs after we treat the hard luck cases. Then the insurance rates go up. And the circle continues.

So, you have two choices.

1. Start denying care. (private method)
2. Eliminate the need for medical insurance. (public method)

Take your pick.
#2 only works if you assume that the profits that health care insurers are making are sufficient to cover all of those "hard luck" cases out there - i.e. take away their profits and use those to pay the premiums for people currently without insurance. I don't know the numbers, but I suspect that math doesn't add up - simply going to "non profit insurance" (i.e. the public method) won't do the trick, either - rationing will still be part of the answer.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

#2 only works if you assume that the profits that health care insurers are making are sufficient to cover all of those "hard luck" cases out there - i.e. take away their profits and use those to pay the premiums for people currently without insurance. I don't know the numbers, but I suspect that math doesn't add up - simply going to "non profit insurance" (i.e. the public method) won't do the trick, either - rationing will still be part of the answer.

The bonuses that the medical insurance CEO's get can pay for a lot of Health Care. We'd be closer. Personally I'd go with the "deny" method anyway. It's time for folks to really start understand what is going on and that's the only way. Course it won't happen until the Baby Boomers are all dead and we're bankrupt and then no one will really notice anyway.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases. Then the hard luck cases have no insurance. Then we all get burdened with higher medical costs after we treat the hard luck cases. Then the insurance rates go up. And the circle continues.

So, you have two choices.

1. Start denying care. (private method)
2. Eliminate the need for medical insurance. (public method)

Take your pick.

Some statistics for you to gnaw on:

Annual cost of uninsured patients, nationwide: $49 billion.
Annual cost of Medicare/caid underpayments to providers, nationwide: $88 billion.
Annual cost of malpractice insurance and unnecessary defensive medicine, nationwide: $250-$325 billion.

Clearly, uninsured patients aren't the biggest problem facing our health care system. Fix even 20% of the latter two issues and paying for uninsured patients is no longer a fiscal issue, especially if a sliding/ability-to-pay scale were enacted for uninsured patients. I'm sure the medical industry would make this trade-off. It's a no-brainer.

Sure. Private Sector does everything better. Time to farm out the military.

Military and defense: Constitutional duty of the federal government. Managing retirement funds: Not a Constitutional duty of the federal government.

Instead, why don't we unionize the military like all of the other government employees?
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Some statistics for you to gnaw on:

Annual cost of uninsured patients, nationwide: $49 billion.
Annual cost of Medicare/caid underpayments to providers, nationwide: $88 billion.
Annual cost of malpractice insurance and unnecessary defensive medicine, nationwide: $250-$325 billion.

Clearly, uninsured patients aren't the biggest problem facing our health care system. Fix even 20% of the latter two issues and paying for uninsured patients is no longer a fiscal issue, especially if a sliding/ability-to-pay scale were enacted for uninsured patients. I'm sure the medical industry would make this trade-off. It's a no-brainer.



Military and defense: Constitutional duty of the federal government. Managing retirement funds: Not a Constitutional duty of the federal government.

Instead, why don't we unionize the military like all of the other government employees?

Not familiar with the Great Depression are we? I suppose all those folks who suffered through that were at fault themselves for their plight?

If the Private Sector can do Health Care so great then why aren't they doing it?
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

For the insurance company to survive they need to make a profit. To make a profit they need to dump the hard luck cases.

Not necessarily (for one thing that is illegal in most states! the actual process is more nuanced and subtle).

For insurance companies to make a profit they need to set premiums so that they roughly equal claims.* As long as potential claims can be factored into their pricing, they do not "need to" and quite often do NOT "dump" people.

For life insurance, for example, if you are issued a preferred policy and then develop cancer several years later, they cannot change your rates. The life insurance companies know that some people will get sick over time and build that into their pricing upfront.

The same is generally true of health insurance (but only to a point): you could buy an individual policy and if you later got sick they could not cancel only your policy, nor single you out individually for a rate increase. Rates only can be increased for the entire "class" of insureds. As far as I know that is the law in all 57 states.

The crux of the problem is this goofy system we have where most health insurance coverage is related to employment. Now, you are okay only as long as you work for someone else (if you change employers, the insurance company there knows it has to enroll all new hires regardless of pre-existing conditions, and so that situation also is baked into their rates). Individual insurance has become so expensive partly because so many people are outside the employer-provided coverage network (state mandates that require everyone to purchase bells and whistles when they only want a stripped-down catastrophe only policy don't help either; there are multiple causes for this problem).

If we eliminated all employer-provided coverage and had "open enrollment" windows periodically in which health insurance companies would take (nearly all) comers (with special risk pools and supplemental assistance for people with certain specified chronic conditions), and they were allowed to offer stripped-down catastrophe only coverage among a broader array of options, and were allowed to set rates based on risk, then there would be no "need" to jettison people from coverage any more.







* Premiums + interest income >= claims + expenses. The Federal Reserve is making things harder on them than most people realize.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

What's funny to me is how the private sector is Plante's solution to everything yet NONE of all the regulations, malpractice, lawsuits, and labor unions would exist today if it were not for the private sector.

The Private Sector caused the collapse of '08 and the Great Depression. When those things happened it was the government that had to come and clean up the mess. But the answer is still to this day "get the government out of the way and everything will be fine.".

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

What's funny to me is how the private sector is Plante's solution to everything yet NONE of all the regulations, malpractice, lawsuits, and labor unions would exist today if it were not for the private sector.

What would exist today if it were not for the private sector? Can you have "government" without anything to "govern"?
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

What would exist today if it were not for the private sector? Can you have "government" without anything to "govern"?

Not my point. If the Private Sector was so wonderful and did things the way they were supposed to there would be no reason to have malpractice insurance, or labor unions, or Lawsuits, or financial regulations.

The private sector runs on greed and profit. Left unfettered it will devour everything in its path and leave nothing but a barren wasteland in its wake.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Not my point. If the Private Sector was so wonderful and did things the way they were supposed to there would be no reason to have malpractice insurance, or labor unions, or Lawsuits, or financial regulations.

The private sector runs on greed and profit. Left unfettered it will devour everything in its path and leave North Dakota in its wake.

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

Don't forget that the legislation puts caps on insurance rate hikes while forcing insurers to accept pre-existing conditions and cover certain procedures without exception.

Try to do the job of an insurance actuary with these stipulations. It is virtually impossible. Thus my belief that this bill is specifically intended to bring about single payer or universal health care. There are already numerous companies pulling out of the individual insurance marketplace.

The bonuses that the medical insurance CEO's get can pay for a lot of Health Care. We'd be closer. Personally I'd go with the "deny" method anyway. It's time for folks to really start understand what is going on and that's the only way. Course it won't happen until the Baby Boomers are all dead and we're bankrupt and then no one will really notice anyway.
This. There is no motivation to change anything for those who are raking in big dough. This whole thing is a business. As long as it is for profit- and it is, otherwise the CEOs wouldn't be making more than the gross product of several small countries- there is nothing to motivate change.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

This. There is no motivation to change anything for those who are raking in big dough. This whole thing is a business. As long as it is for profit- and it is, otherwise the CEOs wouldn't be making more than the gross product of several small countries- there is nothing to motivate change.
I'm not sure if there's a formal name for this fallacy, but there should be. Just because two numbers (health care spending and CEO pay) are both huge does not mean that they are basically the same.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

I'm not sure if there's a formal name for this fallacy, but there should be. Just because two numbers (health care spending and CEO pay) are both huge does not mean that they are basically the same.
Not the same but it is obscene the amount of money they make while claiming they need to raise premiums and they are reimbursing us less and less. I would feel better it they weren't motivated by numbers to increase their bonus or that they get one when they claim they need to pay us less/charge more.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

I'd prefer collaboration between government and business (if it makes sense) as opposed to another inefficient government program.

Yikes!

For all the kvetching about socialism and the like, crony capitalism is just as big, and likely more, of an issue these days. Collaboration between government and business is just about the last thing we want.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Yikes!

For all the kvetching about socialism and the like, crony capitalism is just as big, and likely more, of an issue these days. Collaboration between government and business is just about the last thing we want.

Not only that but Obamacare is exactly that, collaboration between government and business.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Some statistics for you to gnaw on:

Annual cost of uninsured patients, nationwide: $49 billion.
Annual cost of Medicare/caid underpayments to providers, nationwide: $88 billion.
Annual cost of malpractice insurance and unnecessary defensive medicine, nationwide: $250-$325 billion.

Wow, something I've been saying is the biggest problem: malpractice insurance. Heck, that could cut a whole lot on prices!
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Some statistics for you to gnaw on:

Annual cost of uninsured patients, nationwide: $49 billion.
Annual cost of Medicare/caid underpayments to providers, nationwide: $88 billion.
Annual cost of malpractice insurance and unnecessary defensive medicine, nationwide: $250-$325 billion.

Source, please.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Source, please.

Speaking of sources, I see that the CBO has released an updated estimate for PPACA costs, effectively doubling their original estimate. From today's Wall Street Journal:

Last week, the Congressional Budget Office released new budget projections for it [PPACA] over the next 10 years. In March 2010, the CBO estimated the gross cost at $940 billion for 10 years. Now it forecasts the cost to be $1.76 trillion, nearly double. For the eight years (2012 through 2019) included in both estimates, the CBO now says costs will run $90 billion more than originally forecast. The law's coverage provisions (such as premium subsidies and Medicaid outlays), which cost $66 billion in 2014 when implemented, will cost $265 billion in 2022, according to the CBO and the Joint Committee on Taxation.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Speaking of sources, I see that the CBO has released an updated estimate for PPACA costs, effectively doubling their original estimate. From today's Wall Street Journal:

You wouldn't be trying to get away with only half an explanation, would you? Because the full CBO analysis shows a decrease in cost.

From Reuters last week:

Congressional Budget Office cuts cost estimate for PPACA
By David Lawder
March 15, 2012
Print E-mail Reprints Share |


WASHINGTON | Tue., Mar. 13, 2012 11:40pm EDT (Reuters) - The estimated net costs of expanding health care coverage under President Barack Obama's landmark restructuring have been reduced by $48 billion through 2021, though fewer people would be covered under private insurance plans, a new analysis from the nonpartisan Congressional Budget Office showed this week.

The CBO also revised its overall federal budget deficit estimates to show a $92 billion increase in the projected fiscal gap for 2012, confirming a fourth straight year of $1 trillion-plus deficits.

The CBO revisions gave ammunition to both Democrats, who largely support Obama's controversial 2010 health care law, and to Republicans, who staunchly oppose it. The law will take center stage later this month when the U.S. Supreme Court hears oral arguments in a challenge of its constitutionality.

By reducing the estimated net 2012-2021 costs to $1.083 trillion from $1.131 trillion a year ago, the CBO report could help Democrats blunt some of the criticism over the high costs of extending coverage to some 47 million uninsured Americans, as they try to tout savings elsewhere in the law.

These cost reductions are largely due to lower estimates for subsidies and tax credits associated with the law's planned insurance exchanges for individual coverage.

They also include higher revenues from penalties and the tax effects of higher taxable income, as private employers drop health insurance plans in favor of extra compensation for employees to buy insurance via the exchanges.

But the analysis also projected that some 4 million fewer people will obtain insurance through employers or through the insurance exchanges promoted by the health care law by 2016 than estimated a year ago.

Many of those people will need to be covered by government-run Medicaid program for the poor, causing higher Medicaid costs to eat into savings elsewhere.

The CBO also added another year to its overall cost estimate for the insurance provisions, extending it out to 2022, for an 11-year net cost of $1.252 billion.

Before the revenue and tax effects, the gross cost for that period hits a new high: $1.762 trillion, and Republicans wasted little time in pouncing on it and the lower coverage estimate.

"The fact that the outlook for the new law continues to worsen so rapidly, even before it's implemented, is ominous," said Senator Jeff Sessions, the top Republican on the Senate Budget Committee.

Many of the health care law's coverage provisions do not go into effect until 2014.

(Reporting By David Lawder; Editing by Will Dunham and Paul Simao)

© 2011 Thomson Reuters. Click for Restrictions.

---------------------------------------------------------------------------------------------------------------------

Ahhh knuckledraggers. Don't you realize everybody has access to google? Like shootin' freshfish in a barrel.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

I'm not sure if there's a formal name for this fallacy, but there should be. Just because two numbers (health care spending and CEO pay) are both huge does not mean that they are basically the same.

False analogy would probably be the closest one.

That said her premise isnt necessarily wrong...if you cut out the need for profit and raking in fast stacks, or just eliminate the bonus structure as it is, that would help the issue. It wouldnt solve it, but it would help.

Anyone shocked Plante didnt cite his source. It is hard to use MLA when the source is the voices in your head ;)

This issue is screwed either way. If we go government controlled there are numerous issues already listed and if we stay private sector then greed prevails. At this point though I dont trust the private sector to tie its own shoes let alone deal with health care. When left to their own devices people (and the other people known as corporations) will screw over everyone else if it means a few more shekels in their pocket.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

...if you cut out the need for profit...
then you need some other source of accountability for results, and some other source of incentive to improve outcomes. It is a very difficult question.

The best I've heard is "value for value created." The problem with CEO bonuses is not the bonuses itself, but the incentives toward which they drive CEO behavior. Everyone responds to incentives, that is what generally (with notable exceptions) makes the free market so incredibly effective at spurring innovation. The PPACA is all "stick" no "carrot" so to speak, and that merely breeds resentment and avoidance and passive aggressive behavior.

Even Karl Marx said that capitalism is the most efficient economic system ever devised. His critique was that "efficiency" should not be the top priority of a humane society.





(full disclosure: I am a great admirer of Marx' work; "Marxists" have as much to do with Marx as the Crusades or the Inquisition had to do with the teachings of Jesus Christ: zealots reinterpreting what was there to suit their own needs while ignoring the essence of the actual message.

According to Marx, a "communist government" is an oxymoron: there is no formal "government" under "communism" because everyone is so mature, internal self-governance is sufficient. Woefully naive, to be sure, but the "dictatorship of the proletariat" was supposed to be a temporary transitional period followed by the "withering away of the state" and NOT a permanent state of affairs).
 
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