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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

I recommend Bernard Bailyn's "Ideological Origins of the American Revolution"
Ironic that you should mention this book, I actually took that course from Bailyn himself, back in the day. A very good teacher; he seemed truly concerned that his students learn to marshall evidence, sift it and weigh it, review it analytically. He truly seemed more interested that you present a cogent analysis than whether you agreed with him or not.


when you're not being copy-paste polemical you're one of the more interesting political posters on the board.

It may be worth repeating that I rarely copy - paste anything with which I already agree; either
> I've noticed other posters discussing a subject, and I copy something that might be germane to them
"You folks were talking about this topic recently, and I read this and thought you might find it interesting"​
> I have mixed feelings about the subject matter
"I read this recently and I'm not quite sure what to think...how do you folks see it?"​
> I find myself annoyed at two or three people (rarely you) and I feel spiteful
"You think your such a smart&ss, don't you, well nyah nyah nyah"


I think I will do a lot less of the last one, it's not very considerate of everyone else who isn't directly involved....also I think of an old saying, "never try to teach porcines to sing, it frustrates you and annoys them."
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Ironic that you should mention this book, I actually took that course from Bailyn himself, back in the day. A very good teacher; he seemed truly concerned that his students learn to marshall evidence, sift it and weigh it, review it analytically. He truly seemed more interested that you present a cogent analysis than whether you agreed with him or not.
I took con law from Mary Beth Norton who was a Bailyn protege, and almost had a mother-in-law (that was close!) who was another Bailyn protege. Their synopsis of BB was "many academics spend their entire careers rewriting the same book, but if you're going to do that it may as well be a great book!" :)
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

BTW, did anybody else know there is an alternative Ant and Grasshopper Greek fable where the ant is the bad guy? I sure didn't -- very interesting.
um, yes, it seemed to me that this tension always was latent in the story as I'd heard it told, the fable always was interpreted to me that both parties needed to adjust, not only one.

As soon as I saw the reference, my mind immediately thought of the Walt Disney cartoon. I was so impressed with that the very first time I saw it, it was a revelation, a blinding piece of brilliant insight that helped shape all of my subsequent moral thinking. That influence is apparent in my discussions here, about reciprocity and how everyone should contribute something. It was a very nice touch in the Disney cartoon, I thought, for the ant to remind the grasshopper that it actually did have something useful to contribute after all, when the grasshopper had forlornly started to turn away, before being called back by the ant!

I am quite impressed that the collective authorship of that wiki entry devoted so much space in the article to it. It is well deserved. I highly recommend people view it if / when they have a chance!
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Just keep in mind that for a lot of people, 5 grand is about 3 months income. If 5 grand is 3 months income, there's not a snowball's chance in hell of saving it.

This and the 5 grand isn't the key item anyway. You need the 5 grand and insurance. If you can afford to save that much and have all the coverage you need then you're probably in a good spot.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

You could keep tacking stuff onto your story, and it'd be like the cartoon where the two enemies repeatedly pull out bigger and bigger guns to top each other. Sure, 5 grand may not be enough in this day and age (might be up to at least 10 grand), but I would think it'd be up to the person to decide the safety net they need, do what they need to achieve it, and accept the resulting consequences (whether good or bad). Savings techniques need to be brought back at a young age (for example, do you REALLY need to go to that $10 viewing of Harry Potter with your buddies). It's like the old Aesop fable about the grasshopper and the ant.
I think the point is (and I obviously did something wrong that you missed it) that people who do save and have good habits still land in big trouble that affects their long term ability to stay afloat despite their good habits. Accepting the consequence isn't in a vacuum. All of us suffer when those bills go unpaid. It affects the person's household, our insurance rates, the hospital's solvency, etc.

I do not disagree that there are some people who think they don't have $ but won't give up the latte or the manicure. They make me wild- esp if they are on public insurance and have more gold around their neck than I do in my house and are driving an incredible car. This does not discount the people who have very good habits and still can't make it.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

This and the 5 grand isn't the key item anyway. You need the 5 grand and insurance. If you can afford to save that much and have all the coverage you need then you're probably in a good spot.
Man wins the prize.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

I woke up thinking about this comment this morning. This sounds OK but take a reasonable scenario and see how it wouldn't be enough.

Meet Mr. X, a 30 yr old man who has squirreled away about 7K. He works hard at his job as a delivery man as well as a second job on the side doing some carpentry. The second job allows him to put aside $ for a rainy day. He has insurance with a 5K deductible because he is a healthy guy with no problems. He walks out onto the back steps one AM, slips on a patch of ice, and goes down a flight of stairs wrong way up. On the way down he badly fractures his right ankle and when he grips the bannister to stop his fall, wrecks his right shoulder and lacerates his forehead as he strikes his head and briefly loses conciousness. He badly enough hurt that he needs to ride in an ambulance. Lucky for him he just needs the ride and not much more attention (250$ (this is probably 2ce that))

ER visit- CT of head (1000$), xrays of neck, spine, ankle, shoulder and upper arm (1000$ to be minimist), Dr eval- (250+), Pain meds (another 200). They determine he has a concussion but no bleed, needs surgery on ankle with the placement of a plate and a few screws and has a minimal rotator cuff tear. He gets stitches in his head (100). He needs to stay in the hospital overnight waiting for the OR and a surgeon for his ankle (300 for the room and board, 7K for the surgery if we are being really nice/no complications. Oops there goes his nest egg but Yeay for him, he has met his deductible and only has a 250$ for copay and his coverage requires him to pay the first 1K for hospitalization). He gets discharged home in a cast after another day (300 + another 200 charged for various meds and IVs) with crutches, a wheelchair because he can't crutch too well with a bum shoulder (500$ this is not covered, excluded in his insurance). He can't work. He can't drive until after he is cleared by ortho in about 4-6 weeks if he heals amazingly well. He can't do his carpentry because altho he can get someone to drive him and his shoulder doesn't need surgery he has enough pain he can't use his arm consistanty. He didn't think he needed disability insurance because he was healthy. His job gives him 3 weeks of earned time for sick and vacation. He needs PT for both the ankle and shoulder 3 times a week for about 4 weeks because he has both ankle and shoulder issues (200/visit but his insurance only has a 50$ copay X 12). He will probably need PT after he returns to work once a week for a few weeks (50 X2) He needs to see the ortho for post op f/U (200 but only a 50$ copay) and again in 4 weeks (another 200 but he has a 50$ copay). He sees the primary care for removal of the stitches in his head (30$ copay). He needs a cast change in the middle of that (100 but only a copay of 50). He also has HA from the concussion that is persisting after 2 weeks so sees primary for that (30).

Meanwhile he is now out of work for 6 weeks because of his dual injry to shoulder and ankle. He has no income for 3 wks of it. This guy is probably not going to be able to tolerate 2 jobs for about 5-6 months, even if he is Superman, without ending up out again. If he is lucky he won't have lost his job but will probably lost some of his carpenty customer base. He will have residual pain and some loss of function no matter how good the outcome.

This is a best case scenario- the guy has no co-morbidities, doesn't end up needing shoulder surgery (which they would wait to do until he was mobile and would take 6 more weeks of out of work, PT, etc), his post concussive sx go away and he has a nice recovery from his surgery. He has no sick or vacation time left so he better not get sick or have any complications from the injuries because he can't take further time off and get paid.

Work out the math (I hate math so you can do it). This isn't an actual case but a composite of things I have seen with none of the complications that usually show up because they have dog's luck. I have probably underestimated most of the costs.

If the guy is uninsured the $ are even scarier. Go ahead and attach his pay. How much do you want of it % wise? How long do you think it will take for it to be paid off? How long is it going to take to build up a contingency fund of 5K for him, if he can?

This is a trauma, not a sudden dx of a chronic illness such as diabetes. If it was a chronic illness it require an equal amt or more of $ for testing/hospitalization but then require chronic expenditure for meds, follow up, testing etc. Most likely, despite absolute compliance on the patient's part sequelae occur which will increase the cost as more meds/treatment/testing occur. If it was your kid, not you, you would need to take time out from work to do all of that.

Think about it.

For the last 10 years or so prior to my retirement, I was responsible for payroll and benefits for about 1000 employees. Near the end of my career, I had an employee come to my office expressing a need to change her health care provider since her husband had blown through his $2,000,000 limit for health care! I couldn't fathom reaching that max, but she explained how it happened. He was very ill with cancer, and needed doses of a blood product every 2 hours for about 3 days. Cost per dose? $30,000. That's only $360,000 per day. And that's just for that particular course of treatment. It had nothing to do with the rest of his intensive care. It just brought it all home to me that no matter how prudent you are about saving for a rainy day, when you get those 40 day/40 night rains, none of us can handle it. Very, very few people have an ark.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Wait, I got it: Planking.

People are supposedly still doing it. I saw one guy planking across the carry-on shelves in an airplane.
Mother of God. I hope I never actually see anyone planking. I know that I will do something I will regret.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Wait, I got it: Planking.

People are supposedly still doing it. I saw one guy planking across the carry-on shelves in an airplane.
If you saw that in person, you should have asked the air marshal to shoot him. Everyone would have understood.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

A very interesting health-care cost benefit study regarding higher US expenditures relative to peer countries, and what the US gained in return for its extra spending. I'll try to edit out the editorial commentary along the way....


A persistent health-care myth is that the U.S. system is uniquely wasteful versus the European countries that spend far less per patient as a result of tight government control. ... new research shows American patients are often getting more value—better outcomes and longer lives—in return for those extra dollars.

... the news arrives via the policy journal Health Affairs, in a symposium on the cost and quality of U.S. cancer care.

Tomas Philipson of the University of Chicago and colleagues compare U.S. oncology spending over the period from 1983 to 1999 (the last year for which data are available) with that in 10 European Union countries. Costs were lower overall overseas and grew by 16%, while they grew by 49% in the U.S. Yet U.S. cancer mortality rates are lower, despite higher cancer rates, and "We found that the value of survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed 'worth it,'" Mr. Philipson et al. write.

Throughout the entire period, U.S. cancer survival gains were larger, reaching 11.1 years over 1995 to 1999 against 9.3 years in the EU. The researchers then compared the U.S. and EU gains using conservative, commonly accepted measures for the value of a statistical life, less the cost of the care. The U.S. comes out ahead by $598 billion. In other words, though the U.S. spends more, patients and society benefit far more.

Over 1995-1999, each $100 increase in per capita cancer spending—approximately $20,000 per cancer patient—was associated with another 2.3 years of life for the average patient. The authors are also careful to show that these results reflect real patient outcomes.

....

The U.S. system is relatively more expensive because diagnosis and treatment are much more intensive, and doctors tend to leverage the latest therapies and drugs against one of the world's leading killers.

Since people here think they know what kind of comments I'd now append*, I'll refrain and let the facts speak for themselves.





though they are wrong 2 times out of 5
 
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Re: The Sad Case of the Patient Protection and Affordable Care Act

The question that came to my mind instantly- the pool of patients getting care in the US is skewed by who can get care. We may spend more but there are plenty of people who do not get any of that. Some of our people get poor/ minimal care or come so late care is palliative and they die. Others get a top of the line care and therefore have a better outcome. Countries who have national systems offer care to everyone. Wondering if there is a way to look at how that effects numbers.
 
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