The Sad Case of the Patient Protection and Affordable Care Act

[pirate]

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

Nobody is saying that states can't do this either. If it works so well in Mass. then you'd see plenty of other states mirror it in the future.

BTW, whats the waiting time to see a doc in Mass?

Before I'd conclude anything I would also ask if MA was at the national average before the change, if the companies involved are just MA companies or if they are balancing costs across their entire footprint, what political affiliations this organization has, define what cost efficient treatment centers means, adjust satisfaction ratios for the incremental people who went from nothing to something on somebody else's dime, if they are really attributing a 36 percent reduction in cervical cancer to a 6 year old change in medical insurance availability that appears to have increased insurance availability by 173k people, for that matter what is the definition of more?. I'd also like to know what percent of all people in the state are covered by this program, how many have/were households covered by other plans before the change and how they adjusted for people switching in and out of this plan when compiling statistics.

Regardless of your political bent, this type of document would need a lot of vetting before I'd conclude anything.

 

[leswp1]

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

Before I'd conclude anything I would also ask if MA was at the national average before the change, if the companies involved are just MA companies or if they are balancing costs across their entire footprint, what political affiliations this organization has, define what cost efficient treatment centers means, adjust satisfaction ratios for the incremental people who went from nothing to something on somebody else's dime, if they are really attributing a 36 percent reduction in cervical cancer to a 6 year old change in medical insurance availability that appears to have increased insurance availability by 173k people, for that matter what is the definition of more?. I'd also like to know what percent of all people in the state are covered by this program, how many have/were households covered by other plans before the change and how they adjusted for people switching in and out of this plan when compiling statistics.

Regardless of your political bent, this type of document would need a lot of vetting before I'd conclude anything.

These are all excellent questions. Anecdotally (small suburban practice) the plan works very well altho they arbitrarily don't cover odd things. I would rather work with that plan than a lot of the products the same insurances offer commercially. Those are like trying to slog thru frozen molasses sometimes. The usual culprits for this state offer the insurance. The screening sure has increased regardless of what the outcome because people can now come for the screening/other visits they couldn't afford before. Most of the pts in our practice who are covered by this just ran with no insurance before. Many of these people are the working poor who have a few kids and both parents work one or more jobs. The plans have become more workable in the last few yrs. The first few were a CF.

 

[Rover]

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

What Mass has done correctly is solved the big first step, which is everybody has coverage. Once that is in place, they can then go out and attack the problems of accessability and cost. Otherwise a state is like a dog chasing its tale trying to figure out is it the uncovered people causing the problem, crappy insurance policies that don't cover anything, ignorance of benefits available to people, etc.

People who are in favor of this odd "Repeal and Replace" without any indication of what "replace" means are rewarding cowardice. Not necessarily your intent, but that's the effect. At some point you have to address this issue in a more thoughtful way than the Paul Ryan generational pay off to his supporters. If all 50 states wanted to come up with their own way of doing this, be my guest but the problem is there doesn't seem to be a lot of effort to do so. Take the first big step, get people covered, and then attack the other issues. In fairness I don't think the Mass experience necessarily translates to a much larger state, such as CA, TX, or FL. However, why exactly can't either low population states in the Plains and Mid West, Alaska with its oil revenues, the other New England states, or wealthier states of similar population such as NJ, VA, or MD do so? I find it hard to believe that Mass is that unique.

 

[Kepler]

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

People who are in favor of this odd "Repeal and Replace" without any indication of what "replace" means are rewarding cowardice.

It's opportunism. When health care was just a hugely expensive societal problem you couldn't pin it on a political entity. The first people to actually put a mechanism in place to solve it are wide open to opportunistic sniper attacks that invoke the broader problems (expense, finite resources, difficult prioritization decisions) as if they were somehow caused by the attempted solution.

The equivalent would be attacking the fire department because they are present at a lot of bad fires. Nobody says "repeal the fire department." We work to improve fire department training, coverage, response time, but we recognize that the problem the fire department exists to solve is the real threat.

 

[FreshFish]

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

The first people to actually put a mechanism in place to solve it.

Are you suggesting that the PPACA actually does "solve it?" Perhaps, leaving aside all partisan politics, if one merely examines PPACA solely on its merits and drawbacks, one might find that it does not "solve" anything??

 

[Kepler]

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

Are you suggesting that the PPACA actually does "solve it?" Perhaps, leaving aside all partisan politics, if one merely examines PPACA solely on its merits and drawbacks, one might find that it does not "solve" anything??

I'm saying it's trying to address it. That would have been a better way to put it.

My point is those critics who are just going to jump on any attempt and rip on its deficiencies while suggesting no alternative are doing politics, not policy.

 

[FreshFish]

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

I'm saying it's trying to address it. That would have been a better way to put it.

My point is those critics who are just going to jump on any attempt and rip on its deficiencies while suggesting no alternative are doing politics, not policy.

It seems to me that most of the people responding here have made thoughtful and genuine suggestions that provide a much better alternative than the PPACA itself.

Not only is the PPACA itself flawed, there also were serious concerns about the process by which it was <strike>rammed through on a purely partisan basis</strike> passed into law in the first place. Most legislation of this magnitude is done in a series of steps, that are described in plain English, with widespread agreement. Some of these laws were passed only after an enabling Constitutional amendment was ratified first.


I also find your standard ironic: "those critics who are just going to rip on deficiencies while suggesting no alternative are doing politics, not policy." Do you actually mean for that standard to apply to both "sides" of our debates? How critical are you of the absense of alternatives on spending restraint from the Dems? Sure one may disagree with the Reps on their proposals; I hear nothing at all from the Dems regarding any alternatives at all.



I'd really like to have a credible choice put forward by both parties; the Dems have nothing to offer on spending restraint and hire look-alikes to push old ladies over the edge of a cliff; while the Reps offer little on healthcare for people currently under age 55.

 

[Kepler]

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

It seems to me that most of the people responding here have made thoughtful and genuine suggestions that provide a much better alternative than the PPACA itself.

From the tenor of your subsequent remarks it seems pretty clear to me you are taking my remarks as directed at you personally. I assure you this is in no way the case. I was talking about the political chorus among Republican office seekers. Few if any of them talk about the problem of undercovered/uncovered people and how to address it -- they just run "Repeal Obamacare" ads with scare music.

 

[pirate]

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

What Mass has done correctly is solved the big first step, which is everybody has coverage. Once that is in place, they can then go out and attack the problems of accessability and cost. Otherwise a state is like a dog chasing its tale trying to figure out is it the uncovered people causing the problem, crappy insurance policies that don't cover anything, ignorance of benefits available to people, etc.

People who are in favor of this odd "Repeal and Replace" without any indication of what "replace" means are rewarding cowardice. Not necessarily your intent, but that's the effect. At some point you have to address this issue in a more thoughtful way than the Paul Ryan generational pay off to his supporters. If all 50 states wanted to come up with their own way of doing this, be my guest but the problem is there doesn't seem to be a lot of effort to do so. Take the first big step, get people covered, and then attack the other issues. In fairness I don't think the Mass experience necessarily translates to a much larger state, such as CA, TX, or FL. However, why exactly can't either low population states in the Plains and Mid West, Alaska with its oil revenues, the other New England states, or wealthier states of similar population such as NJ, VA, or MD do so? I find it hard to believe that Mass is that unique.

If I were president, I'd hire a secret panel of people from other countries to come in and do a separate assessment of the issues and then make recommendations as a control for the obviously biased versions either party would propose or any mamby-pamby half-way solutions that both parties hold their nose and vote for.

This is an issue of long-term strategic importance to this country and we're making decisions based on solutions from people who run for re-election every few years and are aided by special interest groups.

Since there are no more statesmen, I'd go with people from a mix of other countries. (at least ones with healthcare) I'd likely find some inappropriate way to push the non-partisan version into place and I'd then lose my re-election bid. But, they wouldn't repeal it since the data coming out would be compelling and for the following 100 years, they'd look back and say "that was the right way to do it".

 

[Kepler]

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

We're Americans. We don't believe in other countries.

 

[leswp1]

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

pirate wins the thread. Too bad the entrenched masses in gov't won't buy it.

 

[Handyman]

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

If I were president, I'd hire a secret panel of people from other countries to come in and do a separate assessment of the issues and then make recommendations as a control for the obviously biased versions either party would propose or any mamby-pamby half-way solutions that both parties hold their nose and vote for.

This is an issue of long-term strategic importance to this country and we're making decisions based on solutions from people who run for re-election every few years and are aided by special interest groups.

Since there are no more statesmen, I'd go with people from a mix of other countries. (at least ones with healthcare) I'd likely find some inappropriate way to push the non-partisan version into place and I'd then lose my re-election bid. But, they wouldn't repeal it since the data coming out would be compelling and for the following 100 years, they'd look back and say "that was the right way to do it".

You some kind of Socialist or something?

 

[pirate]

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

You some kind of Socialist or something?

Ha. Hardly.

I'll leave it to those who argue such things if what I proposed was socialism, dictatorship or complete BS.

There is so much money in this mess that I believe we can figure out a way that everybody gets care, nobody pays more and there is ample money and competition for private companies.

Just the waste in the current system would sustain every uninsured person in the country. Of course, if one were to suggest the system become more efficient, they would be attacked from every angle and end up having an unfortunate accident on their way home at night.

p.s. - If I don't post anything tomorrow, send out the search party

 

[leswp1]

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

Ha. Hardly.

I'll leave it to those who argue such things if what I proposed was socialism, dictatorship or complete BS.

There is so much money in this mess that I believe we can figure out a way that everybody gets care, nobody pays more and there is ample money and competition for private companies.

Just the waste in the current system would sustain every uninsured person in the country. Of course, if one were to suggest the system become more efficient, they would be attacked from every angle and end up having an unfortunate accident on their way home at night.

p.s. - If I don't post anything tomorrow, send out the search party

Why don't we just compensate the CEOs at a reasonable rate- that should cover 'few' extra things.

It is always proposed but I have yet to see an instance that it actually happens.Has there ever been a study on the impact of removing waste? It seems the waste would be propping up parts of the economy. If we rid the system of waste all those pencil pushers , all the people who manufacture the wasted stuff, etc would be out of a job. I always wonder about the economic effects of removing waste. Those are the people with the expendable income.

 

[pirate]

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

Why don't we just compensate the CEOs at a reasonable rate- that should cover 'few' extra things.

It is always proposed but I have yet to see an instance that it actually happens.Has there ever been a study on the impact of removing waste? It seems the waste would be propping up parts of the economy. If we rid the system of waste all those pencil pushers , all the people who manufacture the wasted stuff, etc would be out of a job. I always wonder about the economic effects of removing waste. Those are the people with the expendable income.

There is, last I heard, $60B in medicare fraud per year, every year, just in one program. So, would include reducing fraud and streamlining the operation.

I don't know the number of vacancies in other government agencies but my first step would also include freezing all hiring in the types of levels I expect to shrink ...a pencil pusher can figure out how to push pencils in another agency. So, they don't lose jobs, they get transferred to another one. We should be able to wring out 3-4% of the people with little discernable impact.

So, let's reduce fraud by $10B a year for 4 years and save $40B on a run rate basis going forward.

The 3-4% is likely repeatable for 2-3 years netting 6-10% reduction in staff.

As you might guess, I'm not going to regulate CEO pay. I don't think it is the role of the president to set pay scales for private business. If he does, he should start with Carl Crawford.

 

[FlagDUDE08]

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

There is, last I heard, $60B in medicare fraud per year, every year, just in one program. So, would include reducing fraud and streamlining the operation.

I don't know the number of vacancies in other government agencies but my first step would also include freezing all hiring in the types of levels I expect to shrink ...a pencil pusher can figure out how to push pencils in another agency. So, they don't lose jobs, they get transferred to another one. We should be able to wring out 3-4% of the people with little discernable impact.

So, let's reduce fraud by $10B a year for 4 years and save $40B on a run rate basis going forward.

The 3-4% is likely repeatable for 2-3 years netting 6-10% reduction in staff.

As you might guess, I'm not going to regulate CEO pay. I don't think it is the role of the president to set pay scales for private business. If he does, he should start with Carl Crawford.

This October, Obummer will be "campaigning" by messing around with Medicare benefits. Expect him to screw over the voting population if he is re-elected, especially since the only accountability will be through a Congressional impeachment: http://www.nypost.com/p/news/opinion/opedcolumnists/an_billion_trick_ImTBFfz7MeuZLJY7JzXEIJ

 

[pirate]

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

This October, Obummer will be "campaigning" by messing around with Medicare benefits. Expect him to screw over the voting population if he is re-elected, especially since the only accountability will be through a Congressional impeachment: http://www.nypost.com/p/news/opinion/opedcolumnists/an_billion_trick_ImTBFfz7MeuZLJY7JzXEIJ

As long as trying to reduce fraud and waste is positioned as an attack on the needy and certain to leave people dying in squalor, nothing will change.

One side has to deny there is waste and fraud, the other has to grandstand on it, nobody is just taking it for what it is and trying to make it better.

I'd bet my net worth that billions could be saved without one person being denied appropriate care...it wouldn't be called fraud if it was deserving people getting appropriate treatment. But, the anecdotes and fear tactics will commence, gridlock will prevail and nothing will change.

 

[Handyman]

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

Ha. Hardly.

I'll leave it to those who argue such things if what I proposed was socialism, dictatorship or complete BS.

There is so much money in this mess that I believe we can figure out a way that everybody gets care, nobody pays more and there is ample money and competition for private companies.

Just the waste in the current system would sustain every uninsured person in the country. Of course, if one were to suggest the system become more efficient, they would be attacked from every angle and end up having an unfortunate accident on their way home at night.

p.s. - If I don't post anything tomorrow, send out the search party

I know you are not...but bringing in other countries to help advise us...sounds like you are saying ther countries might have better ideas than us. And since undoubtedly some of those nations will have some aspect of socialism involved (at least socialized medicine) it can then be surmised using the transitive property of party politics and scare tactics that you are a SOCIALIST!!!!!11!!!

 

[FreshFish]

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

Hmm....so many Republican governors like the idea of insurance exchanges, as long as they can set them up in a way that fits and makes sense for their state. Another failure of PPACA, it limits severely how the exchanges can be arranged and throws in some extraneous roadblocks as well.

 

[FreshFish]

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

Good news is reported on the health insurance front for the people of Maine, and it further suggests that state-run programs may be better suited to address local and regional needs than some imposed-from-without, only-one-option-for everyone Procrustean "solution" from the Feds.

One tragedy of the Affordable Care Act is that we already know what its regulations will do to insurance markets, because the states have been conducting policy experiments since the 1990s. But we also know from the states that the damage is reversible, as shown by Maine's emerging insurance turnaround.

In 1993, Augusta passed coverage laws that resemble those that ObamaCare is about to impose nationwide: Insurers could only vary premiums within narrow bands regardless of age or health status, a regulation known as community rating. Four of Maine's five insurers in the individual market stopped offering coverage and fled, and the state entered an insurance "death spiral" in which premiums don't cover underlying medical costs. That leads to higher premiums, consumers dropping coverage as a result, and still higher premiums in turn.

Then the 2010 electoral wave carried in Republican Governor Paul LePage and a GOP legislature, and they took modest steps to deregulate the insurance market. Insurers are now allowed to sell policies for premiums that range from 3 to 1 on the basis of age, rather than the prior 1.5 to 1, and to offer incentives or discounts for consumers to choose high-value providers.

The state also created a reinsurance fund that taxes all health plans by $4 a month. If someone ends up requiring extremely expensive care, the fund picks up some of the costs, which means insurers can better manage their future liabilities and pass the savings on to individuals.

The returns are now rolling in for the new coverage that can be offered starting on July 1, and premiums are falling by as much as 69% for Maine's dominant insurer, Anthem.

http://online.wsj.com/article/SB100...62012576398.html?mod=WSJ_Opinion_AboveLEFTTop