The Affordable Care Act

[Ike Bana]

Originally Posted by bobabode

Where have you articulated an alternative to O Care, Mike? I would love to read it. I would love to see any alternative from a conservative or a Repub.

BTW, nice to know that you are spokesman for the conservative hivemind.

I'd sure like to see any GOP politician's alternative or any internet forum right winger's alternative that covers everybody.

It's interesting that the only one I've heard being honest about it is Limbaugh. He's come right out and said that he doesn't care if 30 million Americans have no health insurance. It's just not an issue for him.

Far as I've been able to determine so far, it doesn't appear to be an issue for whell either.

[merrylander]

Of course seeing the reaction by the States to thr ACA I imagine that SinglePayer would be impossible to implement here because of States Rights.

[Ike Bana]

Originally Posted by merrylander

Of course seeing the reaction by the States to thr ACA I imagine that SinglePayer would be impossible to implement here because of States Rights.

It kinda depends, no? Blue states would be more likely to support federal single payer, red states would be more likely to support a federal ban on gay marriage.

It's why the bleating from the right about getting the federal government out of the lives of the people and the business of the States is bullshit. They want the federal government's nose in our business just as much as the left does. I want it in their gun lockers, they want it in my wife's reproductive organs...etc., etc.

[whell]

Originally Posted by bobabode

Where have you articulated an alternative to O Care, Mike? I would love to read it. I would love to see any alternative from a conservative or a Repub.

BTW, nice to know that you are spokesman for the conservative hivemind.

Originally Posted by Ike Bana

I'd sure like to see any GOP politician's alternative or any internet forum right winger's alternative that covers everybody.

It's interesting that the only one I've heard being honest about it is Limbaugh. He's come right out and said that he doesn't care if 30 million Americans have no health insurance. It's just not an issue for him.

Far as I've been able to determine so far, it doesn't appear to be an issue for whell either.

Ike - You have no clue about what is "an issue" for me and what isn't. But you're free to keep making incorrect assumptions. Also, let's be clear: no one has put forward or passed any legislation - neither Dems or Repubs - representing an "alternative that covers everybody." Obamacare was not designed to cover everybody. It may have started out with that objective when it was originally scripted, there were even a fair number of Dems who were unwilling to overhaul the current system to that extent. As it was finally passed, Obamacare's objective was to reduce the number of uninsured. Therefore, any reasonable alternative to Obamacare needs to be viewed through that prism.

Bob - I don't feel like going back and digging it up either. But I'll summarize it below.

The first, best antidote to reducing the number of uninsured it to get the economy moving again. A 1% - 2% annual rate of economic growth just doesn't cut it. It doesn't provide sufficient incentive for individuals/corporations to risk captital. Getting the economy moving again spurs job creation, and job creation creates competition for labor that supports wage growth and, typically, supports employers offering jobs that include benefits.

However, the issue to me is not availability of medical insurance, but the cost of medical insurance and medical care. The two go hand in hand. As the cost of care rises, the cost of insurance rises. The additional issue is that insurance is also the primary culprit in the rising cost of care. Since consumers don't pay the full cost of medical care, they have no incentive to look for ways to save money on care: behave like good consumers usually do.

Recent personal example - I needed an MRI prior to back surgery a couple years ago. The hosptial that I was treating at wanted $5500 for the MRI. Another local hospital - same MRI machine, an MRI tech with the same level of training - wanted $3500. Because I have a larger deductible to pay before my insurance covers anything, I went with the $3500 MRI. I'm confident that most people with more traditional types of insurance plans don't make those same choices. They'd spend days surfing the internet getting information on the purchase of a car, a vacation or the like, but don't do that same when it comes to their medical care. They go to doctors because they're "in the network", but spend less time gettng information about their medical care providers than they do understanding the point spread on an upcoming football game. Their physician tells them they have to undergo 5 tests to support a diagnosis, when 2 test would be sufficent, and they undergo the 5 tests not realizing that the other three are reccommended by the physcian's malpractice liability carrier, but don't contribute much to the medical outcome of the patient. All these items and many, many more contribute to the cost of care, and most patients have far more control than they realize, or currently care to exercise, becuase in most cases they don't pay the full bill.

Increasing access to insurance coverage as Obamacare does is not a solution, becuase the market incentives that support the increasing cost of care are locked in to the system. Yes, Obamacare does create some incentives for health care providers to enter into agreements to be compensated based on health / efficient outcomes. However, it also cements into place the key problem - in my opinion - of rising medical costs which is using an insurance product as the primary method of reimbursing for physician/medical services. Folks completely understand that if they are in a car accident, there's a probabllity that their auto insurance premium rises. However, most folks look forward to being covered under health insurance so that it will reduce their out of pocket costs for even routine medical costs, yet are incensed when the premiums rise year after year. They don't seem to grasp that the same economics that drive the cost of auto insurance - including claims experience / utilization - also drive medical insurance.

My house burning down, or me getting into a car accident is not a likely event from an actuarial perspective. My kid getting strep throat from another kid in school, and taking the kid to the doctor for treatment, is a much more likey event actuarially. The insurnace coverage for the likelyhood of each event is priced accordingly. If you've ever had your car in a repair facility you know that insurance company reimbursment practices will attempt to reduce the cost of repair, sometimes to the policy holders detriment. Yet, when these same practices are applied by insurance carriers to reduce expenses associated with human body repair, folks seem surprised and incensed by this.

Long story short - get rid of insurance as the primary means of covering first - dollar out of pocket costs for medical services.

Get rid of employer - sponsored group health coverage. Give individuals the ability to purchase the coverage of their choice with premiums that are dollar for dollar tax deductable. To make the libs happy, you can even phase out the tax deduction as income rises. The coverage for health insurance is limtied to covering preventive services and major medical services only. Routine medical care is on the patient's dime. The net effect of this will be very similar, and far less expensive, to Obamacare's premium subsidized plans.

Employers provide plans that allow employees to pay for insurance premiums and save for health care expenses on a pre-tax basis. These tax - favored plans are great if you work for someone, but it you're self employed or retired you have no access to such plan. So, I'd expand health savings acccounts to provide incentives to indivduals to save money to cover the cost of routine care.

And, since folks are spending their own money on routine care, they'll finally have some skin in the game and start treating medical care purchases the same as any other product or service they purchase.

Overhaul the FDA and how the FDA regulates the pharma industry, so that new drugs and maintenance medications can get to the consumer faster and at a lower cost. Provide profit tax rebates for pharma industries that have the greatest net positive impact on signficiant heath issues each year. In exchange, reduce the duration of patent protection on new drugs so that the cost of those drugs comes down sooner over time.

Keep safety net programs like medicare and medicaid in place for individuals that don't have other altermnatives, or are incapable of self-care.

Review medical service delivery requirements/laws. For example, do I really need a doctor to dianose my bronchitis, or could a physician's assistant or clinical nurse practitioner do the job just as well and at a lower cost?

There's more, but I think you get the gist. Attack the issue from all sides, but attack those issues that drive up costs while having zero impact on medical / quality outcomes. Meanwhile, put the consumer in the drivers seat, rather than the insurance company or health system, to help reduce costs / utilization of health services.

[merrylander]

Didn't some greek philosopher write a story about that place? Called Cloud Cuckoo Land if memory serves.

[finnbow]

Originally Posted by whell

Ike - You have no clue about what is "an issue" for me and what isn't. But you're free to keep making incorrect assumptions.

Dubya and a Republican Congress had six years to do something like what you describe and did nothing. For better or worse, Obama took the only model for universal health care that had been successfully passed and implemented at the state level (and coincidentally designed by conservatives) and got it passed on a national basis. The GOP has had ample time to contribute to an improved health care delivery system and have never lifted a finger to do anything (other than Romney in MA, of course).

I'm not a particular fan of Obamacare, but remain convinced that once it gets past its birthing pains it will be at least a slight improvement over the status quo that preceded it.

As for your contention that health care decisions can and should be made by the consumer in a rational economic manner, this presumes that the purchaser of these services is aware of all options; be they doctor, hospital, pharmaceuticals, drug interactions, surgical procedures, efficacy of treatment, rehab and the cost/benefit of all such options. You're fooling yourself if you think you have anywhere near the knowledge to make such informed decisions.

[whell]

Originally Posted by finnbow

Dubya and a Republican Congress had six years to do something like what you describe and did nothing. For better or worse, Obama took the only model for universal health care that had been successfully passed and implemented at the state level (and coincidentally designed by conservatives) and got it passed on a national basis. The GOP has had ample time to contribute to an improved health care delivery system and have never lifted a finger to do anything (other than Romney in MA, of course).

I'm not a particular fan of Obamacare, but remain convinced that once it gets past its birthing pains it will be at least a slight improvement over the status quo that preceded it.

As for your contention that health care decisions can and should be made by the consumer in a rational economic manner, this presumes that the purchaser of these services is aware of all options; be they doctor, hospital, pharmaceuticals, drug interactions, surgical procedures, efficacy of treatment, rehab and the cost/benefit of all such options. You're fooling yourself if you think you have anywhere near the knowledge to make such informed decisions.

BS on all points.

Health savings accounts / high deductible health plans were introduced in 2002 legislation, and these plans have been growing in terms of market share and consumer satisfaction ever since. IMHO thesis plans Neec to be expanded.

Obamacare, per my post above, firmly entrenches all of the things that make our current system inefficient and dysfunctional. It's the wrong solution for the challenges the system currently has.

People make informed decisions about their health every day. They choose whether or not to seek treatment, where to go for treatment, and whether or not to follow their doctors orders. People smoke, drink and consume illegal drugs in spite of the best medical advise against such behavior, and every day someone decides to go for a walk or a jog, ride a bike or take an exercise class because of the perceived health benefits. People consult with their docs about all manner of things, and the decision is ultimately theirs about which course of treatment to follow. Most patients with insurance don't, however, often enough ask the question what's the best and most cost effective course of action.

[finnbow]

Originally Posted by whell

BS on all points.

Health savings accounts / high deductible health plans were introduced in 2002 legislation, and these plans have been growing in terms of market share and consumer satisfaction ever since. IMHO thesis plans Neec to be expanded.

FWIW, Obamacare offers several levels of coverage with the lowest levels offering the highest deductibles and lowest premiums. Nothing new or novel there.

Obamacare, per my post above, firmly entrenches all of the things that make our current system inefficient and dysfunctional. It's the wrong solution for the challenges the system currently has.

While I agree that single-payer would be far better, the fact remains that the GOP has never offered any serious plan that was able to garner political support that would improve things whatsoever.

People make informed decisions about their health every day. They choose whether or not to seek treatment, where to go for treatment, and whether or not to follow their doctors orders. People smoke, drink and consume illegal drugs in spite of the best medical advise against such behavior, and every day someone decides to go for a walk or a jog, ride a bike or take an exercise class because of the perceived health benefits. People consult with their docs about all manner of things, and the decision is ultimately theirs about which course of treatment to follow. Most patients with insurance don't, however, often enough ask the question what's the best and most cost effective course of action.

Deciding whether or not to have a smoke, drink or hike is quite a bit different type of health decision than deciding the most cost-effective treatment for complicated illnesses or injuries.

If you indeed practice what you preach, I have to assume you have advance notice of the full costs at all of your area hospitals for treating any injury or illness that will land you in the emergency room. If so, you're the only person in the nation that possesses such information. Similarly, if you know the cost vs. efficacy of every drug everyone in your family takes, you should be a lead researcher at NIH.

Lastly, the only way to somewhat accurately make these judgments is with the much-maligned-by-the-GOP "death panels," groups of experts who, through education and experience, have the experience/education to make such judgments.

[BlueStreak]

Originally Posted by finnbow

Dubya and a Republican Congress had six years to do something like what you describe and did nothing. For better or worse, Obama took the only model for universal health care that had been successfully passed and implemented at the state level (and coincidentally designed by conservatives) and got it passed on a national basis. The GOP has had ample time to contribute to an improved health care delivery system and have never lifted a finger to do anything (other than Romney in MA, of course).

I'm not a particular fan of Obamacare, but remain convinced that once it gets past its birthing pains it will be at least a slight improvement over the status quo that preceded it.

As for your contention that health care decisions can and should be made by the consumer in a rational economic manner, this presumes that the purchaser of these services is aware of all options; be they doctor, hospital, pharmaceuticals, drug interactions, surgical procedures, efficacy of treatment, rehab and the cost/benefit of all such options. You're fooling yourself if you think you have anywhere near the knowledge to make such informed decisions.

There is no GOP plan, Finn. Making a plan would require effort.

I find it as no surprise that the GOP is still full of nothing but vapid talking points, empty quasi-patriotic sloganeering and other manifestations of utter uselessness. Hasn't this been the case for decades now?

Smaller government, anyone? Where is it? Where is the evidence that they've ever made any serious effort in that regard? Trickle down economics? We have more wealthy people now than ever, more people working without union wages or protection-----Where is it? Where is this great economic boom that those conditions are supposed to generate? That party has become virtually worthless. They do nothing, they achieve nothing. Failures who simply refuse to acknowledge their failure. All they offer is more of the same shit that isn't working now.

[whell]

Originally Posted by finnbow

FWIW, Obamacare offers several levels of coverage with the lowest levels offering the highest deductibles and lowest premiums. Nothing new or novel there.

BS again. Health Saving Accounts were "new and novel". You can only contribute to such accounts if you have a qualified high deductible plan. Before 2002, such options were not available.

While I agree that single-payer would be far better, the fact remains that the GOP has never offered any serious plan that was able to garner political support that would improve things whatsoever.

Single payer is just another form of cost shifting and managed care, where the consumer has no skin in the game. it's "far better" than a sharp stick in the eye, I guess.

Deciding whether or not to have a smoke, drink or hike is quite a bit different type of health decision than deciding the most cost-effective treatment for complicated illnesses or injuries.

If you indeed practice what you preach, I have to assume you have advance notice of the full costs at all of your area hospitals for treating any injury or illness that will land you in the emergency room. If so, you're the only person in the nation that possesses such information. Similarly, if you know the cost vs. efficacy of every drug everyone in your family takes, you should be a lead researcher at NIH.

Lastly, the only way to somewhat accurately make these judgments is with the much-maligned-by-the-GOP "death panels," groups of experts who, through education and experience, have the experience/education to make such judgments.

BS, and more BS.

The "average" medical insurance plan has about a $1500 individual deductible, $3000 for a family. In an average plan year, less than 20% of participants in a typical insured group meet or exceed their deductible. That means that most folks covered under that group policy aren't treating for "complicated illnesses or injuries.". They are incurring costs more typically for scrpts and more routine medical services. That's where the opportunities for medical consumers to get engaged truly are.