Obamacare

[Matilda_Bennett]

Please remember that discussions of particular political parties are not allowed in this forum. Thank you for your cooperation.

 

[JSSD]

Intersting history re employer involvement. But doesn’t sound like good public policy!

I’d say it was a result of bad public policy. When you try to restrict the free market, the free market tries to find a way. Or it becomes a grey / black market. Legislation is so rarely the solution, and so often the problem.

I think there is more to it than that as well in terms of perverting culture compared to other nations. [Some liberal] Americans look to European nations so often and wonder why we can’t have the socialized medicine they have. Our supply and demand curves are so dramatically different (from a multitude of reasons), but it is my opinion that a long history of employer sponsored plans have generally shielded the average American from the true cost of care. In actuality, combination with government programs has shielded insurance side and care delivery side both from these costs and no one knows what the true cost is. I can tell you what the price is. I can tell you what the charge is (which is different), but the true cost? As a result, the value is completely distorted.

 

[Rau]

I’d say it was a result of bad public policy. When you try to restrict the free market, the free market tries to find a way. Or it becomes a grey / black market. Legislation is so rarely the solution, and so often the problem.

In this case, the problem is perhaps much larger than simply restricting the free market. Health Care in the US is the best in the world if you are wonderfully wealthy, not so good if you are struggling.

Be careful what you wish for - the free market, unrestrained, can be brutal - that is why EVERY country has rules to govern the conduct of the free market, even markets where competition is adequate. Of course, some controls may do more harm than good, or simply fail entirely.

… but it is my opinion that a long history of employer sponsored plans have generally shielded the average American from the true cost of care. In actuality, combination with government programs has shielded insurance side and care delivery side both from these costs and no one knows what the true cost is. I can tell you what the price is. I can tell you what the charge is (which is different), but the true cost? As a result, the value is completely distorted.

It is good that we are, to a degree, shielded from the true cost, as is the case with all forms of “insurance”. For left to our own resources, many of us could never fund the true cost of the medical care we need. It is also true that we must all contribute, and we must not abuse the system.

 

[JSSD]

In this case, the problem is perhaps much larger than simply restricting the free market. Health Care in the US is the best in the world if you are wonderfully wealthy, not so good if you are struggling.

Be careful what you wish for - the free market, unrestrained, can be brutal - that is why EVERY country has rules to govern the conduct of the free market, even markets where competition is adequate. Of course, some controls may do more harm than good, or simply fail entirely.

It could be a lot more free than it is. Completely unrestrained would imply no rule of law, no consequences for externalities, no recourse for wrongs. At the same time, I’d much prefer to be on that end of the spectrum, myself. But I’m another one of those MBAs with an interest in finance and econ, a fan of the Austrian school or some of the University of Chicago guys.

It is good that we are, to a degree, shielded from the true cost, as is the case with all forms of “insurance”. For left to our own resources, many of us could never fund the true cost of the medical care we need. It is also true that we must all contribute, and we must not abuse the system.

Or it could drive the costs down. Routine eye care, including lasik, and dental are pretty free market, and pretty affordable because of competition. Why has medical imaging technology advanced like gangbusters and dropped in price like mobile telephones and HD TVs? Because of government constraints and a lack of competition.

Even with insurance, I very much disagree with the good of being shielded. If everything is either free or a $20 copay, well of course I want it all, even if I don’t truly need it. And costs spiral out of control. That doesn’t help anyone. So, how do we get “all” to contribute and simultaneously all to not abuse the system? Especially with costs largely obfuscated? I don’t think it is going to happen in the US’s current culture, especially with our current system of incentives and disincentives. And this gets back to my very first thought in the thread about risk stratification. If we’re all in the same pool, we’ve perverted some incentives for sure.

 

[Rau]

It could be a lot more free than it is. Completely unrestrained would imply no rule of law, no consequences for externalities, no recourse for wrongs. At the same time, I’d much prefer to be on that end of the spectrum, myself. But I’m another one of those MBAs with an interest in finance and econ, a fan of the Austrian school or some of the University of Chicago guys.

Or it could drive the costs down. Routine eye care, including lasik, and dental are pretty free market, and pretty affordable because of competition. Why has medical imaging technology advanced like gangbusters and dropped in price like mobile telephones and HD TVs? Because of government constraints and a lack of competition.

Even with insurance, I very much disagree with the good of being shielded. If everything is either free or a $20 copay, well of course I want it all, even if I don’t truly need it. And costs spiral out of control. That doesn’t help anyone. So, how do we get “all” to contribute and simultaneously all to not abuse the system? Especially with costs largely obfuscated? I don’t think it is going to happen in the US’s current culture, especially with our current system of incentives and disincentives. And this gets back to my very first thought in the thread about risk stratification. If we’re all in the same pool, we’ve perverted some incentives for sure.

It comes down to tolerating some misuse, or tolerating the disenfranchisement of many.

 

[Viki63]

It
Even with insurance, I very much disagree with the good of being shielded. If everything is either free or a $20 copay, well of course I want it all, even if I don’t truly need it. And costs spiral out of control. .

I don’t know about you, but I sure have better things to do than access unneeded healthcare. My husband and I routinely turn down unnecessary tests and appointments that our doctors think should be done. They’re good doctors and they mean well, but they think nothing of ordering a crate of dressing change supplies for us when I can get similar things at Target for 1/10 the cost.

 

[teeboy]

It is a good thing that the availability of healthcare is not subject to the financial resources of individuals. But the system in the U.S. does appear to be a mess. Why are employers involved?

Employers are involved in order to help recoup the cost.

 

[teeboy]

Is this a rhetorical complaint or do you really want to know?

If you are really wondering, this might be helpful for you:

ebri.org/publications/facts/index.cfm?fa=0302fact

Incidentally, the PPACA (“Obamacare”) has very much demonstrated that the “availability of healthcare” and the “availability of healthcare coverage” are two very different things. The latter is now easier to get but I can assure you it doesn’t necessarily translate 1:1 with the former.

Good point about health care vs. health care coverage.

 

[JSSD]

It comes down to tolerating some misuse, or tolerating the disenfranchisement of many.

One of the common sticking points was that it actually wasn’t that many. The media was reporting ~30 million (in a pop. of 320-330), but a less reported breakdown was that by the time you filtered out non-citizens and intentionally uninsured, it was closer to 13-15. So, is it worth re-writing the rules of the entire 320-330 for the sake of the 13-15? That’s your judgment call. For the vast majority that felt the existing system worked, the answer is no. For those cases as mentioned above which were largely uninsurable, the answer is yes. Someone else above asked why we couldn’t have written yet another entitlement or expansion of an existing entitlement. I don’t know, but that might have seemed more reasonable, and it certainly fuels the argument that it isn’t about health as much as power, control, and corruption.

Either way, there was plenty of misuse before, there is plenty now, and will be plenty tomorrow.

I don’t know about you, but I sure have better things to do than access unneeded healthcare. My husband and I routinely turn down unnecessary tests and appointments that our doctors think should be done. They’re good doctors and they mean well, but they think nothing of ordering a crate of dressing change supplies for us when I can get similar things at Target for 1/10 the cost.

Hat tip to you guys, but I can assure you that isn’t the common practice. And arguably, (I’ve never done this), but I have better things to do than make an extra run to Target for dressings when I can get it right there under my co-pay.

I think you touch on another brilliant point few realize. They are good doctors who mean well for the most part. We cite “defensive medicine” as a common cause of costs spiraling out of control. Why do an MRI when you could do an X-ray, why do a pheno when you can do a geno, why do a quantitative when you could do a qualitative (drug concentration, perhaps)? We didn’t do that a generation ago! Well, we didn’t always have it a generation ago either. Technology moves forward and of course your physician wants more info for staging, for treatment, for prognosis. If you want to deny them, that’s fine, but most don’t even realize this is an option.

 

[Rau]

One of the common sticking points was that it actually wasn’t that many. The media was reporting ~30 million (in a pop. of 320-330), but a less reported breakdown was that by the time you filtered out non-citizens and intentionally uninsured, it was closer to 13-15. So, is it worth re-writing the rules of the entire 320-330 for the sake of the 13-15? That’s your judgment call. For the vast majority that felt the existing system worked, the answer is no. For those cases as mentioned above which were largely uninsurable, the answer is yes. Someone else above asked why we couldn’t have written yet another entitlement or expansion of an existing entitlement. I don’t know, but that might have seemed more reasonable, and it certainly fuels the argument that it isn’t about health as much as power, control, and corruption…

I need to limit my comments to principles, rather than the detailed mechanics of Obamacare or other machinery - since I’m a non-American and don’t know the details.

If the 13-15 (or 30?) million who have no medical insurance (be that government provided or provided via private health insurance means) are in large part in that position due to inadequate personal finances, then as a society, we should feel some obligations to assist them.

 

[Rau]

… We cite “defensive medicine” as a common cause of costs spiraling out of control. Why do an MRI when you could do an X-ray, why do a pheno when you can do a geno, why do a quantitative when you could do a qualitative (drug concentration, perhaps)? We didn’t do that a generation ago! Well, we didn’t always have it a generation ago either. Technology moves forward and of course your physician wants more info for staging, for treatment, for prognosis. If you want to deny them, that’s fine, but most don’t even realize this is an option.

MRI’s are an effective, very expensive tool, and less damaging than radiation-based scans (X-Rays, CT, etc.) Preventing overuse is important to preventing spiralling costs. In jurisdictions with which I am familiar, this is done by “interfering with the free market”! For example, a (government) health scheme will pay a regulated fee for an MRI so long as the clinical circumstances meet certain criteria (eg. patient symptoms and part of body to be scanned). If you don’t have rules like this, then costs will certainly spiral. Of course, if you can pay the commercial price for an MRI yourself, then you can get the MRI - so ultimately, the wealthy will always have the edge in accessing the best medical treatment…that’s life. We just want to ensure the gap between the wealthy and the poor is not so large as to leave the poor at great risk.

 

[JSSD]

I need to limit my comments to principles, rather than the detailed mechanics of Obamacare or other machinery - since I’m a non-American and don’t know the details.

Nah, no need to apologize or feel bad about that at all.

If the 13-15 (or 30?) million who have no medical insurance (be that government provided or provided via private health insurance means) are in large part in that position due to inadequate personal finances, then as a society, we should feel some obligations to assist them.

I don’t have the breakdown anymore, nor does does it matter, but a huge chunk were non-citizens. Another huge chunk were young folks (presumably healthy) who’d simply made other choices for their money. Foolish, but are we a free nation or not? (Not really)

Again, if we want to assist, there were many ways we could have done that without re-writing the entire healthcare blueprint for the nation, arguably. This is why it is sometimes assigned a more sinister motive. Maybe that’s too strong of a term, but it was certainly not pure altruism, IMHO.

MRI’s are an effective, very expensive tool, and less damaging than radiation-based scans (X-Rays, CT, etc.) Preventing overuse is important to preventing spiralling costs. In jurisdictions with which I am familiar, this is done by “interfering with the free market”! For example, a (government) health scheme will pay a regulated fee for an MRI so long as the clinical circumstances meet certain criteria (eg. patient symptoms and part of body to be scanned). If you don’t have rules like this, then costs will certainly spiral. Of course, if you can pay the commercial price for an MRI yourself, then you can get the MRI - so ultimately, the wealthy will always have the edge in accessing the best medical treatment…that’s life. We just want to ensure the gap between the wealthy and the poor is not so large as to leave the poor at great risk.

Don’t get hung up on X-ray vs. CT vs. MRI. Again, just one of a million potential examples. It could have been CT vs. PET. It could have been surgical biopsy vs. radiological imaging. The specifics don’t matter - but to your other point, I’d again argue in our case “interfering with the free market” has perverted this: You’re shielded from the cost due to government reimbursement. Of course there are certain criteria, best practices, clinical guidelines, and sometimes reimbursement criteria, but given an uncertain diagnosis, there is often a lot of latitude in ordering. You may even get both! (I did get all of the above)

As a personal anecdote to this - I am a cancer survivor. I’ve had more than my share of X-rays, CTs, PETs. If a CT or PET is 3-400 CXR equivalents of radiation, I’m basically spiderman. A PET is more expensive than a CT. Due to government interfering with the free market in terms of reimbursement, it is vice-versa that reality for myself and patients with my company which is an insurance carrier, but which takes direction from federal reimbursement. I typically needed a scan (either would do) from neck to crotch. My CTs were 3x the co-pay for 3 “regions” (chest / abdomen / pelvis), but a PET is 1 co-pay, full body. Guess which one most folks, self included, would pick?

Well, one day my company is trying to investigate the “overuse” of PETs. Sadly, for some corporate execs, it was a shock when I’m explaining the more expensive test is 1/3 the cost for the patient - and to be honest, a MUCH more pleasant test in terms of prep, etc. (Who wants diarrhea all afternoon?!?) Again, I’d definitely argue the opposite: free market would set that course back from the deviation government interference caused. If I had some burden of the true cost, perhaps I’d choose differently. (But unlikely due to the unpleasantness, at least until the guidelines changed, years later).

 

[Michael_Mayo]

Catholic bishops endorse Medicaid expansion in Kansas

kansas.com/news/politics-government/article19951290.html

 

[Sunbreak]

This administration had no business sticking its nose into my health care. If the government wanted to offer medical insurance (not the business of government anyway) to the uninsured, the democrats could have just expanded the Medicare program to include all Americans; but no, they had to mess it up, complicate things and force citizens into paying much more for less. Any law that is thousand of pages long, instead of one or two is not good.

Not possible because there was too much objection to having “socialized” medicine. To appease the Republicans and the big insurance lobbies, insurance had to be offered so that the insurers still would benefit.

 

[Michael_Mayo]

Not possible because there was too much objection to having “socialized” medicine. To appease the Republicans and the big insurance lobbies, insurance had to be offered so that the insurers still would benefit.

And it is also important to change our entire culture to embrace what is now being called “lifestyle Medicine”.

lifestylemedicine.org/define

 

[Selah_KY]

Yes, if you include everyone that was previously considered uninsurable, the rates will for everyone will go up. I

In reality, by forcing those who are healthy but not currently using their insurance into the plan, rates should be going down.

Would you feel it is fair for your auto insurance to be the same cost as a person who wrecked two Ferraris? Would you feel it is fair that a 20 year old pay the same life insurance premium as a 65 year old?

You’re missing part of the equation here. The person who wrecked two Ferraris was paying premiums BEFORE he wrecked his cars. He didn’t run to the insurance company as soon as the first one was wrecked, saying, “Hey! Fix my car and now I’ll start paying premiums!”

With health insurance, the 65yo and the 20yo SHOULD be paying the same premium. The difference is that the 20yo will likely pay more into the system each year than he uses, but he will have paid enough into it that by the time he’s 65 and taking more out, it will balance.

Actually, the majority of folks who were counted as having to file bankruptcy for medical bills filed because the primary earner for the family died. It wasn’t the bills, it was the cessation of income. Problem with a lot of the figures thrown around is how folks come up with the figures.

I would love to see an actual source to back this up. I know many families who have had to file to bankruptcy because of medical bills and there wasn’t a single case where the primary earner died.

Why are employers involved?

The million dollar question. They got involved after WWII when they were competing for the best workers and it’s snowballed from there.

[Some liberal] Americans look to European nations so often and wonder why we can’t have the socialized medicine they have.

And some liberal Americans wonder how we could have perverted our culture to the point where the free market is held in such high esteem that we allow corporations to profit providing a basic human need. We are the ONLY developed nation in the world with a for-profit health insurance system.

I don’t know about you, but I sure have better things to do than access unneeded healthcare.

How blessed you are that you have access to health care you don’t need.

If the 13-15 (or 30?) million who have no medical insurance (be that government provided or provided via private health insurance means) are in large part in that position due to inadequate personal finances, then as a society, we should feel some obligations to assist them.

I tend to agree with you as do a nice chunk of American Christians. Unfortunately, too many talking heads have convinced people that social justice is patently unChristian. Confounds me, because my faith is the very core of what defines my beliefs regarding social justice.

Not possible because there was too much objection to having “socialized” medicine. To appease the Republicans and the big insurance lobbies, insurance had to be offered so that the insurers still would benefit.

You need to rephrase that… “so the insurers would still PROFIT.”

All that said, here hid at the bottom of my post, I will say that I would have much preferred a single payer system. Given the unlikelihood of that ever happening, I’ll keep praying for new laws requiring health insurance companies to be non-profit.

 

[Selah_KY]

This policy happened to be my policy. Therefore, I dropped Obamacare, yet I continued to receive premium notices from a BlueCross Liscensee.

Let’s clear up one HUGE misconception. The ACA (Obamacare) is a LAW. It isn’t an insurance company. You do not have “Obamacare”, you have a policy through a Blue Cross licensee that is causing you problems. Lay blame where blame is due - on the FOR PROFIT company that is not serving its customers and is causing the delay in your tax refund.