The health care debate thread.

[U-Ute]

This thread is here instead of in the health forum because it is intended to be the landing spot for the debate concerning our current health care system, which I'm sure most of us agree is broken to some extent. The broken nature of which is contributing significantly to the budgetary problems our country currently faces.

To that end, I bring a slightly different look at the problem. Instead of looking at "how do we pay for it", this piece from Time magazine (http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/) takes a look at "why is it so expensive to begin with".

While it does lean a bit left in the conclusions it makes at the end concerning Medicare and a single payer system, I think it takes a good deep look into the world of medical charges. It helps answer some of the questions I had when I was looking at the bills coming out of my wife's two trips to the ER last year for kidney stones. It is a lengthy read, but it is worth it whether you are left or right.

[CardiacCoug]

Yeah I liked that Time article. I spent 4 years working across the street from MD Anderson in Houston so I liked his description of the Texas Medical Center glass skyscrapers as reminiscent of Dubai. Sure seems like there's something wrong with that when people are getting fabulously wealthy off the backs of people who are sick and dying and paying tens of thousands of dollars in hope of possibly extending their life a few months in the face of cancer.

"Rescue" medical care in this country is awesome. I think people who get in car accidents, have heart attacks, have septic shock, etc. in this country generally get amazing care and have really great outcomes. Cancer care is great in this country as well. And this care is legitimately expensive, although not as expensive as hospital charges obviously.

Why is health care so expensive? Because patients don't ask (and if they ask then nobody knows the answer to the question) "How much is this going to cost?" Patients only ask, "My insurance is going to cover this, right?" Since "somebody else" is paying the costs skyrocket.

Really there are two ways to fix health care: 1. Price transparency with high-deductible insurance and the majority of costs for the majority of patients paid from health savings accounts OR 2. Single payer government health care, extending basic Medicare/Medicaid type coverage to everyone.

Option 1 would work if costs and quality/outcomes for every visit and every procedure test were mandated to be posted on the internet by every health care provider and patients paid out-of-pocket (had "skin in the game") for all this stuff. That would bring back competition and price transparency that is now sorely lacking. But I think eventually this country will work itself to Option 2 because that is where public sentiment seems to be in my experience. That's why Obama won the election. People who have no problem paying $1000 for a car repair bill are outraged if they have to pay $1000 for a medical bill. Most people don't want to take personal responsibility for the cost and quality of their own health care -- people want their taxes to pay for it and the government to regulate it tightly. And I do think that probably at the end of the day single payer government funded health care will be the most efficient and cheapest system that we could have.

[tooblue]

I am a universal health care advocate. The tax burden is heavy but, in my estimation, it is worth it. My family greatly benefits from access to universal health care. The article linked below, however, highlights some of the potential problems with the system, especially in smaller or, rural communities:

A decade of pain: The only foot surgeon in Nova Scotia has waiting list 3,500 names long

http://news.nationalpost.com/2013/02/26/a-decade-of-pain-the-only-foot-surgeon-in-nova-scotia-has-waiting-list-3500-names-long/


“I know you have to wait your turn in Canada,” Ms. Berringer says. “I understand that. But sometimes the system doesn’t seem to work for the people that need it.

“I am kind of back to full circle, back to Dr. Glazebrook, and he has a 3,500-person waiting list. I have waited over 10 years to see him and I’m not getting any younger, you know.”

[LA Ute]

Really there are two ways to fix health care: 1. Price transparency with high-deductible insurance and the majority of costs for the majority of patients paid from health savings accounts OR 2. Single payer government health care, extending basic Medicare/Medicaid type coverage to everyone.

You're right. I think. What's interesting (and frustrating/funny) is that people seem to want the choice that (1) would give them, but they don't want to pay for that choice or take responsibility for their own healthcare. Obamacare will push us towards (2), I think, and we'll be there in 20 years or less. Maybe 10.

[Mormon Red Death]

Here is an interesting tidbit. There are ~10 million people in Michigan. We are expecting that by the end of 2014 roughly 11% of all those in Michigan will be on some sort of individual health plan (IE they don't get their insurance from work). The health care exchanges are going to be a BIG game changer.

To put that in perspective. The Health Plan I work for has about 450k members of which 5k of them are individual plans (1%). If things hold up expectations then ~45k more members will be moved to Individual plans

[LA Ute]

MRD, what impact do you see health care exchanges having on the insurance markets? Here in CA the system is shaping up as a very intrusive one (no surprise).

Meawhile, here's a interesting blog post on the "volume to value" trend:

Divided Healthcare Nation (http://thehealthcareblog.com/blog/2013/02/17/divided-healthcare-nation/)

[Mormon Red Death]

MRD, what impact do you see health care exchanges having on the insurance markets? Here in CA the system is shaping up as a very intrusive one (no surprise).


As I said before they are going to be a gigantic game changer. The subsidies by the feds and state will drive how successful those exchanges are. I would expect more and more companies to just provide a subsidy and their employees go to private (and public) exchanges.

[Chad Sexington]

I watched a report on 60 minutes about six months ago, or so, and they were talking about concierge systems and how they work. Apparently, an average cost of an MRI test, as priced through a hospital and paid by risk transfer (some type of insurance), is approximately $10,000. When the same procedure was priced through a concierge system that operated on a cash basis for patients the cost was $300, for the same tests/procedures (I know that repetition is redundant, but I think this point deserves some attention). Now when I ask about medical service I always ask about cash pricing. It has made sense to pay some expenses from my pocket (MSA) and disregard annual deductible limits.

I have been happy so far with my concierge/cash approach, and have persuaded my family physician to accept cash payment for a 40% across the board reduction in cost. The only problem is that this discount does not extend to tests or procedures outside of his office, so it is an incomplete approach. Still, it's the health insurance companies driving this chaos. I also wonder what impact on the economics is produced by the legal sysytem and it's effects on doctors, hospitals and care.

I wonder if a true free market existed in health care what would be the result?

[FMCoug]

I am self employed with a $ 6000 deductible. Just brought my wife come from getting some outpatient surgery. This is gonna hurt.

But I am a middle class white guy so I have obviously got too much money anyway.

[Ma'ake]

Healthcare is an interesting market, because when people need it, they're far less likely to shop dispassionately, as you might when you're evaluating a purchase of a dishwasher, for example.

"My mother has breast cancer, and I've found a place that offers 40% off radiation treatments this month!" It doesn't quite work that way, neither does it work for emergencies, like who does price shopping for bypass operations while they're in a medical helicopter?

When there's something wrong with your body, you entire being, your existence, is at stake. And when we see the same level of distress in others, we empathize, which is why Reagan signed the law that mandates emergency rooms treat people who need emergency care, regardless of their ablity to pay. This single law has caused a great distortion in the whole market, with attendant cost shifting, the cat-and-mouse games people play when they go to the ER, etc.

If we wanted to truly incentivize the free market in healthcare, give hospitals the ablity to turn people away who don't have insurance or enough $$$$ on the spot to pay for their treatment. Sure, this will result in some people dying on the front lawns of emergency rooms, but it will send the message to everyone else that they need to have insurance, and THEN the cost shifting problem will start to evaporate.

The biggest problem with this is it's totally against what Jesus taught, and when it comes down to it, Americans have a hard time being brutally Darwinistic.

It's hard - and maybe unrealistic - to fully apply the free market to healthcare.

[BioUte]

Even if you had time, How would you price shop procedures? It's not like you can call around and say, yeah, I'm a 1978 Caucasian from Buffalo, what would you charge to replace my starter... and what if you used aftermarket parts? Complications arise during surgeries, things turn out to be worse than originally thought, procedures change on the fly. You may have multiple providers working on you (anesthesia etc), are you going to try to price shop all of them?

Most patients don't have the knowledge of what's wrong with them to do something like that. Regardless, if I have someone call me and they have a high IQ of what's going on and what they need to do a price comparison, I'm going to do my own assessment. That costs additional money, even if you bring your labs/x-rays etc.

Also, how variable do you think healthcare prices are? As variable as washing machine prices?

[Chad Sexington]

I'm not sure why a patient would have to try to bargain shop a service or procedure. There are referral networks operating now, whether it's physician or provider facilitation, it's a referral service. Concierge networks would presumably operate in the same way. So if you are now part of a gatekeeper system or hmo or whatever, you would instead be a part of a concierge network where cash is king. Your primary would still refer to specialists. The only difference is that insurers would be out of the picture, mostly.

[Mrs. Funk]

It's a clear sign to me that the system is broken that I'm having a huge internal debate as to whether to take my dehydrated toddler who has been vomiting and having diarrhea for the past 36 hours to the ER. His ashen cheeks and sunken eyes are convincing in the affirmative, but it's unfortunate that getting him an IV will set us back an arm and a leg.

Like many here, we have an independent high deductible HSA plan. The total bills for an ER visit for a head wound Mpfunk had about 6 months ago came back at around $1,800 out of pocket cost for us. And people complain that lawyers overcharge for their time! We were in ER for maybe 40 minutes.

[Mormon Red Death]

It's a clear sign to me that the system is broken that I'm having a huge internal debate as to whether to take my dehydrated toddler who has been vomiting and having diarrhea for the past 36 hours to the ER. His ashen cheeks and sunken eyes are convincing in the affirmative, but it's unfortunate that getting him an IV will set us back an arm and a leg.

Like many here, we have an independent high deductible HSA plan. The total bills for an ER visit for a head wound Mpfunk had about 6 months ago came back at around $1,800 out of pocket cost for us. And people complain that lawyers overcharge for their time! We were in ER for maybe 40 minutes.

Take him to urgent care. Much cheaper and get him some pedialite

Sent from my SGH-T999 using Tapatalk 2

[Mrs. Funk]

Take him to urgent care. Much cheaper and get him some pedialite

Sent from my SGH-T999 using Tapatalk 2

We called about 6 urgent cares. None will place an IV on a 19-month-old. The ER is our only option if we have to take him tonight. Believe me, the urgent care was our first choice. And we're all over the Pedialyte. I do appreciate your response. Thanks.

[Jarid in Cedar]

We called about 6 urgent cares. None will place an IV on a 19-month-old. The ER is our only option if we have to take him tonight. Believe me, the urgent care was our first choice. And we're all over the Pedialyte. I do appreciate your response. Thanks.

Get a teaspoon dropper. Give 5 ml of the pedialyte every 10 minutes, until no vomiting for an hour, then give 10 ml every 10 minutes until no vomiting for an hour, then give 20 ml every 15 minutes. If they vomit at any time start over at 5ml every 10 minutes. Keep doing that even if he is vomiting.

By following this protocol, you can successfully hydrate almost 90% of infants without using an IV.

Good luck!

[Mrs. Funk]

Get a teaspoon dropper. Give 5 ml of the pedialyte every 10 minutes, until no vomiting for an hour, then give 10 ml every 10 minutes until no vomiting for an hour, then give 20 ml every 15 minutes. If they vomit at any time start over at 5ml every 10 minutes. Keep doing that even if he is vomiting.

By following this protocol, you can successfully hydrate almost 90% of infants without using an IV.

Good luck!

Thanks for the advice. (And sorry for the threadjack.) The severe active vomiting was more yesterday. He's kept some liquids and a popsicle down recently so the immediate danger is lessened. Today has been 14 diarrhea blowouts. 7 loads of laundry today alone. Ugh.

[OrangeUte]

Thanks for the advice. (And sorry for the threadjack.) The severe active vomiting was more yesterday. He's kept some liquids and a popsicle down recently so the immediate danger is lessened. Today has been 14 diarrhea blowouts. 7 loads of laundry today alone. Ugh.

Little kiddos that are sick can be so draining. Ugh! I hope that gets better and u and the mr. can get some rest. It sounds like he might be on the men.

[Mrs. Funk]

Little kiddos that are sick can be so draining. Ugh! I hope that gets better and u and the mr. can get some rest. It sounds like he might be on the men.

Thanks for the good thoughts. He's getting better, yes. On the other hand, mpfunk is sick and I'm succumbing to the same plague. He'll probably be loads better tomorrow. Nothing like caring for an active, healthy child while battling cholera.

[Mormon Red Death]

Could have Patient Center Medical Home (http://www.detroitnews.com/article/20130228/OPINION01/302280331/Column-Can-return-basics-save-U-S-health-care-?odyssey=mod|newswell|text|FRONTPAGE|s) be a cost saver for the system

[LA Ute]

Jenkins: Yes, Hospital Pricing Is Insane, But Why? (http://online.wsj.com/article/SB10001424127887323978104578334082993009730.html?m od=opinion_newsreel)

It's a short but interesting piece:


"What is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?" Mr. Brill asks. But his question is rhetorical since he doesn't exhibit much urge to understand why the system behaves as it does, treating its nature as a given.

In fact, what he describes—big institutions dictating care and assigning prices in ways that make no sense to an outsider—is exactly what you get in a system that insulates consumers from the cost of their health care.

[FMCoug]

I've been thinking about this lately and am wondering if we're debating something where the ship has already sailed. Health care is so institutionalized at this point, with the costs totally separated from the consumer, that it's basically like dealing with the government. Is fighting with (insert insurance company here) any different than dealing with (insert government agency here)? Should it just be gov't / single payer and be done with it? I honestly don't know ... not trolling or proposing one thing or another. I just think that most people equate medical stuff (insurance, bills, etc.) about the same as dealing with the IRS or the like.

[LA Ute]

Here's an interesting perspective from Walter Russell Mead:
(http://blogs.the-american-interest.com/wrm/2013/03/23/medical-breakthroughs-and-smart-policy/)

"The world is in the early stages of a golden age of biotech innovation, one that has the potential to revolutionize everything from health care and manufacturing to energy production. And the biotech revolution will build on and add to the infotech revolution that has been shaking the world for the last 50 years. The 21st century will be more different from the 20th than the 20th was from the 19th. And the 22nd century will be something else again, if we don’t kill ourselves en route.


"VM never gets tired of pointing this out for one very simple reason: wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal...."


The whole blog post is worth reading.

[Mormon Red Death]

So Obamacare is going to cost a lot more than thought (http://money.msn.com/now/post.aspx?post=a95ffba3-3bdf-472b-a2ca-b4bdbab04257). Its nice that the hardest hit states are the ones who voted for Obama.


But that increase won't be felt evenly across the country because the study forecasts that some states will feel more pain than others. Among the hardest-hit will be Ohio, where claims costs will jump by almost 81%, and California, with a 62% increase.

[LA Ute]

So Obamacare is going to cost a lot more than thought (http://money.msn.com/now/post.aspx?post=a95ffba3-3bdf-472b-a2ca-b4bdbab04257). Its nice that the hardest hit states are the ones who voted for Obama.

In the words of the immortal Dan Patrick, they could've done it better.

[UtahDan]

So Obamacare is going to cost a lot more than thought (http://money.msn.com/now/post.aspx?post=a95ffba3-3bdf-472b-a2ca-b4bdbab04257). Its nice that the hardest hit states are the ones who voted for Obama.

So the upshot is this?


What does that mean for individuals? If you're already covered by your employer's plan, not much. But if you're uninsured or buy health insurance directly, the study indicates costs could rise for some people, according to The Associated Press (http://money.msn.com/health-and-life-insurance/news.aspx?feed=AP&date=20130327&id=16284705).

The linked article in the quote says this:


The Obama administration challenged the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law, such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick.

The study also doesn't take into account the potential price-cutting effect of competition in new state insurance markets that will go live Oct. 1, administration officials said.

At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can't be compared to the comprehensive coverage available under the law. "Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus," she said. "They're really mortgage protection, not health insurance."

Sebelius said the picture on premiums won't start coming into focus until insurers submit their bids. Those results may not be publicly known until late summer.

Sounds to me like the jury is still out.

[Mormon Red Death]

So the upshot is this?
The linked article in the quote says this:
Sounds to me like the jury is still out.

Well seeings how the Obama admin has such a vast history of correctly estimating costs maybe we should disregard the study. :rofl:

[LA Ute]

Well seeings how the Obama admin has such a vast history of correctly estimating costs maybe we should disregard the study. :rofl:

This is going to be a bumpy transition. Obamacare was designed by people who cut their healthcare policy teeth in the 90s (Nancy-Ann Min DeParle, for example) and they tried to update and cobble together all the "great" (unproven) ideas of that era into a massive package that still keeps people insulated from the cost of their own care and that doesn't recognize the disruptive technological breakthroughs of our own time. They are the


wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal.

http://blogs.the-american-interest.com/wrm/2013/03/23/medical-breakthroughs-and-smart-policy/

[UtahDan]

Well seeings how the Obama admin has such a vast history of correctly estimating costs maybe we should disregard the study. :rofl:

No one in government ever gets cost estimates right, seemingly. But at a minimum it at least sounds like there are several more variables to factor in that can't be quantified at this point.

[Mormon Red Death]

No one in government ever gets cost estimates right, seemingly. But at a minimum it at least sounds like there are several more variables to factor in that can't be quantified at this point.

wow... talk about giving them the benefit of the doubt. Obama and his admin underestimated the first law of insurance.


Moral Hazard: When people have insurance they use it.

[LA Ute]

Jim Lott is the executive vice president of the Hospital Association of Southern California, where he is essentially the chief “policy guy.” Here’s his latest short blog post about how California is trying to implement its insurance exchange:

http://www.hasc.org/blog-entry/covered-california-gets-creative
(http://www.hasc.org/blog-entry/covered-california-gets-creative)
The first comment to Jim’s post is an example of the more pessimistic view we hear expressed. Lots of fireworks about all this.

[UtahDan]

wow... talk about giving them the benefit of the doubt. Obama and his admin underestimated the first law of insurance.

That would be a major oversite if true given that the whole point was for people to use the insurance.

[U-Ute]

I don't think that Obamacare is anywhere near what we want to have in the long run, but he induced change into a system that was stuck in a state of "paralysis by analysis" - ie: we couldn't figure out what we wanted, so we did nothing.

This at least makes changes to help us decide what does and doesn't work.

[LA Ute]

I don't think that Obamacare is anywhere near what we want to have in the long run, but he induced change into a system that was stuck in a state of "paralysis by analysis" - ie: we couldn't figure out what we wanted, so we did nothing.

This at least makes changes to help us decide what does and doesn't work.

I think this is true. I'd be more sympathetic to Republican complaints if they had EVER taken serious steps to address the problems in the system.

[GarthUte]

I don't think that Obamacare is anywhere near what we want to have in the long run, but he induced change into a system that was stuck in a state of "paralysis by analysis" - ie: we couldn't figure out what we wanted, so we did nothing.

This at least makes changes to help us decide what does and doesn't work.

The problem is that once government gets involved, it seems damn near impossible to get government out. Obamacare was ruled constitutional as a tax and the government is hell bent on keeping taxes in place. It may reduce the rate of taxes from time to time, but how many times has a tax been repealed?

[Mormon Red Death]

That would be a major oversite if true given that the whole point was for people to use the insurance.

The point was too have insurance. Not to use it.

Sent from my SGH-T999 using Tapatalk 2

[U-Ute]

The problem is that once government gets involved, it seems damn near impossible to get government out. Obamacare was ruled constitutional as a tax and the government is hell bent on keeping taxes in place. It may reduce the rate of taxes from time to time, but how many times has a tax been repealed?

Normally I agree, but in this case, the federal government was already subsidizing hospitals to help pay for health care for people who don't have insurance. So you have already been paying that tax, but you didn't know you were paying it. Or at least you didn't know how much you were paying for it since it gets lumped in with a much larger line item in the budget.

At least this is a tax we can put a number on and know how much we are spending on it.

[GarthUte]

Normally I agree, but in this case, the federal government was already subsidizing hospitals to help pay for health care for people who don't have insurance. So you have already been paying that tax, but you didn't know you were paying it. Or at least you didn't know how much you were paying for it since it gets lumped in with a much larger line item in the budget.

At least this is a tax we can put a number on and know how much we are spending on it.

That doesn't make me feel any better. http://www.cougarstadium.com/images/smilies_custom/anger.gif

[LA Ute]

Why become a doctor? (http://thehealthcareblog.com/blog/2013/03/31/why-become-a-doctor/?utm_source=THCB+3.0&utm_campaign=81a7f03015-First_Do_Net_Harm_10_16_2012&utm_medium=email)


Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend so much time in training if your prospects are not much better? More recently, the New York Times article points out job prospects for radiology trainees are thinning, meaning the well known “ROAD” (Radiology, Ophthalmology, Anesthesiology, and Dermatology) to success may soon become a road to nowhere if there are no jobs....

[SavaUte]

I'm sure 99% of the country would happily take on $200,000 in low interest debt in return for a 6 figure salary.

So why don't more people do it?

It was a career path I considered, but decided it wasn't worth it, the 200k debt not even factoring into the decision.

[SavaUte]

Ok, I'm done being contentious. I just read part of the article linked and what I read it was talking about going into debt and all that not being worth it anymore.

[#1 Utefan]

I am a universal health care advocate. The tax burden is heavy but, in my estimation, it is worth it. My family greatly benefits from access to universal health care. The article linked below, however, highlights some of the potential problems with the system, especially in smaller or, rural communities:

A decade of pain: The only foot surgeon in Nova Scotia has waiting list 3,500 names long

http://news.nationalpost.com/2013/02/26/a-decade-of-pain-the-only-foot-surgeon-in-nova-scotia-has-waiting-list-3500-names-long/


This is foot surgery. It is also commonplace for those that need serious cardiovascular procedures such as stents, bypasses, etc. to face long waiting lists as well. I have had discussions with many US doctors over the years that have told me it isn't uncommon for them to perform these type of procedures on wealthier Canadians that have been put on 6+ month waiting lists that are concerned about dying before it is their turn. Cancer care in Canada is below US standards as well.

Universal healthcare works great for basic, primary care type of conditions such colds, flu, broken bones, etc. As you get older and need more specialized care, there are a lot of problems such as those mentioned in this article. I'm not sure many of us will be singing the Universal Healthcare model works great for me tune as we get older and find fewer specialists (oncologists, cardiologists, etc.) and need access to newer and potentially lifesaving procedures and technology.

I fear it will only be the very wealthy that will be able to afford access to top notch care in a universal healthcare system. The rest of us will have such a big tax burden, we will not have the income or means to pay for our own private insurance if we prefer.

I don't pretend to have all the answers as to how to fix the spiraling healthcare cost problem. It is a complex, multifaceted issue for which there are no easy answers. Unfortunately, I am pretty sure Obamacare has ironically accelerated the pace of rising costs considerably. I have read articles just in the past few weeks stating that insurers in many states are raising premiums 15-50% this coming year to be able to cover the costs associated with the requirements and regulations in this bill.

I would have preferred an incremental approach implementing some of the ideas already mentioned rather than the huge Obamacare overhaul and associated costs we will now be facing. Obamacare or not, tort reform and caps on punitive damages should have been a part of any healthcare reform bill IMO. While by no means the only problem contributing to out of control healthcare costs, doctors practicing defensive medicine and ordering thousands of unnecessary tests and procedures each year doesn't help the situation.

[Rocker Ute]

All hail the HDHP!

I've had a high deductible plan for about 6 years now because we are essentially non-utilizers with the occasional check-up or cold.

Last month we were worried my 2yo had broken her arm. A late night visit to the ER and a few x-rays later we found out everything was fine but I cringed at what the bill would look like. It came in at just over $100.

Two weeks ago my son is complaining about ear pain, we take him in, doc says it isn't infected. 10 days later he is screaming in pain, we take him back in, burst ear drum it is so infected. Doesn't think straight amoxicillin will do it, prescribes a stronger antibiotic that is $120.

Get the bill for the first 5 minute visit $145. Get the second bill, another $145. So we are into $400+ for an ear infection in a clinic visit, and $100 in an ER visit.

I told my wife that were it not crooked it would make financial sense for healthy people like us to drop insurance and just use the ER and our primary care provider.

Meanwhile premiums for me and my employees continue to go up 10-20% a year.

Things are bassackward in the system, and as a person formerly in health care I'm not seeing much in the Affordable Care Act that makes things more affordable for people like us not addressing the most obvious problems.

[CardiacCoug]

Why become a doctor? (http://thehealthcareblog.com/blog/2013/03/31/why-become-a-doctor/?utm_source=THCB+3.0&utm_campaign=81a7f03015-First_Do_Net_Harm_10_16_2012&utm_medium=email)

It is totally asinine when people say it's as good or even preferable to be a nurse practitioner or physician assistant instead of a physician. Completely ridiculous. What the hell kind of person wants to be subordinate and only take care of patients under the supervision of somebody else for an entire career?

I see these surveys with unhappy doctors and I honestly don't get it. Most people I work with love their job and really what's not to like? It's very meaningful and important work, great income, 100% job security unless you commit a crime. These whiny doctors who complain about their job are idiots.

[Jarid in Cedar]

It is totally asinine when people say it's as good or even preferable to be a nurse practitioner or physician assistant instead of a physician. Completely ridiculous. What the hell kind of person wants to be subordinate and only take care of patients under the supervision of somebody else for an entire career?

I see these surveys with unhappy doctors and I honestly don't get it. Most people I work with love their job and really what's not to like? It's very meaningful and important work, great income, 100% job security unless you commit a crime. These whiny doctors who complain about their job are idiots.

Fully agree. It isn't for everyone, but i wouldn't do anything different for many of the reasons stated by cardiac, and several others he hasn't listed:

Live just about anywhere you could desire.
Many other pathways for a career besides clinical work.
Instant excuse for any traffic violation.

[CardiacCoug]

Fully agree. It isn't for everyone, but i wouldn't do anything different for many of the reasons stated by cardiac, and several others he hasn't listed:

Live just about anywhere you could desire.
Many other pathways for a career besides clinical work.
Instant excuse for any traffic violation.

Yep. I saw some survey recently that said something like 70% of physicians say they were underpaid and believe they would have made more money in a non-medical field. Made me wonder what kind of fantasy world those docs are living in.

Another huge intangible benefit of being a physician is being able to help family members and friends with health problems and figuring out the health care system and which docs to see. I could go on and on about how happy I am with my career. From time to time I have undergrad students who want to hang out with me and when I tell them how great my job is they usually say something like, "Really? Every other doctor is telling my how horrible it is and how much they regret their career choice." I find it totally bizarre how negative a lot of docs are. Just proves that no matter how good people have it it's still easy for so many people to wallow in misery.

[jrj84105]

Healthcare is an interesting market, because when people need it, they're far less likely to shop dispassionately, as you might when you're evaluating a purchase of a dishwasher, for example.

"My mother has breast cancer, and I've found a place that offers 40% off radiation treatments this month!" It doesn't quite work that way, neither does it work for emergencies, like who does price shopping for bypass operations while they're in a medical helicopter?

When there's something wrong with your body, you entire being, your existence, is at stake. And when we see the same level of distress in others, we empathize, which is why Reagan signed the law that mandates emergency rooms treat people who need emergency care, regardless of their ablity to pay. This single law has caused a great distortion in the whole market, with attendant cost shifting, the cat-and-mouse games people play when they go to the ER, etc.

If we wanted to truly incentivize the free market in healthcare, give hospitals the ablity to turn people away who don't have insurance or enough $$$$ on the spot to pay for their treatment. Sure, this will result in some people dying on the front lawns of emergency rooms, but it will send the message to everyone else that they need to have insurance, and THEN the cost shifting problem will start to evaporate.

The biggest problem with this is it's totally against what Jesus taught, and when it comes down to it, Americans have a hard time being brutally Darwinistic.

It's hard - and maybe unrealistic - to fully apply the free market to healthcare.

Exactly this (I think I've posted almost an identical description before). As long as the mandated ER provision is in place, universal/single payer health care will be the eventual outcome.

Healthcare is incredibly complex and virtually every physician, outside her own area of expertise, is poorly equipped to make her own personal acute health care decisions. The lay public is even worse off to the extent that individuals can rarely make TIMELY informed Heath care decisions despite best attempts to explain benefits risks, etc. The huge market for quackery and health care fraud is further evidence that self educated health consumers tend to make VERY POOR decisions with their discretionary health care spending even in non-acute settings.

there are however some very generalize able and easily learned lifestyle modifications and preventive care actions that could be incentivized effectively in a single payer system with substantial reductions to the largest contributors to overall costs (I.e diabetes/cardiovascular disease/effective cancer screening programs).

[jrj84105]

Not to mention fellow ward members!

My wife and I find that to be unethical. My wife won't fill RXs for those that do. I'm surprised many docs are still willing to take the medicolegal risk (I've seen a few bad mistakes by friends/neighbors dabbling outside of their specialty or after they were effectively retired). Fortunately, I can just tell friends/relatives to see their regular physician or check back with me when they're dead (pathologist humor).

[CardiacCoug]

My wife and I find that to be unethical. My wife won't fill RXs for those that do. I'm surprised many docs are still willing to take the medicolegal risk (I've seen a few bad mistakes by friends/neighbors dabbling outside of their specialty or after they were effectively retired). Fortunately, I can just tell friends/relatives to see their regular physician or check back with me when they're dead (pathologist humor).
Is your wife a pharmacist or something?

I find her refusal to fill a valid prescription unethical. She won't fill one if a doc wrote it for a ward member? Bizarre. How does she determine something like that?

[jrj84105]

There are some differences state-to-state but it is pretty much universally within the pharmacist's discretion. In some state's law such a prescription-for a family member and especially for controlled substances- is NOT a valid prescription.

generally, the distinction would be (assuming you're a cardiologist) that a prescription for atenolol would be filled, but if you wrote for adderall, OxyContin, etc for your wife, she would decline to fill because you would be prescribing controlled substances outside of your practice setting in a situation with a high probability of diversion (writing a bogus RX for a spouse/household member is a good/common way for drug addicted docs to divert- really this is the main reason why docs should avoid this practice).

[CardiacCoug]

There are some differences state-to-state but it is pretty much universally within the pharmacist's discretion. In some state's law such a prescription-for a family member and especially for controlled substances- is NOT a valid prescription.

generally, the distinction would be (assuming you're a cardiologist) that a prescription for atenolol would be filled, but if you wrote for adderall, OxyContin, etc for your wife, she would decline to fill because you would be prescribing controlled substances outside of your practice setting in a situation with a high probability of diversion (writing a bogus RX for a spouse/household member is a good/common way for drug addicted docs to divert- really this is the main reason why docs should avoid this practice).

Sure, it would be idiotic for a doc to try to prescribe a controlled substance for a family member. That has nothing to do with writing scripts for ward members with medical problems, which was the post you responded to calling it unethical.

[U-Ute]

All hail the HDHP!

I've had a high deductible plan for about 6 years now because we are essentially non-utilizers with the occasional check-up or cold.

Last month we were worried my 2yo had broken her arm. A late night visit to the ER and a few x-rays later we found out everything was fine but I cringed at what the bill would look like. It came in at just over $100

It's only been a month and you've only received one bill? I wouldn't exhale yet. By my reckoning, you should receive 3: hospital, ER doctor, and radiologist.

When my wife went into the ER for kidney stones last year, it took about 3 hours to schedule the CT scanner, perform the CT scan, and to have someone read it (we didn't know it was kidney stones when we walked in). Roughly the same routine your boy received. We were occupying an ER bay during the whole process.

IIRC, the bill from the hospital to the insurance company charged around $2000 just for the ER bay usage - or roughly $700-$800 an hour. The total bill was around $4000. I think another $1000 was the CT scan, and the rest was ER doctor, radiologist, and IV medications (pain management, hydration, flomax, etc), and miscellaneous.

Buy far the most reasonable were the bills from the doctors themselves. Somewhere in the neighborhood of $500 combined I think.

[mUUser]

When my wife went into the ER for kidney stones last year,....


Bless her everlovin' heart. Once you've had one kidney stone, there's no mistaking the second one, and will save you lots of time and loot on a diagnosis.

[U-Ute]

Yeah, she had another one a few months later. :(

Nothing since then, thank heavens.

[LA Ute]

The reality of implementing the Affordable Care Act is sinking in. (http://washingtonexaminer.com/democrats-have-doubts-about-obamacare-too/article/2526351)


President Obama is eager to build public support for his health care overhaul in the few months remaining before its implementation, but waning enthusiasm from Democrats threatens his effort right out of the gate.


Two-thirds of Democrats now believe Obama's health care reforms will either hurt them personally or have no effect on their daily lives, a Quinnipiac University poll released Thursday shows. In comparison, just 27 percent of Democratic respondents said the reforms would help them.

I don't mean this as a political comment, because the law is the reality now and isn't going to be repealed. It is full of problems, however (largely because of the way it was rammed through -- OK, there's my political comment!) and we are going to have to fix those as we put this thing into action. There are going to be lots of bumps in the road.

[jrj84105]

Sure, it would be idiotic for a doc to try to prescribe a controlled substance for a family member. That has nothing to do with writing scripts for ward members with medical problems, which was the post you responded to calling it unethical.

Real life example of more banal Rx for acquaintance:
Antibiotics RX'd for minor infection to teen girl by family friend. Teen girl did not reveal that she was sexually active and also taking OCP (being filled at pharmacy different than family pharmacy). Girl gets pregnant. Successfully sues pharmacist for child support for not counseling concerning drug interaction (OCP was not in med profile). Family friend who wrote the RX was not sued.

Do you take a complete medication and drug history prior to writing for ward members? After the fact, do you inform the primary provider that script was written so that the med profile can be updated? Do you review pertinent laboratory data when available? Do you chart the interaction so that it is part of the patient's medical record and available for review by the insurer or future treating physicians? If not, then you are bypassing systems for safety and accountability which is unethical.

[CardiacCoug]

Real life example of more banal Rx for acquaintance:
Antibiotics RX'd for minor infection to teen girl by family friend. Teen girl did not reveal that she was sexually active and also taking OCP (being filled at pharmacy different than family pharmacy). Girl gets pregnant. Successfully sues pharmacist for child support for not counseling concerning drug interaction (OCP was not in med profile). Family friend who wrote the RX was not sued.

Do you take a complete medication and drug history prior to writing for ward members? After the fact, do you inform the primary provider that script was written so that the med profile can be updated? Do you review pertinent laboratory data when available? Do you chart the interaction so that it is part of the patient's medical record and available for review by the insurer or future treating physicians? If not, then you are bypassing systems for safety and accountability which is unethical.

Teenage girl successfully sues pharmacist for child support because she got pregnant while secretly taking an OCP and an antibiotic at the same time? Huh? Lawyers can we get a ruling on this? Pretty sure neither doctor nor pharmacist gives any guarantee of 100% efficacy of any OCP and why on earth would they be responsible when the patient is lying to them about her sexual activity and OCP? I'm not buying it. Sounds like a made up story to scare pharmacy students or med students to me.

Obviously a doctor should ask about allergies and other pertinent medications before writing a script. The rest of that advice is good in an ideal situation but "unethical" is a pretty strong word to throw around in those cases I think. People buy meds in Mexico and Canada all the time -- ultimately it's the patient's responsibility to keep his docs informed and to know what he is putting in his body.

[CardiacCoug]

I've been given a prescription by a family member twice. I was very grateful each time. Each time I saved much time and money and possibly health. I've also had a doctor in the ward give a prescription for my daughter. There was nothing unethical about it. Just someone giving a little of his time and talents. That's one small part of what makes Mormons a community.

There are a lot of people who tell med students and residents they will get sued if they give a neighbor medical advice or prescribe an antibiotic for them. That always seemed ridiculous to me.

[Virginia Ute]

I hear these kinds of sentiments from doctors regularly. And the doctors I hear them from are all very wealthy. Med school is still one of the surest paths to wealth that we have. I'm sure 99% of the country would happily take on $200,000 in low interest debt in return for a 6 figure salary.

I agree with your sentiment, but with one correction: that debt is not low interest. Student loans for med school are around 7-8%, depending on the type of loan. That interest starts to accrue from day 1 of school, and some don't start paying it off until 6-10 years later when they're done with residency. That's a lot of money.

I agree with you, though, still a pretty good investment.

[LA Ute]

I listened to a presentation yesterday by a human resources/benefits consultant and can confirm that based on what he taught us, this guy is absolutely right:

To sign up for Obamacare, start filling out the forms now and hire a good accountant (http://www.forbes.com/sites/scottgottlieb/2013/04/03/to-sign-up-for-obamacare-start-filling-out-the-forms-now-and-hire-a-good-accountant/)

As presently structured, on a consumer and employer level this is going to be a nightmare. I am hoping that pushback from the public will get the government to simplify the process. I am doubtful that my hopes will be realized.

[U-Ute]

Why chemotherapy that costs $70,000 in the U.S. costs $2,500 in India.

The battle for how we pay for pharmaceuticals. (http://www.theatlantic.com/health/archive/2013/04/why-chemotherapy-that-costs-70000-in-the-us-costs-2500-in-india/274847/)

Nothing new, but it highlights the gap between the U.S. and developing nations, and dives into how they are working to keep costs low.

[FMCoug]

I have been thinking about this and had a thought which would make a big difference to all income earning taxpayers.

Make all health care expenses 100% tax deductible. No limits, no phasing out based on income, etc. Include everything. Insurance premiums, co-pays, prescriptions, etc.

[NorthwestUteFan]

That was a large part of John McCain's plan. He wanted to take away the deduction from employers and give it directly to the consumers. (Strictly speaking he wanted to give consumers a $5000 tax credit, but for most people in most years that would be preferable to a 100% tax deduction).

[LA Ute]

For those who saw the news stories about hospital pricing, this is a very smart breakdown of what really is happening.

The Rest of the Story about Hospital Pricing (http://thehealthcareblog.com/blog/2013/05/09/the-rest-of-the-story-about-hospital-pricing/)

[Diehard Ute]

Sorta. Medicare actually tells the hospital what percentage of the charge they'll actually pay, and the hospital has to say ok.

[LA Ute]

Sorta. Medicare actually tells the hospital what percentage of the charge they'll actually pay, and the hospital has to say ok.

Correct. But the hospitals, until now, have made up the difference by charging private insurance and health plans more. I think Medicare covers about 80% of the cost of care, Medicaid much less.

[Diehard Ute]

Correct. But the hospitals, until now, have made up the difference by charging private insurance and health plans more. I think Medicare covers about 80% of the cost of care, Medicaid much less.

Try 60%

Medicaid is 40% or so in Utah.

The reality is whatever Medicare sets their prices at is the starting point for negotiations with everyone else. The government is in control of a lot more than they want you to believe. (I worked in billing at the U before going to the force)

Best paying "insurance" in Utah? Utah State Prison.

[LA Ute]

Try 60%

Medicaid is 40% or so in Utah.

The reality is whatever Medicare sets their prices at is the starting point for negotiations with everyone else. The government is in control of a lot more than they want you to believe. (I worked in billing at the U before going to the force)

Best paying "insurance" in Utah? Utah State Prison.

LOL. True in CA too. The inmates get very good care. And it's free!

[Mormon Red Death]

Try 60%

Medicaid is 40% or so in Utah.

The reality is whatever Medicare sets their prices at is the starting point for negotiations with everyone else. The government is in control of a lot more than they want you to believe. (I worked in billing at the U before going to the force)

Best paying "insurance" in Utah? Utah State Prison.

one quibble... the best paying insurance is auto... meaning you get in an accident that requires health care due to the accident they pay 100% of charges.

[Mormon Red Death]

Correct. But the hospitals, until now, have made up the difference by charging private insurance and health plans more. I think Medicare covers about 80% of the cost of care, Medicaid much less.

the problem with that statistic is "cost of care". Better way to explain it is Medicare pays about 26% of charges. Insurances around 34-35. Medicaid is 19-20

[Diehard Ute]

one quibble... the best paying insurance is auto... meaning you get in an accident that requires health care due to the accident they pay 100% of charges.

Perhaps. But that is a rare instance. I worked in billing for 7 clinics in the hospital, all of which scheduled multiple inpatient stays a week, never once dealt with auto insurance.

Even in the ER it's somewhat uncommon. I investigate a lot of accidents. Maybe 10% require treatment at a hospital

[Mormon Red Death]

Perhaps. But that is a rare instance. I worked in billing for 7 clinics in the hospital, all of which scheduled multiple inpatient stays a week, never once dealt with auto insurance.

Even in the ER it's somewhat uncommon. I investigate a lot of accidents. Maybe 10% require treatment at a hospital

about as often as prison care woudn't you say?

[Diehard Ute]

about as often as prison care woudn't you say?

Nope. I saw prisoners several times a week. They were quite common.

[San Diego Ute Fan]

Nope. I saw prisoners several times a week. They were quite common.

In California, state prison inmates get best of the best healthcare carte blanche. During the 5 years of my wife's cancer treatments I personally witnessed this. This was at Moores Cancer Center at UCSD, a top 50 center in the U.S. There were one or more of these prisoners EVERY time we went.

Note that each inmate was transported by two paramedics; and two state guards, all of whom would accompany said inmates during every minute of every hour at the center. I can only imagine the cost. I spoke to many of the guards and paramedics. They were pretty put off that the inmates were afforded this level of care. Many of the prisoners were convicted murderers.

[Diehard Ute]

In California, state prison inmates get best of the best healthcare carte blanche. During the 5 years of my wife's cancer treatments I personally witnessed this. This was at Moores Cancer Center at UCSD, a top 50 center in the U.S. There were one or more of these prisoners EVERY time we went.

Note that each inmate was transported by two paramedics; and two state guards, all of whom would accompany said inmates during every minute of every hour at the center. I can only imagine the cost. I spoke to many of the guards and paramedics. They were pretty put off that the inmates were afforded this level of care. Many of the prisoners were convicted murderers.

In Utah all care for both the Utah State Prison and Salt Lake County Jail occurs at The University of Utah Medical Center.

Now, they do take much of the basic care to the prison, and they do some consuls via video.

The jail has nurses and doctors (on call), but serious things do come to the hospital.

Inmates who are transported have 2 guards. This changed as I was leaving due to Curtis Algier killing his guard at a U clinic and leading SLCPD on a chase after.

There are no medics.

Healthcare for people accused or convicted is an interesting issue I see from the law enforcement side now. I have a lot to say, but can't.

[U-Ute]

For those who saw the news stories about hospital pricing, this is a very smart breakdown of what really is happening.

The Rest of the Story about Hospital Pricing (http://thehealthcareblog.com/blog/2013/05/09/the-rest-of-the-story-about-hospital-pricing/)

I guess I didn't catch the "rest of the story" portion of this.

As he said, the Medicare pricing has been known for a long time. So nothing new there.

The only bit of new information was an unsubstantiated prediction that as people ask for pricing information, the market will follow. Well, that is dependent on some provider making the first leap. Making that first leap doesn't necessarily lend itself to new customers as they will have relatively solid numbers on what it will cost at hospital A, whereas hospitals B, C, and D won't tell you. It could be more. It could be less. Either way, it is a total crapshoot and doesn't really help in decision making, and it probably doesn't help hospital A one bit as I believe the sticker shock from hospital A will probably drive them to B, C, or D, not knowing that the prices are just as high.

Until a third actually mines this information and makes it public, it is rather pointless. Given HIPPAA regulations, the chances of this happening are pretty slim.

Because of the discussion here, last month I tried asking Primary Children's how an endoscope procedure on my son would cost. They couldn't tell me. What do I do? Tell them no?

[LA Ute]

So does Congress want an Obamacare waiver?

http://live.wsj.com/video/opinion-congress-wants-an-obamacare-waiver/92D57CDF-3CAA-45BB-A6CA-33C7E986F610.html?mod=WSJ_article_outbrain&obref=obnetwork#!92D57CDF-3CAA-45BB-A6CA-33C7E986F610

Looks like some of them do.

[Diehard Ute]

So does Congress want an Obamacare waiver?

http://live.wsj.com/video/opinion-congress-wants-an-obamacare-waiver/92D57CDF-3CAA-45BB-A6CA-33C7E986F610.html?mod=WSJ_article_outbrain&obref=obnetwork#!92D57CDF-3CAA-45BB-A6CA-33C7E986F610

Looks like some of them do.

They already treat themselves better than the common folk employees. I'm sure they'll find a way to make their healthcare better too.

[LA Ute]

They already treat themselves better than the common folk employees. I'm sure they'll find a way to make their healthcare better too.

Some have the right attitude. Richard Burr, one of North Carolina's senators: “I have no problems with Congress being under the same guidelines,” Burr said. “I think if this is going to be a disaster — which I think it’s going to be — we ought to enjoy it together with our constituents.”

Read more: http://www.politico.com/story/2013/04/obamacare-exemption-lawmakers-aides-90610_Page2.html#ixzz2TNN3kPEu

[Diehard Ute]

Some have the right attitude. Richard Burr, one of North Carolina's senators: “I have no problems with Congress being under the same guidelines,” Burr said. “I think if this is going to be a disaster — which I think it’s going to be — we ought to enjoy it together with our constituents.”

Read more: http://www.politico.com/story/2013/04/obamacare-exemption-lawmakers-aides-90610_Page2.html#ixzz2TNN3kPEu


Just like the few (such as Matheson) who try to stop the yearly pay raise.

Sadly they're few and far between

[GarthUte]

Because the IRS will be in charge of enforcing Obamacare, this is something to worry about:

http://www.courthousenews.com/2013/03/14/55707.htm

[U-Ute]

So Obamacare is going to cost a lot more than thought (http://money.msn.com/now/post.aspx?post=a95ffba3-3bdf-472b-a2ca-b4bdbab04257). Its nice that the hardest hit states are the ones who voted for Obama.

So far, that does not seem to be the case.

Obamacare premiums in California lower than predicted (http://money.cnn.com/2013/05/23/news/economy/california-obamacare-premiums/)

[LA Ute]

So far, that does not seem to be the case.

Obamacare premiums in California lower than predicted (http://money.cnn.com/2013/05/23/news/economy/california-obamacare-premiums/)

It's early yet.

[LA Ute]

There is more to the California story.

Rate Shock and Awe in California (http://thehealthcareblog.com/blog/2013/05/28/california-rate-shock-and-awe/)
I have to say I was surprised with the press reports last week that there wasn’t “rate shock” in California when the California exchange offered preliminary information about their new plans and rates. At least one prominent health actuarial group had predicted a 30% baseline increase in costs for California’s new health insurance exchange plans under the Affordable Care Act (ObamaCare”). As the director of the California exchange put it (http://www.latimes.com/business/la-fi-calif-health-rates-20130524,0,7036553.story), “These rates are way below the worst-case gloom-and-doom scenarios we have heard.”


But a few days later there is lots more information coming out and it would appear we have a case of apples to oranges to grapefruit. And, we have a pretty good case of rate shock....

[GarthUte]

There is more to the California story.

Rate Shock and Awe in California (http://thehealthcareblog.com/blog/2013/05/28/california-rate-shock-and-awe/)



So, because the new health law will outlaw many of the existing plans, it would seem that many won't be able to keep their existing plan. And folks may not be able to keep their doctor. More Obama lies. No surprise.

And isn't it great that people will be denying consumers a choice? Wow! No wonder the jackasses who forced this on the American people are trying to find a way to opt out of it.

And as if it wasn't enough, taxes will go up. Hooray nationalized health care!

[Irving Washington]

In California, state prison inmates get best of the best healthcare carte blanche. During the 5 years of my wife's cancer treatments I personally witnessed this. This was at Moores Cancer Center at UCSD, a top 50 center in the U.S. There were one or more of these prisoners EVERY time we went.

Note that each inmate was transported by two paramedics; and two state guards, all of whom would accompany said inmates during every minute of every hour at the center. I can only imagine the cost. I spoke to many of the guards and paramedics. They were pretty put off that the inmates were afforded this level of care. Many of the prisoners were convicted murderers.

Unfortunately, the mental health care in the California correctional systems is abysmal. I believe that the Los Angeles County Jail (?) is one of the largest mental health care providers in the USA and its mental health care system is notoriously bad. The MH care at the Utah State prison is inadequate and often when inmates act out, and the behavior is a product of their MI, they are placed in 23 hour lockdown at Uintah 1 and receive minimal mental health treatment. The Uintah units are the most secure units at the Draper prison.

[Irving Washington]

I listened to a presentation yesterday by a human resources/benefits consultant and can confirm that based on what he taught us, this guy is absolutely right:

To sign up for Obamacare, start filling out the forms now and hire a good accountant (http://www.forbes.com/sites/scottgottlieb/2013/04/03/to-sign-up-for-obamacare-start-filling-out-the-forms-now-and-hire-a-good-accountant/)

As presently structured, on a consumer and employer level this is going to be a nightmare. I am hoping that pushback from the public will get the government to simplify the process. I am doubtful that my hopes will be realized.
What seems to be missing from this thread is the discussion of the balance between a system that is less costly for those who can presently access it v. a system that is open to all that need it. Everything government costs money. The question is whether it is appropriate, and whether the cost meets the objective. I think everyone here feels that adequate health care is critical, and everyone should have access to it. As a number of you have pointed out, it is unclear whether it will cost much more than the legislation predicts. Given the incredible need, we should at least see whether or not it is cost prohibitive. The data from California is encouraging, if not complete. Medicare Part C was confusing as hell at first, and may still be so, but it is working, and I doubt there are many seniors who wish it was never created.

[LA Ute]

What seems to be missing from this thread is the discussion of the balance between a system that is less costly for those who can presently access it v. a system that is open to all that need it. Everything government costs money. The question is whether it is appropriate, and whether the cost meets the objective. I think everyone here feels that adequate health care is critical, and everyone should have access to it. As a number of you have pointed out, it is unclear whether it will cost much more than the legislation predicts. Given the incredible need, we should at least see whether or not it is cost prohibitive. The data from California is encouraging, if not complete. Medicare Part C was confusing as hell at first, and may still be so, but it is working, and I doubt there are many seniors who wish it was never created.

I have knowledgeable friends and colleagues (with deep health care industry experience) who are on both sides of Obamacare. A few think it is going to be wonderful, and a few think it will be a total disaster. The great majority in the middle seem to think it is a mess simply by virtue of its sheer size and complexity, and recognize that as presently designed it simply will not work. As Obamacare is implemented it will have to be tweaked in major and minor ways -- some of which we can anticipate now, and some of which we haven't even discovered yet. I'm in that middle group. We would be looking at big bumps in the road and hiccups anyway, with any policy change this massive, but in this case the outrageous way the legislation was written and enacted ensures even more of that. (That last sentence is my own opinion.)

[GarthUte]

More info on the cost of health insurance in California: http://www.forbes.com/sites/theapothecary/2013/05/30/rate-shock-in-california-obamacare-to-increase-individual-insurance-premiums-by-64-146/

[GarthUte]

I wonder if we're going to see more doctors do what this doctor has done in Maine.

Prices for services provided. (http://www.ciampifamilypractice.com/Our_Prices.html)

Of course, if one needs major surgery, is there some sort of catastrophic insurance to cover that kind of care available? I'm not familiar enough with all of this to know the answer, but I will admit that I like the idea of paying the doc out of pocket for services rendered.

[U-Ute]

I wonder if we're going to see more doctors do what this doctor has done in Maine.

Prices for services provided. (http://www.ciampifamilypractice.com/Our_Prices.html)

Of course, if one needs major surgery, is there some sort of catastrophic insurance to cover that kind of care available? I'm not familiar enough with all of this to know the answer, but I will admit that I like the idea of paying the doc out of pocket for services rendered.

The problem isn't the doctors. Its the hospitals.

[pangloss]

The problem isn't the doctors. Its the hospitals.

How about the 30% for administrative and general expenses and profits?

[Mormon Red Death]

The problem isn't the doctors. Its the hospitals.

the problem is the whole system. for starters 85 - 90% of all health care is not an "insurable" event meaning that you pay your premium to insure against a catastrophic event.

[LA Ute]

Oh, brother. Many congressional aides and even some members of Congress may leave because they're going to have to get health insurance the same way everyone else will - under the Affordable Care Act. There's even some talk about fixing this "problem" so they can keep their generous health bennies under the FEHP. I like to think they wouldn't dare do that, but that would be naive.

http://www.politico.com/story/2013/06/obamacare-lawmakers-health-insurance-92691.html

[GarthUte]

The Death Panel? (http://online.wsj.com/article/SB10001424127887324634304578539823614996636.html)

[Rocker Ute]

Anybody know when the 'affordable' part of the Affordable Care Act is going to kick in? Another near 20% premium hike for a group of essentially non-users. We are up about 78% from 5 years ago when I started my business. WSJ has an article today about individual low-utilizers on the health exchange programs will likely be hit hard, with high risk seeing decreased rates. We're seeing it on a group plan today. Oh, did I mention our insurance sucks too, with an extremely high deductible?

This recent rate increase actually probably priced us out of hiring another person in the near term that we desperately need. Maybe we'll have to see how desperate we are for them.

The cold realization of the effects of this plan are coming to life for a lot of people. A good friend of mine and an avid Obama supporter is looking for work and can only find jobs hiring for less than 29 hours and no benefits. She admits that she would happily like the choice to take a full-time job and feed her family instead. It sucks when the effects of this stuff start hitting real people on the street.

While I get that costs are going to go up as the risk pool gets riskier, and while I'm for them having access to care, it all seems bass-ackwards to me.

[LA Ute]

Anybody know when the 'affordable' part of the Affordable Care Act is going to kick in? Another near 20% premium hike for a group of essentially non-users. We are up about 78% from 5 years ago when I started my business. WSJ has an article today about individual low-utilizers on the health exchange programs will likely be hit hard, with high risk seeing decreased rates. We're seeing it on a group plan today. Oh, did I mention our insurance sucks too, with an extremely high deductible?

This recent rate increase actually probably priced us out of hiring another person in the near term that we desperately need. Maybe we'll have to see how desperate we are for them.

The cold realization of the effects of this plan are coming to life for a lot of people. A good friend of mine and an avid Obama supporter is looking for work and can only find jobs hiring for less than 29 hours and no benefits. She admits that she would happily like the choice to take a full-time job and feed her family instead. It sucks when the effects of this stuff start hitting real people on the street.

While I get that costs are going to go up as the risk pool gets riskier, and while I'm for them having access to care, it all seems bass-ackwards to me.


http://www.youtube.com/watch?v=3tTgr3fG_tg

[U-Ute]

http://www.bostonglobe.com/business/2013/06/30/americans-pay-world-highest-prices-for-childbirth/CjybahT28CqVSCUoqatdfK/story.html

It seems like the biggest problem is cost transparency with anything hospital related.

[LA Ute]

http://blogs.wsj.com/peggynoonan/2013/08/13/the-high-cost-of-obamacare/


Four points. First, no mother or child should be put in this position by a government ostensibly trying to improve their lives. Second, everyone in America knows health care is a complicated and complex subject, that a national bill will have 10 million moving parts, and that when a government far away—that would be Washington, D.C.—decides to take greater control of the nation’s health care it will likely get many, maybe a majority, of the moving parts wrong. A bill that is passed and is meant to do A will become Law U—a law of unforeseen, unplanned and unexpected consequences. And that’s giving Washington the benefit of the doubt, and assuming they really meant to honestly produce Law A. Third, because health-care legislation is so complex, it is almost impossible for people to understand it, to get their arms around what may be a given bill’s inadequacies and structural flaws. Stories of those inadequacies and flaws dribble out day by day, in stories like this one. They produce a large negative blur, and a feeling of public anxiety: What will we find out tomorrow? The administration reacts, as the president has, with protestations about how every large, life-enhancing bill has hitches and bumps along the way. But this thing looks now like one large hitch, one big and never ending bump. Fourth, when a thousand things have to be changed about a law to make it workable, some politician is going to stand up and say: “This was a noble effort in the right direction but let’s do the right thing and simplify everything, with a transparent and understandable plan: single payer.” Will that be Mrs. Clinton’s theme in 2016?

[LA Ute]

733

[LA Ute]

10 Ways Obamacare Isn’t Working (http://blog.heritage.org/2013/09/09/morning-bell-10-ways-obamacare-isnt-working/)

1. WAIVERS: The Administration established a legally questionable program of temporary waivers (http://www.cms.gov/CCIIO/Resources/Files/approved_applications_for_waiver.html) when firms announced they were considering dropping coverage (http://online.wsj.com/article/SB10001424052748703431604575522413101063070.html) rather than comply with the law’s costly requirements. Even though more than half of the recipients of these waivers (http://www.cms.gov/CCIIO/Resources/Files/approved_applications_for_waiver.html) were members of union plans, many union leaders are still not satisfied (http://thehill.com/business-a-lobbying/319685-labor-frustration-boils-over-with-president-on-obamacare)—they want another waiver (http://www.realclearpolitics.com/articles/2013/08/30/labor_leaders_wh_discuss_obamacare_fixes.html), to receive taxpayer-funded subsidies for their employer-provided coverage.


2. ILLEGAL TAXPAYER SUBSIDIES FOR CONGRESS: Last month, following heavy lobbying from leaders in both parties (http://dyn.politico.com/printstory.cfm?uuid=5A754D54-0FCE-4974-9155-C283E89AF9E3)—and an intervention from President Obama himself (http://www.politico.com/story/2013/07/obama-hill-health-care-dispute-95017.html)—the Administration issued a rule (http://www.gpo.gov/fdsys/pkg/FR-2013-08-08/pdf/2013-19222.pdf) regarding coverage for Members of Congress and their staffs, who will retain their taxpayer-funded insurance subsidies in the exchanges. Unfortunately, as previous research (http://www.heritage.org/research/reports/2013/08/congress-in-the-obamacare-trap-no-easy-escape) has documented, the Administration had no legal basis on which to make this ruling.


3. EMPLOYER MANDATE: In July, the Administration announced (http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx) it would not enforce Obamacare’s employer mandate until 2015, effectively granting big business a one-year delay (http://blog.heritage.org/2013/07/02/its-official-administration-admits-obamacares-a-job-killer/). This action came despite language in Section 1514(d) of the law (http://housedocs.house.gov/energycommerce/ppacacon.pdf) requiring employers to act “beginning after December 31, 2013,” and despite the fact that hard-working Americans are not getting a delay from the other harmful effects of Obamacare.


4. PRE-EXISTING CONDITIONS: Immediately after Obamacare was signed, Democratic staffers admitted (http://www.huffingtonpost.com/2010/03/24/health-care-protection-children_n_510868.html) that under the law as written, insurers “still would be able to refuse new coverage to children because of a pre-existing medical problem.” The Department of Health and Human Services (HHS) took it upon itself to issue regulations (http://www.regulations.gov/#%21documentDetail;D=HHS-OS-2010-0014-0001) prohibiting plans from turning down such applicants three years earlier than the law required. As a result, insurers stopped offering child-only plans in 17 states (http://www.help.senate.gov/imo/media/doc/Child-Only%20Health%20Insurance%20Report%20Aug%202,%2020 11.pdf), fearing that only parents of sick children would apply for insurance coverage.


5. OUT-OF-POCKET CAPS: Section 1302(c)(1) of the law (http://housedocs.house.gov/energycommerce/ppacacon.pdf) includes caps on out-of-pocket expenses and explicitly states they are to take effect “beginning in 2014.” But earlier this year, the Administration delayed these new caps from taking effect as scheduled. What’s more, as The New York Times reported (http://www.nytimes.com/2013/08/13/us/a-limit-on-consumer-costs-is-delayed-in-health-care-law.html?pagewanted=all&_r=0), the Administration made this unilateral change not by issuing rules subject to public comment, but by posting a series of questions and answers (http://www.dol.gov/ebsa/faqs/faq-aca12.html) on an obscure website.


6. BASIC HEALTH PLAN: This government-run health plan for people above the Medicaid income level was created in Section 1331 of Obamacare (http://housedocs.house.gov/energycommerce/ppacacon.pdf) as a way to promote “state flexibility,” but the Administration unilaterally delayed (http://capsules.kaiserhealthnews.org/index.php/2013/02/hhs-delays-basic-health-plan-option-until-2015/) it for one year. One Democratic Senator criticized (http://www.youtube.com/watch?v=vee4UdW_u-8) the Administration for this move, saying it does not “live up” to the law as written.


7. TAX DISCLOSURES: Section 9002 of Obamacare (http://housedocs.house.gov/energycommerce/ppacacon.pdf) requires employers to report the value of workers’ health insurance on W-2 filings, effective for all “taxable years after December 31, 2010.” But the Administration unilaterally delayed (http://www.irs.gov/pub/irs-drop/n-2010-69.pdf) this requirement, and employers did not have to report these data until after the 2012 presidential election.


8. HONOR SYSTEM: In July, the Administration announced (http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf) it was placing most Americans on the “honor system (http://www.reuters.com/article/2013/07/05/us-usa-healthcare-exchanges-idUSBRE96402X20130705)” when it came to verifying their income and access to employer-provided health coverage. As prior research has documented (http://blog.heritage.org/2013/07/29/how-the-obamacare-honor-system-will-encourage-fraud/), this move, coupled with loopholes written into the law, gives many Americans a strong incentive to “game the system” and obtain more in taxpayer-funded insurance subsidies than they should actually receive.


9. PRIVACY: Former HHS General Counsel Michael Astrue, when serving as Commissioner of Social Security earlier this year, complained strongly (http://www.weeklystandard.com/print/articles/privacy-be-damned_741033.html) within the Administration about the security risks posed by Obamacare’s new data hub. However, the Administration overrode his objections, using what Astrue called “an absurdly broad interpretation of the Privacy Act’s ‘routine use’ exemption.”


10. TOBACCO PENALTIES: Section 1201 of the law (http://housedocs.house.gov/energycommerce/ppacacon.pdf) allows insurance companies to charge smokers up to 50 percent more in premiums. But due to a “computer glitch (http://www.foxnews.com/politics/2013/07/09/another-obamacara-glitch-computer-problem-temporarily-limits-penalties-for/),” those penalties will be limited for “at least a year”—meaning non-smokers may have to pay more as a result.


In the end, Nancy Pelosi (http://www.youtube.com/watch?v=hV-05TLiiLU) was wrong. Congress passed the bill, but we still don’t know what’s in it—because the Obama Administration keeps changing rules and ignoring the law. That’s why Congress should use its power of the purse and stop a single dime from being spent (http://obamacare.heritage.org/) on this unworkable, unfair, and unpopular measure.

[LA Ute]

788

[U-Ute]

10 Ways Obamacare Isn’t Working (http://blog.heritage.org/2013/09/09/morning-bell-10-ways-obamacare-isnt-working/)

I eagerly await this unbiased institution'a follow up article on 10 ways it is helping.

[LA Ute]

Ain't no such thing as an unbiased person when it comes to Obamacare. I don't necessarily agree with Heritage on everything said there. I can tell you that virtually everyone in the healthcare industry that has to implement the new law recognizes that it simply won't work as structured and it will be revised extensively. All this trouble, IMO, results from the disgraceful way Congress passed Obamacare.

[GarthUte]

I eagerly await this unbiased institution'a follow up article on 10 ways it is helping.

Is there even a single way this horrendous law is helping? If it's so damn terrific, why does Obama keep postponing bits and pieces of it - which he has no constitutional power to do - rather than sing its praises in its entirety?

[Mormon Red Death]

Ain't no such thing as an unbiased person when it comes to Obamacare. I don't necessarily agree with Heritage on everything said there. I can tell you that virtually everyone in the healthcare industry that has to implement the new law recognizes that it simply won't work as structured and it will be revised extensively. All this trouble, IMO, results from the disgraceful way Congress passed Obamacare.

for personal reasons I hope the states let the federal government run how claims will be reimbursed with the exchanges. Its is is insane how messed up each state reimburses their providers with Medicaid.

[U-Ute]

Is there even a single way this horrendous law is helping? If it's so damn terrific, why does Obama keep postponing bits and pieces of it - which he has no constitutional power to do - rather than sing its praises in its entirety?

Millions of people having health insurance and not going to emergency rooms for health care is a great start.

Politically he has to because he is getting zero help from the Republican Party and their minions. Maybe if they shifted their position to worrying about their country over worrying about their party, we would have a better solution.

[LA Ute]

Millions of people having health insurance and not going to emergency rooms for health care is a great start.

Politically he has to because he is getting zero help from the Republican Party and their minions. Maybe if they shifted their position to worrying about their country over worrying about their party, we would have a better solution.

Do you really think the ACA will provide universal coverage? I don't.

[U-Ute]

Do you really think the ACA will provide universal coverage? I don't.

No. I don't know that it is designed to. But it is designed to give people opportunities to be insured that they may not normally have.

[RobinFinderson]

Millions of people having health insurance and not going to emergency rooms for health care is a great start.

Politically he has to because he is getting zero help from the Republican Party and their minions. Maybe if they shifted their position to worrying about their country over worrying about their party, we would have a better solution.

This is the thing I don't understand. We pay for those without insurance one way or another. Paying for healthcare via the emergency room seems like the least efficient option, and is one of the factors that has heavily contributed to spiraling healthcare costs. I understand the so-called 'capitalist' position on this, but the markets didn't resolve the issue before the spiraling costs of healthcare forced the nation to do address the problem. This debate has been going on for longer than most of us have lived, yet there were no signs that a purely market-based solution was ever going to come to the table. So here we are, with an imperfect plan, but one that can be slowly fixed into something workable.

And the government shutdown is just going to hurt the GOP. Have fun with that.

[UtahDan]

Have people seen the video at this link which has been making the rounds? It certainly paints a very complex picture of the problem.

http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2

[GarthUte]

Millions of people having health insurance and not going to emergency rooms for health care is a great start.

Politically he has to because he is getting zero help from the Republican Party and their minions. Maybe if they shifted their position to worrying about their country over worrying about their party, we would have a better solution.

Obama doesn't have the power to do what he wants with the law. But then, he hasn't ever shown much respect for the Constitution, so I don't know why I would expect anything different from him.

And do you really think that Obama was worrying about the country when he pushed this POS law? Remember his words to the GOP? I paraphrase "elections have consequences. I won. You lost."

Again, if this thing is so great, why has Obama exempted himself, Congress, his union pals, etc., from it?

[LA Ute]

In my opinion, Robin, a purely market-based system will never work and wouldn't be acceptable anyway, because as a USA society we've decided we're going to find a way to put a buffer between people and the harsh realities of the marketplace, at least as far as healthcare is concerned. We do that very imperfectly, to say the least. So our system is a hybrid that runs on a mix of free market principles and social welfare principles. The debate is really over what that mix should be. Obamacare leans heavily away from the free market and that's what has conservatives riled up.

There's no magic solution. What we want in America is a high-end BMW ("the ultimate healthcare machine") for the price of a low-end Hyundai. It can't be done, but I think a mix that leans more towards market principles can get us closer, would provide more and better choices for consumers and would keep our world-leading innovation going. (The Swiss healthcare system is a good model, IMO.)

And when you get right down to it that is the essence of the healthcare debate, at least in my view.

[utefan]

Ain't no such thing as an unbiased person when it comes to Obamacare. I don't necessarily agree with Heritage on everything said there. I can tell you that virtually everyone in the healthcare industry that has to implement the new law recognizes that it simply won't work as structured and it will be revised extensively. All this trouble, IMO, results from the disgraceful way Congress passed Obamacare.

One could also argue that the problems with Obamacare stem from the fact that Congress wasted all that time pushing bills to repeal it, which they knew would never pass the Senate and absolutely would not be signed into law by Obama. They could and should have been voting on changes to the law which would fix the problems in the existing law.

[U-Ute]

Obama doesn't have the power to do what he wants with the law. But then, he hasn't ever shown much respect for the Constitution, so I don't know why I would expect anything different from him.

And do you really think that Obama was worrying about the country when he pushed this POS law? Remember his words to the GOP? I paraphrase "elections have consequences. I won. You lost."

Again, if this thing is so great, why has Obama exempted himself, Congress, his union pals, etc., from it?

None of this is about the law itself. Do you have anything constructive to add?

[GarthUte]

None of this is about the law itself. Do you have anything constructive to add?

Probably not.

Tell me how Obama delaying so much of the law and exempting himself and his acolytes is not about the law?

[LA Ute]

One could also argue that the problems with Obamacare stem from the fact that Congress wasted all that time pushing bills to repeal it, which they knew would never pass the Senate and absolutely would not be signed into law by Obama. They could and should have been voting on changes to the law which would fix the problems in the existing law.

That's what they'll end up doing anyway, and they all know it. What we are seeing is all political theater. I still blame Obama and the Democrats for cramming down on us all a deeply flawed law. We could have had the Wyden-Bennett bill, a truly bipartisan proposal that would have given some people on both the left and the right something to hate. I think it would have been better and much less controversial.

http://en.wikipedia.org/wiki/Healthy_Americans_Act (http://www.huffingtonpost.com/charles-kolb/winning-republicans-over_b_449926.html)

[U-Ute]

Obama doesn't have the power to do what he wants with the law. But then, he hasn't ever shown much respect for the Constitution, so I don't know why I would expect anything different from him.

And do you really think that Obama was worrying about the country when he pushed this POS law? Remember his words to the GOP? I paraphrase "elections have consequences. I won. You lost."

Again, if this thing is so great, why has Obama exempted himself, Congress, his union pals, etc., from it?

The problem is this law did nothing to reform health care. All it did was change how we pay for it. It accomplished this by spreading the costs around a bit more. Consequently, people are using their influence to exclude themselves from the increased costs.

[RobinFinderson]

In my opinion, Robin, a purely market-based system will never work and wouldn't be acceptable anyway, because as a USA society we've decided we're going to find a way to put a buffer between people and the harsh realities of the marketplace, at least as far as healthcare is concerned. We do that very imperfectly, to say the least. So our system is a hybrid that runs on a mix of free market principles and social welfare principles. The debate is really over what that mix should be. Obamacare leans heavily away from the free market and that's what has conservatives riled up.

There's no magic solution. What we want in America is a high-end BMW ("the ultimate healthcare machine") for the price of a low-end Hyundai. It can't be done, but I think a mix that leans more towards market principles can get us closer, would provide more and better choices for consumers and would keep our world-leading innovation going. (The Swiss healthcare system is a good model, IMO.)

And when you get right down to it that is the essence of the healthcare debate, at least in my view.

I agree with the bolded point. But that is exactly what the Right has argued (at least they did on CUF) whenever anyone tried to make the point that the market hadn't corrected the healthcare cost spiral, the Right would respond, "But we haven't really tried a TRUE market-based solution." But as you point out, a true market-based solution (whatever that would mean) isn't ever going to happen, so we can't continue to wait for it, when spiraling healthcare cost have come to threaten so much that is so important to so many.

How does Obamacare not lean heavily toward free market principles? People will still get their insurance from private companies, and the government is only going to subsidize the cost of insurance for the relatively poor. Where Obamacare seems to have some promise is in precisely how it leverages market principles -- private insurance companies will compete to get their piece of Obamacare subsidies, which means that market forces will drive down the cost of insurance. Meanwhile, the government defines what minimum care must be covered, in order to sell a product as 'insurance,' meaning that consumers have a better sense of what they are getting for their healthcare dollar. Increased consumer understanding of the purchased product + an increase in competition both seem like the essence of free market principles.

Regarding innovation, it hasn't been the needs of poor people that has driven innovation in the healthcare industry (though we may see an increase of innovation in the market for basic services, now that the market for routine maintenance and preventative care is being expanded). The innovation that was driven by the most privileged healthcare consumers in the past will continue, because those people will continue to enjoy access to privileged care, because they will continue to have the ability to pay for it. Healthcare catastrophes leave the poor and middle classes in economic ruin, sometimes even when they have insurance, whereas the wealthy have the means to absorb a catastrophe without losing a life's savings. So I am not sure what you are talking about... unless you are suggesting that the whole healthcare industry is going to go John Galt, leaving behind no one to care for any of us bottom-feeders.

[utefan]

That's what they'll end up doing anyway, and they all know it. What we are seeing is all political theater. I still blame Obama and the Democrats for cramming down on us all a deeply flawed law. We could have had the Wyden-Bennett bill, a truly bipartisan proposal that would have given some people on both the left and the right something to hate. I think it would have been better and much less controversial.

http://en.wikipedia.org/wiki/Healthy_Americans_Act (http://www.huffingtonpost.com/charles-kolb/winning-republicans-over_b_449926.html)

I think the left and the right both have plenty to hate in the current Obamacare law. I just wish they'd start fixing the things we all hate about it instead of crying about it. They could easily tweak that existing law into something we all like.

We all know it's not going to get repealed. How many times have they voted to repeal it already, like 40? And they know the Senate will never repeal it. And even if the Senate did repeal it, Obama would absolutely not sign it.

We paid them their high salaries for this waste of time?

This is the absolute worst Congress ever.

[LA Ute]

This non-partisan (as far as I can tell) article is long but does a good job of laying out the coming difficulties in implementing the law.

http://www.marketwatch.com/story/10-things-health-exchanges-wont-tell-you-2013-09-27

[U-Ute]

This non-partisan (as far as I can tell) article is long but does a good job of laying out the coming difficulties in implementing the law.

http://www.marketwatch.com/story/10-things-health-exchanges-wont-tell-you-2013-09-27

For the most part, the story implies those difficulties are named "Republicans".

[LA Ute]

For the most part, the story implies those difficulties are named "Republicans".

I think the law's implementation should be delayed so it can be fixed. But I understand the reasoning and feelings of those who are so philosophically opposed to it that they want to stop it altogether.

[utefan]

I think the law's implementation should be delayed so it can be fixed. But I understand the reasoning and feelings of those who are so philosophically opposed to it that they want to stop it altogether.

I think it should be implemented so it can be fixed. They've had several years to fix it between the time it was passed and the time it was scheduled to be implemented. Rather than fix it, they chose to have about 40 meaningless vies to repeal it that they knew had no chance of passing. I'm not convinced a delay would be any different.

[U-Ute]

I think the law's implementation should be delayed so it can be fixed. But I understand the reasoning and feelings of those who are so philosophically opposed to it that they want to stop it altogether.

I see what you're saying, but there lies the rub now doesn't it: the Republicans are the ones responsible for putting those flaws in the bill in the first place by adding all of the exemptions and loop holes. Why would anyone believe they'd put a good faith effort into fixing them the second time around?

Personally, I don't think we will have a good solution to this problem until we, as a country, have a frank discussion about how to handle those who have fatal/chronic conditions without the resources to pay for treatment. Do we really want to be a country where the bodies of children pile up because dad got laid off and insuring/treating his child would adversely affect the shareholder returns of insurance companies or hospitals? I don't think anyone, including Republicans, want to see that, but the solution will probably require some combination of social nets and government regulation. Unfortunately, the rhetoric coming from Republicans has put them into a position where they can't have that discussion so they avoid it completely. Philosophically speaking, they have painted themselves into a corner.

[U-Ute]

Blah blah democrats...blah blah republicans. I don't know a thing about this bill, but I do know this - whoever came up with the HSA system should be shot. Worst idea ever.

How so?

[Mormon Red Death]

People lose money in these accounts each year. If you overestimate your health spending, you lose money that you worked for. How is one supposed to accurately guess health expenses for the upcoming year in November? Instead of the HSA saving people money, it costs them money.

These accounts encourage frivolous spending, You have $500 left over in December? Time for another pair of prescription sunglasses. Should we take the baby to see if she has an ear infection? Sure, why not? We have to use up our HSA.

These accounts only benefit people with the skills to manage them, so many of the poor and less educated see none of the tax benefit. I imagine that these things were created with the less fortunate in mind, yet it's the middle and upper classes that get the most benefit.

Finally, these accounts are a pain in the butt even for those who do have the skills to manage them.

Like most bizarre tax incentives and rules, a simple reduction across the board would be a greater benefit.

HSA question for the doctors. If I have $500 left in mid December, can I just go to a doc and have that doc charge me $500 for whatever? I get my $500 reimbursement, and the doc gets $500 for no work at all. I realize that $500 is probably well below the doc's hourly rate, but still.

That isn't a hsa That is a flex spending account. There is a difference

Sent from my SGH-T999 using Tapatalk 2

[Mormon Red Death]

I clearly don't know the difference, but I'm talking about the crappy one.

One major difference is that the health savings account can be rolled over from year to year so you don't lose your health savings account dollars at the end of the year

Sent from my SGH-T999 using Tapatalk 2

[Solon]

That would make the idea less dumb, but still not great.

We have an HSA and it works pretty good because my family doesn't get sick very much. My employer gives me money every month to put in it, in addition to whatever I decide to put in. Once we built up the little nestegg in there, it's been nice to cut back on contributions. But it's definitely not for everyone.

As for the Affordable Care Act, where I personally have encountered the most havoc is in the job announcements looking for people to work 29 hours/week.

[Rocker Ute]

That would make the idea less dumb, but still not great.

Actually, I think that everyone should have a version of an HSA and a high deductible health plan, if we are really interested in reducing the cost of healthcare. As mentioned, the savings rolls over from year to year and you can even cash out that savings at an advanced age. A high deductible plan keeps the consumer with some skin in the game an incentives to improve health and seek the most appropriate care. Properly managed you can have essentially the same risk as a $500 deductible plan, if you are healthy you get the reward of a growing HSA and reduced medical costs.

[LA Ute]

Actually, I think that everyone should have a version of an HSA and a high deductible health plan, if we are really interested in reducing the cost of healthcare. As mentioned, the savings rolls over from year to year and you can even cash out that savings at an advanced age. A high deductible plan keeps the consumer with some skin in the game an incentives to improve health and seek the most appropriate care. Properly managed you can have essentially the same risk as a $500 deductible plan, if you are healthy you get the reward of a growing HSA and reduced medical costs.

HSAs are great, but they tend to favor the well-off and well-educated so they are not popular in Congress (on the more liberal side of the aisle).

[Rocker Ute]

This HSA sounds worlds better than the FSA I am offered. The FSA is a horrible idea - why should we encourage this type of gambling? How many people lose more than they would have saved by not emptying the account before the year ends?

But even the HSA appears to have the problem of being a gift to the competent and/or lucky at the expense of those who either aren't offered an HSA or those who can't manage/set-up that type of account.

Right now they are definitely that way. And LA cites why they don't have much favor in congress for some of the reasons cited. The problem with them is you do have to be measured, you do have to sock away the appropriate amount of money, you do have to do a little thinking to make them work.

But there is no reason to not set up a hybrid model of this that would help the less educated and self-disciplined, and if you are working for a company that manages this stuff for you, they should be offering this to you and helping you manage it.

Thinking about it, if you had a choice between a good plan with a $500 deductible that was $1000/mo in premiums, or you could opt for a $10,000 deductible HDHP that was $280/mo in premiums, and took the $720/mo and put that into your HSA, after one year, if you were a non-utilizer, you'd have your entire deductible paid off always. That'd roll over and you could opt to only pay $280/mo after that, or continue to contribute pre-tax into an account that acts a lot like an IRA (there are even some interest earning options). If your employer contributes, even better.

I'm self-employed, that is what I do for me and my few employees, and I work with a company called Health Equity that helps manage the HSA. People complained the first year, but the next year when they had 'money in the bank' good coverage and reduced rates they were happy.

Going back to FSA's though, the one GOOD thing about them is you can get essential an interest free loan with them if you manage them right. For example, tied to a HDHP of $2000/deductible, if you said in November you wanted to contribute $2000 to your FSA, in January you could have a procedure that hit your deductible, you could use the FSA to pay for it, and only have contributed $160 or so to it. You'd then have the rest of the year to pay the rest off to the FSA.

[U-Ute]

That's a good use, but it's a pretty special circumstance to have a known, delayable procedure.

I am in a situation just as common - we are going to try to have another kid in 2014. Having a kid will cost more than the max contribution to my FSA. So we should max out contributions and save hundreds of dollars. But what we aren't successful in having that kid? We may lose thousands. So we have to decide what type of gamble we'd like to take with our money.

But the most common situation is to have no idea what the health care expenses of the upcoming year will be. I still think the FSA is just a bad system.

So, back to my question. Can a doc set up a December clinic charging whatever you need to get out of your FSA for a quick physical? Patient gets to make sure none of the FSA money goes to waste, and doc gets easy Christmas cash.

They changed the law a couple of years ago so that you have until June of the following year to use any money in your FSA. So you shouldn't have to zero it out by 12/31.

That being said, back when you did have to zero it out, if we had any leftover money in December, we went and got eye exams and new glasses.

[LA Ute]

This is appropriate for this thread.

SNL Obamacare Cold Open (http://www.nbc.com/saturday-night-live/video/obamacare-cold-open/n41321/)

[LA Ute]

http://www.youtube.com/watch?v=sx2scvIFGjE

[LA Ute]

http://www.youtube.com/watch?v=e3-RKS0_NKk#t=14

[LA Ute]

John Stewart weighs in. (http://www.thedailyshow.com/watch/mon-october-21-2013/the-weakest-link---healthcare-gov)

[LA Ute]

L.A. Times:

Some health insurance gets pricier as Obamacare rolls out (http://touch.latimes.com/#section/-1/article/p2p-77942344/)

"I was all for Obamacare until I found out I was paying for it...."

[Dawminator]

Sadly, I have about as much confidence in the Republican party to use this in any meaningful to get the thing overturned in part or in whole.

[U-Ute]

I think it is pretty easy to cherry pick stories about specific people whose premiums are increasing. There were a lot of people who carried nothing but cheap catastrophic health insurance, whereas all insurance must cover at least preventative procedures now. I suspect a lot of people who went bankrupt due to medical bills, even though they had insurance, would probably in hind sight wish they had purchased the higher level of insurance that is now required.

[U-Ute]

That may be true, but it doesn't make things any easier to swallow for people losing either lots of money or their entire job over the change. "You can't make an omelette without breaking a few egss" works out for everyone but the eggs. You can support or oppose this thing (or be confused by it or ignore it or wait and see), but it's good to at least acknowledge that a few people's careers will be ruined over it and have sympathy for the unlucky losers.

I wasn't trying to be unsympathetic. There are both winners and losers in all of this. But just focusing on those who were stung by this is just as disingenuous as only focusing on those it helped.

Although, frankly, I'm not sure who won in all of this, outside of maybe insurance companies. It will be interesting to see where profit margins of insurance companies are in the next two years. My guess is that they raised rates a bit more than they needed to in order to cover for some of the unknowns with regards to not being allowed to deny coverage for chronic problems.

[Rocker Ute]

I have (had - mine is being discontinued) catastrophic coverage and liked my plan. Here is why:

My family are non-utilizers and it was coupled with an HSA so we could cover the preventive care visits and other minor things yet still not be devastated if something more serious happened. In other words we were responsible and managing it.

But it was our decision, the right one financially, and now that plan will be gone 2014.

So that is my personal anecdote.

I went through on ufn some of the other problems I came across with the site, no biggie, but now I'll have the privilege of paying for things we likely won't use and the additional privilege of not socking that money away for a rainy day.

[Rocker Ute]

Although, frankly, I'm not sure who won in all of this, outside of maybe insurance companies. It will be interesting to see where profit margins of insurance companies are in the next two years. My guess is that they raised rates a bit more than they needed to in order to cover for some of the unknowns with regards to not being allowed to deny coverage for chronic problems.

Yeah, this. I've heard people talk about the Republican's being the the insurer's back pocket, but I've gotta believe that they love a government mandate to buy their product and the government will subsidize those who can't afford it. I wish I could figure out a way to get the government to mandate that for my business.

Truth for me at this point, and maybe it is just because I'm feeling defeated or like one of them commies, but with what has happened to me personally I think I'd just rather see a single-payer system out there.

[Scratch]

I have (had - mine is being discontinued) catastrophic coverage and liked my plan. Here is why:

My family are non-utilizers and it was coupled with an HSA so we could cover the preventive care visits and other minor things yet still not be devastated if something more serious happened. In other words we were responsible and managing it.

But it was our decision, the right one financially, and now that plan will be gone 2014.

So that is my personal anecdote.

I went through on ufn some of the other problems I came across with the site, no biggie, but now I'll have the privilege of paying for things we likely won't use and the additional privilege of not socking that money away for a rainy day.

Why don't you understand that we just can't trust you to make decisions for you and your family?

[Rocker Ute]

Why don't you understand that we just can't trust you to make decisions for you and your family?

You have a point with me being allowed to make decisions for my family, but I've got to believe there are maybe other people out there that should be trusted. Who that is, I have no idea.

[U-Ute]

Why don't you understand that we just can't trust you to make decisions for you and your family?

How can you tell Rocker Ute apart from the ones that can't make decisions before anyone ends up in the hospital?

[Scratch]

How can you tell Rocker Ute apart from the ones that can't make decisions before anyone ends up in the hospital?

If you're going to mandate something, why does that mandate have to exclude the reasonable decision that Rocker made for his family as one of the permissible choices?

[Sisyphus]

I haven't been a part of this thread but I wanted to weigh in.

My overall assessment of the health care system is that as currently evolved, it rewards the rent-seekers spectacularly well.

Obamacare is simply going entrench and strengthen the status quo. It enriches, reinforces and solidifies the major players already in existence and will be a boon to Washington and large health care entities that play in that game.

There isn't anything affordable about the Affordable Care Act. Its primarily going to be funded by new money into the system by the young and healthy, who will no longer benefit from the information asymmetry they currently enjoy. Ironically, this is the segment that overwhelmingly voted for the guy that will screw them with a tax (as ruled by the Supreme Court) that will probably exceed their income taxes liability during their healthy-but-poor years.

https://www.evernote.com/shard/s16/res/c15355dd-7a0e-44b4-b040-6072f7789f32.jpg?search=health%20care&resizeSmall&width=951

In the end we will all pay more (as a % share of GDP), health outcomes will not have any needle-moving improvement, utilization will increase and the entire health system will have a growing share of a slowly growing GDP pie. All of this is clearly predicted from the Oregon Health Study: http://www.nber.org/oregon/

In a way, the problems of education and health care mirror each other and the "solutions" cannot be crafted in the context of better policies in this political environment. Both education and health systems fail by completely avoiding fundamental principles of economics.

[LA Ute]

If you're going to mandate something, why does that mandate have to exclude the reasonable decision that Rocker made for his family as one of the permissible choices?

Because Congress decided that as many people as possible must be forced into a certain segment of the insurance pool in order to make the pool actuarially sound insofar as certain types of coverage are concerned. Essentially, healthy people who might otherwise choose less insurance are not allowed to do so under the ACA. We might call it insurance market "reform." It's a coercive approach to the market. As many say, elections have consequences.

[Two Utes]

Sorry, didn't mean to sound accusatory. I learned yesterday that some good coworker friends may lose their jobs over this, so I guess I'm sensitive.

I tried to read a little about Obamacare to understand what is going on. I still know very little. What I do know is that I am now being charged a "medicare surtax" on my paycheck. I had no idea that Obamacare included a direct tax like this until I actually looked at my paycheck. I understand there are other direct taxes as well that most Americans are unaware of. All these folks who supported this program have no f'ing idea of its effects. In essence, it is a huge tax on the lower middle class. Those who are uninsured, will either be forced to get insurance or be taxed and they have no idea that this is coming. As for the middle class, many insurance programs will be dropped and they will be forced to pay for more expensive insurance--another tax as the United States Supreme Court has noted.

Of course, I am preaching to the choir with most of this group. If I posted this over at Utefans (the internet version of those who used to listen to Tom Barberi) they would just tell me that the more expensive insurance is great because it is better insurance and people should be forced to take that insurance (in other words, the government can make these decisions for people better than the private sector and the public at large, a pillar of "liberal" thought process)

The Republicans weren't as dumb as everybody thinks by book marking their protest of Obamacare right before implementation were they?

OK concerned, now it's your turn to take up the Utefans' defense of Obamacare.

[wuapinmon]

Here's what I want.

Universal healthcare for anyone 18 & under, or up to 25 if enrolled full-time in a college or vocational degree-seeking accredited program.

Everyone else, pay for it like an adult, and save for old age.

No one should ever have to make decisions about their kids' health based on what they can afford. Adults should absolutely decide what they can afford. No more Medicare, no more Social Security, and no more Medicaid (except for maternity care) for anyone born after 1960. I'll keep paying the taxes until I'm 65 (25 more years) to put an end to those programs, my sacrifice to make up for the grossly irresponsible largesse of the "Greatest Generation" and the Boomers.

I also think that we should amend the Constitution to make it a law that Congress shall pass no law that exempts them from the laws to which their constituents are subject.

[Diehard Ute]

Here's what I want.

Universal healthcare for anyone 18 & under, or up to 25 if enrolled full-time in a college or vocational degree-seeking accredited program.

Everyone else, pay for it like an adult, and save for old age.

No one should ever have to make decisions about their kids' health based on what they can afford. Adults should absolutely decide what they can afford. No more Medicare, no more Social Security, and no more Medicaid (except for maternity care) for anyone born after 1960. I'll keep paying the taxes until I'm 65 (25 more years) to put an end to those programs, my sacrifice to make up for the grossly irresponsible largesse of the "Greatest Generation" and the Boomers.

I also think that we should amend the Constitution to make it a law that Congress shall pass no law that exempts them from the laws to which their constituents are subject.

So what do you do with all the people who are over 25? They're going to still go to the hospital and who's going to pay for it?

[wuapinmon]

So what do you do with all the people who are over 25? They're going to still go to the hospital and who's going to pay for it?

They're going to be adults and pay on their medical debts for years like I have.

[Diehard Ute]

They're going to be adults and pay on their medical debts for years like I have.

Ha. You've never worked in medicine have you?

[wuapinmon]

Ha. You've never worked in medicine have you?

I'm not that kind of doctor.

[Mormon Red Death]

I haven't been a part of this thread but I wanted to weigh in.

My overall assessment of the health care system is that as currently evolved, it rewards the rent-seekers spectacularly well.

Obamacare is simply going entrench and strengthen the status quo. It enriches, reinforces and solidifies the major players already in existence and will be a boon to Washington and large health care entities that play in that game.

There isn't anything affordable about the Affordable Care Act. Its primarily going to be funded by new money into the system by the young and healthy, who will no longer benefit from the information asymmetry they currently enjoy. Ironically, this is the segment that overwhelmingly voted for the guy that will screw them with a tax (as ruled by the Supreme Court) that will probably exceed their income taxes liability during their healthy-but-poor years.

https://www.evernote.com/shard/s16/res/c15355dd-7a0e-44b4-b040-6072f7789f32.jpg?search=health%20care&resizeSmall&width=951

In the end we will all pay more (as a % share of GDP), health outcomes will not have any needle-moving improvement, utilization will increase and the entire health system will have a growing share of a slowly growing GDP pie. All of this is clearly predicted from the Oregon Health Study: http://www.nber.org/oregon/

In a way, the problems of education and health care mirror each other and the "solutions" cannot be crafted in the context of better policies in this political environment. Both education and health systems fail by completely avoiding fundamental principles of economics.

How do the youth benef it from asymetrical information? Do you have that term confused with adverse selection?

Sent from my SGH-T999 using Tapatalk 2

[LA Ute]

Daniel Henninger:


American progressivism is politics by cramdown. Ask Jamie Dimon. Ask the coal miners the EPA is putting out of business. Ask the union workers waiting for jobs on the Keystone XL pipeline. Ask Boeing BA +0.02% in South Carolina or the harmless tea party groups from towns no one has ever heard of that were shut down by the IRS, or the 20,000 inner-city parents and students who marched across the Brooklyn Bridge to protest obliteration of their charter schools by New York's progressive mayoral candidate, Bill de Blasio.

Up to now, most of the events of the Obama presidency have passed in and out of the news as just politics. But with ObamaCare and its details touching so many people all at once, it has become impossible not to recognize that the Affordable Care Act is an offensive ideological exercise, not merely an entitlement program. By Mr. Obama's own admission, this law is the way he wants the world to work in the U.S.—whether in health, education, energy, infrastructure or finance. And what Americans now riding through the ObamaCare hurricane of canceled policies, disappearing doctors and rebooted promises have to be asking themselves is: Do I want to live with this level of personal enforcement in the U.S.?

http://online.wsj.com/news/articles/SB10001424052702303618904579167671265894490?mod=WS J_Opinion_LEADTop

[Rocker Ute]

Uhg, this makes me even more sick. I decided after my post to go back and look at our healthcare expenses over the past 4 years. I mentioned I was on a catastrophic coverage health plan ($10k deductible after which 100% was covered) coupled with an HSA, so everything over the past 4 years has been paid for out of pocket after charges were adjusted simply by being insured (that is another debate... if I wanted to just pay straight up, why would it cost more?)

So here is the breakdown

4 years ago - ~$6800 (We had a baby)
3 years ago - ~$260
2 years ago - ~$240
1 year ago - ~$360 (persistent ear ache for my son)
This year to date - $190

So even on the most gold-plated of gold-plated health plans we wouldn't even be getting into the deductible amount where we might get some return on having a plan. I should note those were all preventive care / scheduled check-ups and a couple of ear aches.

We're an insurers wet dream... we pay them money for doing nothing on even their very best plans. In the meantime we'd put enough into an HSA we were covered better than being on a gold plated plan if catastrophe struck.


I get it, things can change quick... one serious bike accident and in year two I might be singing a different tune, but don't we live our lives like that all the time? Do we all have a contingency plan for every disaster, particularly when we are young.

I like waup's everyone under 18 insured idea, heck why not under 21? In fact, I might even be okay with a yearly preventive care waiver for all people, where you get one doctor visit on the house.

This crap though... no thank you.

[Sisyphus]

How do the youth benef it from asymetrical information? Do you have that term confused with adverse selection?

Adverse selection is the existing consequence/condition of asymmetrical information possessed by the younger & healthier crowd about their own health status or risks.

The young/healthy know they are low risk for pretty much everything except pregnancies and accidents. Those that actually have health problems ( a friend of mine that has Type I Diabetes comes to mind) are sure to get insurance. Others that have very low risk forego insurance, avoiding thousands in premiums each year paid for an unlikely event.

[LA Ute]

What Everyone Knew About Obamacare and Wouldn't Say (http://www.bloomberg.com/news/2013-10-30/what-everyone-knew-about-obamacare-and-wouldn-t-say.html)



As I noted the other day, (http://www.bloomberg.com/news/2013-10-28/obamacare-s-big-thinkers-forgot-to-bring-in-the-doers.html) when Obamacare "czar” Jeffrey Zients announced that the health-insurance exchanges would be working by Nov. 30, he bought the administration some time. Unfortunately for them, most of that time has so far been spent discussing “rate shock” and policy cancellations: the folks in the individual market whose policies were canceled thanks to new regulations and will now have to replace them with something more expensive or that carries a higher deductible.


We don’t actually know how bad a problem this is. Mathematically, two things must be true: There are some people in this country who are losing their current insurance and gaining better insurance at a lower cost, and there are some people in this country who are losing their current insurance and getting worse insurance at a higher cost. And there are some who are now getting insurance they couldn’t afford at all before.

We don’t know how many people are in each group. Nor do we know how big a problem rate shock will be for the folks who experience it. But that doesn’t matter for the news story, which, in the absence of data, will be a war of anecdotes. Not ideal, but frankly, most of the folks now complaining about the “rate shock” anecdata were often the same folks who eagerly showcased every anecdotal story about a poor single mom who was excited to be getting insurance for the first time. So I find it hard to take their distress too seriously...

[Diehard Ute]

I really don't think most people realize just how much charity care we all pay for without the use of Medicaid etc.

Many many people use 911 as their "doctor" and many more use emergency rooms for the same purpose.

Because an ER can't refuse service many of those charges are never paid for....meaning those of us who either have insurance, or pay cash, have those losses factored in.

The last year I worked at University Medical Center, 2006-07 there were roughly $250,000,000 in charges written off by the U's hospitals and clinics. (Approximately 25% of all charges that year).

I have no idea what the cost the abuse of EMS is. But I know I go to a lot of non emergent calls with the fire department

[Sisyphus]

So here is the breakdown

4 years ago - ~$6800 (We had a baby)
3 years ago - ~$260
2 years ago - ~$240
1 year ago - ~$360 (persistent ear ache for my son)
This year to date - $190

We're an insurers wet dream... we pay them money for doing nothing on even their very best plans. In the meantime we'd put enough into an HSA we were covered better than being on a gold plated plan if catastrophe struck.


The dirty, GIANT secret of the whole system is that 90% of us are just like you and would drop insurance in an instant if we just had access to the same pricing that insurance companies have. The bulk of us, frankly, are scared into getting insurance because of the possibility of financial ruin from a medical emergency generating 300-400% marked up charges totaling in the 10s of thousands of dollars. Insurance Companies ends up paying 10-20% of those huge bills. If there was true price transparency, total health coverage plan enrollment would be waaaaaay lower and catastrophic coverage would be the norm to cover something that might happen once every 10-20 years, similar to Homeowners' Insurance.

LA Ute can confirm/refute this but I recall over half of all expenditures of the system are "consumed" by less than 2% of the population, a large portion of whom are in their last 30 days of life.

If you have a more sensible and dignified end-of-life process compared to our "anything and everything it takes, damn the costs" approach our costs as a share of GDP get cut in half.

There is a big difference in the whole "value of life" conversation in the US vs the rest of the developed world. The US has a different value tradition, circa 2010 than other, more secular nations, particularly compared to Western Europe and Japan. This all shows up within the Health Care and the Abortion debates. Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

Nowhere has this change in culture/expectations been discussed. To try to do something about it is to be accused of wanting "Death Panels"

[Sullyute]

The dirty, GIANT secret of the whole system is that 90% of us are just like you and would drop insurance in an instant if we just had access to the same pricing that insurance companies have. The bulk of us, frankly, are scared into getting insurance because of the possibility of financial ruin from a medical emergency generating 300-400% marked up charges totaling in the 10s of thousands of dollars. Insurance Companies ends up paying 10-20% of those huge bills. If there was true price transparency, total health coverage plan enrollment would be waaaaaay lower and catastrophic coverage would be the norm to cover something that might happen once every 10-20 years, similar to Homeowners' Insurance.

LA Ute can confirm/refute this but I recall over half of all expenditures of the system are "consumed" by less than 2% of the population, a large portion of whom are in their last 30 days of life.

If you have a more sensible and dignified end-of-life process compared to our "anything and everything it takes, damn the costs" approach our costs as a share of GDP get cut in half.

There is a big difference in the whole "value of life" conversation in the US vs the rest of the developed world. The US has a different value tradition, circa 2010 than other, more secular nations, particularly compared to Western Europe and Japan. This all shows up within the Health Care and the Abortion debates. Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

Nowhere has this change in culture/expectations been discussed. To try to do something about it is to be accused of wanting "Death Panels"


I agree with everything you say, but it is much easier to change a policy than a culture. I also think that it is not fair to compare the hodgepodge of cultures in the US to the much more homogenous cultures of Europe and Japan.

In the US we tend to be a little more ambivolent to/accepting of violent death (war, crime, movies, video games, etc.) , but we have a harder time aceepting natural death. How do you change or reverse that? Maybe we should have mandatory viewings of the movie Cocoon?

[U-Ute]

Maybe we should have mandatory viewings of the movie Cocoon?

I was thinking maybe Soylent Green.

[U-Ute]

L.A. Times:

Some health insurance gets pricier as Obamacare rolls out (http://touch.latimes.com/#section/-1/article/p2p-77942344/)

"I was all for Obamacare until I found out I was paying for it...."

It turns out she was wrong (http://www.latimes.com/business/hiltzik/la-fi-mh-debunked-20131030,0,6010994.story#axzz2jL2PTBjj)


Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.


At her age, she's eligible for a good "silver" plan for $333 a month after the subsidy -- $40 a month more than she's paying now. But the plan is much better than her current plan -- the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit -- but all visits would be covered, not just two.


If she wanted to pay less, Cavallaro could opt for lesser coverage in a "bronze" plan. She could buy one from the California exchange for as little as $194 a month. From Anthem, it's $256, or $444 a year less than she's paying now. That buys her a $5,000 deductible (the same as she's paying today) but the out-of-pocket limit is lower, $6,350. Office visits would be $60 for primary care and $70 for specialties, but again with no limit on the number of visits. Factor in the premium savings, and it's hard to deny that she's still ahead.

It sounds like she didn't quite shop around like she thought she did.

[LA Ute]

It turns out she was wrong (http://www.latimes.com/business/hiltzik/la-fi-mh-debunked-20131030,0,6010994.story#axzz2jL2PTBjj)....

Anecdotes are like that.

[Mormon Red Death]

The dirty, GIANT secret of the whole system is that 90% of us are just like you and would drop insurance in an instant if we just had access to the same pricing that insurance companies have. The bulk of us, frankly, are scared into getting insurance because of the possibility of financial ruin from a medical emergency generating 300-400% marked up charges totaling in the 10s of thousands of dollars. Insurance Companies ends up paying 10-20% of those huge bills. If there was true price transparency, total health coverage plan enrollment would be waaaaaay lower and catastrophic coverage would be the norm to cover something that might happen once every 10-20 years, similar to Homeowners' Insurance.

LA Ute can confirm/refute this but I recall over half of all expenditures of the system are "consumed" by less than 2% of the population, a large portion of whom are in their last 30 days of life.

If you have a more sensible and dignified end-of-life process compared to our "anything and everything it takes, damn the costs" approach our costs as a share of GDP get cut in half.

There is a big difference in the whole "value of life" conversation in the US vs the rest of the developed world. The US has a different value tradition, circa 2010 than other, more secular nations, particularly compared to Western Europe and Japan. This all shows up within the Health Care and the Abortion debates. Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

Nowhere has this change in culture/expectations been discussed. To try to do something about it is to be accused of wanting "Death Panels"

You will spend more in the last 6 months of your life than the rest combined

Sent from my SGH-T999 using Tapatalk 2

[LA Ute]

Here's a younger citizen who thinks his generation is paying too much under Obamacare. And he's not happy about it.

http://touch.latimes.com/#section/-1/article/p2p-77972774/

[Diehard Ute]

Here's a younger citizen who thinks his generation is paying too much under Obamacare. And he's not happy about it.

http://touch.latimes.com/#section/-1/article/p2p-77972774/

Reality is our entire system of who pays for what is screwed up. It's certainly never been based on who uses what

[LA Ute]

Reality is our entire system of who pays for what is screwed up. It's certainly never been based on who uses what

The dirty secret of healthcare (which everyone in the industry knows) is that no one knows what it really costs. I can tell you what is charged for an artificial hip but no one can tell you what it actually costs.

[LA Ute]

It turns out she was wrong (http://www.latimes.com/business/hiltzik/la-fi-mh-debunked-20131030,0,6010994.story#axzz2jL2PTBjj)

It sounds like she didn't quite shop around like she thought she did.

By the way, with a silver and bronze plan in CA, your choices of physician and hospital are very limited. They're called "narrow networks." It's especially narrow with Bronze plans. So I'll bet that while her choices seem decent in terms of cost, they're not so good when it comes to choice of provider. This is one of the next things people will be upset about as they discover what has happened.

More about that here:

http://dailycaller.com/2013/10/30/what-obamacare-pollyannas-miss/

[GarthUte]

http://farm8.staticflickr.com/7444/10610804353_b09028e324.jpg

[LA Ute]

CNN: Senate Democrats supported rule that led to insurance cancellations (http://politicalticker.blogs.cnn.com/2013/10/31/senate-democrats-supported-rule-that-lead-to-insurance-cancellations/)


Senate Democrats voted unanimously three years ago to support the Obamacare rule that is largely responsible for some of the health insurance cancellation letters that are going out.

In September 2010, Senate Republicans brought a resolution to the floor to block implementation of the grandfather rule, warning that it would result in canceled policies and violate President Barack Obama’s promise that people could keep their insurance if they liked it.

“The District of Columbia is an island surrounded by reality. Only in the District of Columbia could you get away with telling the people if you like what you have you can keep it, and then pass regulations six months later that do just the opposite and figure that people are going to ignore it. But common sense is eventually going to prevail in this town and common sense is going to have to prevail on this piece of legislation as well,” Iowa Sen. Chuck Grassley said at the time.

“The administration's own regulations prove this is not the case. Under the grandfathering regulation, according to the White House's own economic impact analysis, as many as 69 percent of businesses will lose their grandfathered status by 2013 and be forced to buy government-approved plans,” the Iowa Republican said.

On a party line vote, Democrats killed the resolution, which could come back to haunt vulnerable Democrats up for re-election this year.

Senate Democrats like Mary Landrieu, Jeanne Shaheen, Mark Pryor, Kay Hagan and Mark Begich – all of whom voted against stopping the rule from going into effect and have since supported delaying parts of Obamacare.

[Dawminator]

That's pretty damning of the democrats.

[LA Ute]

People are posting photos of their cancellation notices at:

http://mycancellation.com/

[GarthUte]

Let's just hope there aren't enough people to start a mypinkslip.com.

Why would they get fired? The law stole their insurance from them, not their employers.

[Rocker Ute]

Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.


This reminds me of the passing of my grandpa over ten years ago now. He had been in a care facility for some time and a quick deterioration in his health indicated he was approaching the end of his life. He had a living will that explicitly spelled out what he wanted done, particularly that if he wasn't responsive and there wasn't hope of returning to a reasonable quality of life to let him go. My father and uncle made the tough decision based on this to switch him to hospice care and to let him go. My father described it as one of the toughest decisions of his life.

When the let their decision be known my grandfather's doctor protested vehemently. He accused my dad and uncle of just wanting to cash out their inheritance (he was a high school teacher his whole life and had been in a rest home for a number of years, there wasn't much left to inherit) and a number of other rotten things. As it turns out, the doctor actually was part owner of the facility my grandpa was in, so his death represented $4000/mo going away.

So as they argued the doctor said he refused to take him off of life support, to which my dad replied, "Okay, well then you're fired... you are no longer his doctor." The doctor incredulous said, "I don't work for you, you can't fire me!" My dad said, "Watch me..." Called some friends to find a good doctor in the area and that was that. The new doctor came in, agreed that he wouldn't return to any quality of life and helped put him on hospice care.

Point being, some people think it is pretty cold to not fight for the last breath, while others find dignity in passing as nature may want. My grandpa was smart enough to spell out what he wanted beforehand.

Interestingly one of the very last lucent conversations my grandpa had with my dad was him quoting the church hymn, "Do what is right let the consequence follow / Battle for freedom in spirit and might / And with stout hearts look ye forth till tomorrow / God will protect you so do what is right."

Good advice for anyone regardless of religious affiliation I think.

[LA Ute]

Looks like the White House knew about the impending Obamacare rollout disaster long before those wascally wepublicans started obstructing.

http://m.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_story.html

[Rocker Ute]

Looks like the White House knew about the impending Obamacare rollout disaster long before those wascally wepublicans started obstructing.

http://m.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_story.html

Ironically, and I thought this the whole time during the government shutdown, if the Republicans had been principled enough and actually believed what they were saying about Obamacare they should have stop obstructing and could have let it collapse under the weight of its own hubris and then had a solid platform to run on going forward the "We told you so / Repair or Repeal Obamacare" all the way through to the 2016 presidency.

I say this of course assuming by their previous actions that they (along with most of our elected officials) really don't care about collapsing our government.

[Mormon Red Death]

Ironically, and I thought this the whole time during the government shutdown, if the Republicans had been principled enough and actually believed what they were saying about Obamacare they should have stop obstructing and could have let it collapse under the weight of its own hubris and then had a solid platform to run on going forward the "We told you so / Repair or Repeal Obamacare" all the way through to the 2016 presidency.

I say this of course assuming by their previous actions that they (along with most of our elected officials) really don't care about collapsing our government.

The problem is that once an entitlement starts its near impossible to revoke it

Sent from my SGH-T999 using Tapatalk 2

[LA Ute]

Megan McArdle is an economist right-leaning but level-headed. She writes a lot about Obamcare. Her latest:


There’s a reason that unions fight so hard to keep their gold-plated insurance, even making significant salary concessions to do so, and that’s because their members really want low-deductible insurance.


U.S. cost-sharing is actually low, by international standards; just 23 percent of our private health spending comes from out-of-pocket expenditures by the consumers of health care. We like being insulated from costs, and we’re rich enough to demand it. Assuming that the Cadillac tax goes into effect (though I’m still sort of skeptical), a whole lot of those in the 80 percent category are going to lose a plan they liked because the government made it too expensive for companies to keep delivering it. Yes, of course, companies already cancel plans quite frequently. But these cancellations are going to happen all at once, because the law demanded it.


Moreover, the people who end up in those plans won’t just be choosing them as the cost of other plans goes up; they’ll be forced into them because the other plans aren’t offered at all. They are going to be screaming mad, and Democrats should not delude themselves that they will be soothed by all the marvelous things that may then be happening in the individual market. That’s why I still think there is a good chance that this gets rolled back before it goes into effect — but that is going to create its own, not insubstantial, budget problem: The Cadillac tax is supposed to raise about $80 billion by 2023.


And this just looks at price, not things such as provider networks, which is going to bring on a long and lasting wave of public outrage starting sometime around March of next year.

http://www.bloomberg.com/news/2013-11-01/health-consumers-finding-out-they-were-sold-a-lemon.html

[LA Ute]

Megan McArdle is smart:


Obamacare’s biggest problem, as I have written, was that the architects of the law demanded an enormously ambitious software project on an impossibly hubristic deadline. Whatever slim chance this had of working was ultimately doomed — not by Republicans, but by the administration’s own paranoid and self-destructive decisions to manage a software project as if it were a top-secret campaign strategy rather than a mission-critical component of the most ambitious federal entitlement expansion in almost 50 years.

Remember that when Cutler wrote that devastating memo, Democrats still had control of both houses of Congress. The administration failed to rectify the shortcomings he identified because it did not understand that making a program happen is very different from writing out a description of it.

The administration did not refuse to issue key regulations and guidelines, or to announce the final number of states that would be building their own exchanges, because Republicans used secret mind-control rays or stole the notebooks they had used to write the draft memo. They delayed because they did not want Republicans to be able to tell the public about them before Barack Obama was safely re-elected to a second term.

In other words, most of the damage was done not by lack of funding, but because the administration was either incompetent or trying to insulate itself from the perfectly ordinary, natural, legitimate and, dare I say, patriotic function of an opposition party, which is to point out to the public when the party in charge is doing something that the public wouldn’t like. Reframing “criticism of the administration” as “sabotage” deserves an Oscar for outstanding lifetime achievement in the field of political spin.

http://www.bloomberg.com/news/2013-11-05/obamacare-shouldn-t-have-been-managed-like-a-campaign.html

[LA Ute]

http://www.youtube.com/watch?v=mSQ7b3_iVHs

[LA Ute]

Richard Fernandez: (http://pjmedia.com/richardfernandez/2013/11/15/the-clattering-train/)


Obama is waist deep in quicksand. The first rule of quicksand is not to struggle; to swim your way out. But Obama won’t. Can’t. The deeper he gets the harder he thrashes. No shame. No self control. And therefore this may end in the manner of the Beast From Hollow Mountain.”

Plus this:


Meanwhile the conservatives, who cannot at present account for more than half the voters, are in a strategic waiting game. At best they can consolidate the half into the nether millstone against which events may grind. The single greatest task for conservatives is to fix their own leadership problems. In so doing they must avoid the single greatest mistake Obama has made, which is to rely on fantasy. The facts, however unpalatable. The truth, no matter how bitter.

And this (http://online.wsj.com/news/articles/SB10001424052702303789604579197883480604424?mod=WS J_Opinion_LEADTop) from Peggy Noonan:


People are wondering if we are seeing the end of liberalism. We are not. Liberalism, a great and storied American political tradition, will survive this. But progressivism—liberalism without blood—has been badly, deeply damaged. We are seeing the end of its first major emanation, ObamaCare.

[LA Ute]

Walter Russell Mead: (http://blogs.the-american-interest.com/wrm/2013/11/18/the-most-shocking-obamacare-revelation/)


All this has plunged the White House into the deepest hole of the Obama presidency to date, but the biggest shock isn’t about the cruddy rollout, the kludgy law or the disingenuous sales job by which it was passed. The biggest shock and the most damning revelation came in the President’s hasty and awkward press conference when President Obama responded to a reporter’s question about his knowledge of the website’s problems:


OK. On the website, I was not informed directly that the website would not be working as — the way it was supposed to. Ha[d] I been informed, I wouldn’t be going out saying, boy, this is going to be great. You know, I’m accused of a lot of things, but I don’t think I’m stupid enough to go around saying, this is going to be like shopping on Amazon or Travelocity, a week before the website opens, if I thought that it wasn’t going to work.
This was eyepopping. Obamacare is the single most important initiative of his presidency. The website rollout was, as the President himself has repeatedly stated, the most important element of the law’s debut. Domestically speaking there was no higher priority for the President and his staff than getting this right. And the President is telling the world that a week before the disaster he had no idea how that website was doing.


Reflect on that for a moment. The President of the United States is sitting in the Oval Office day after day. The West Wing is stuffed with high power aides. His political appointees sit atop federal bureaucracies, monitoring the work of the career staff around them. The President has told his core team, over and over, that the health care law and the website rollout are his number one domestic priorities.


And with all this, neither he nor, apparently, anyone in his close circle of aides and advisors knew that the website was a disaster. Vapid, blind, idly flapping their lips; they pushed paper, attended meetings and edited memos as the roof came crashing down. It is one thing to fail; it is much, much worse not to see failure coming. There is no way to construe this as anything but a world class flop.

[LA Ute]

This is a devastating political ad.


http://www.youtube.com/watch?v=hYyMMs-WO4U

[GarthUte]

It's come to this:

http://www.csmonitor.com/var/ezflow_site/storage/images/media/content/2013/1218-obamacare-ad-onesie/17692915-1-eng-US/1218-Obamacare-ad-onesie_full_600.jpg

:rofl:

[Ute88]

This is a devastating political ad.


http://www.youtube.com/watch?v=hYyMMs-WO4U

Yes, it is. It's going to be difficult for the Senators who voted against the Enzi amendment now to explain their votes to the public. All of these Senators deserve to lose in the upcoming election given that they knew fully well what this was going to do to the country (see, for example, the DPHHS estimates in the CFR release for June 18, 2010) and that they chose to ignore it.

[Rocker Ute]

This is why we do this people. This is why Obamacare is important.

http://dooce.com/2014/01/14/someone-got-new-eyewear/

When a presumably wealthy mommy-blogger who has a Christmas list like this (http://dooce.com/2013/12/12/for-her-2/), or who can afford to leave the kids behind when things just get too stressful for a quick jaunt to the east coast (http://dooce.com/2014/01/02/crane-beach/), or while she flies across the world on poverty tourism (http://dooce.com/2013/11/26/thus-spoke-the-travel-clinic/)... but now... now she only has to pay a $25 copay versus full price to replace her daughter's broken glasses.

It is these people who I love seeing are no longer a victim to an out of control healthcare system with robber-barrons waiting to make you fly coach at every corner.

Apologies for the rant. Truth is if a family that couldn't afford replacement glasses can now get them or things like that, then mission accomplished with Obamacare, but I'll be honest when I say it bothers me to read of this person whining about the cost of healthcare when she lives a life of which 90% of the US population can only dream.

[Rocker Ute]

So I know I upset people when I joke about it, but I'm being sincere when I ask... How do you guys find this stuff? Seriously.

Lol -zing. I know her and her ex-husband actually. She is actually quite a funny writer and my wife follows her blog.

Now how other people know about Kristina Basket's every move is between them and the bush they are hiding behind (although I discovered vinneedee works with the gymnasts, so he is excused but not the others).

[Diehard Ute]

Lol -zing. I know her and her ex-husband actually. She is actually quite a funny writer and my wife follows her blog.

Now how other people know about Kristina Basket's every move is between them and the bush they are hiding behind (although I discovered vinneedee works with the gymnasts, so he is excused but not the others).

Yes, he does and has for years. And some of us are friends of his, and others on the coaching staff (and former assistants who are now head coaches elsewhere)

The alumni provide them with updates about what they're doing that they can share. They often post it on the Utah Gymnastics Facebook page as well.

[Rocker Ute]

Yes, he does and has for years. And some of us are friends of his, and others on the coaching staff (and former assistants who are now head coaches elsewhere)

The alumni provide them with updates about what they're doing that they can share. They often post it on the Utah Gymnastics Facebook page as well.

But you have to admit there are some people out there who may have a obsession with her ranging from slightly creepy to unhealthy.

[Diehard Ute]

But you have to admit there are some people out there who may have a obsession with her ranging from slightly creep to unhealthy.

Having known many gymnasts and their parents, there are a few for almost every gymnast unfortunately.

[Rocker Ute]

So I mentioned earlier that I was one of those, "If you like your health plan we are gonna bump you off your health plan" people in Utah. We got dropped, picked up new insurance through Blue Cross. Our pediatrician was on the plan when we switched, confirmed with both the provider and the insurer. Our plan is supposed to have free flu shots with in-network providers so my wife takes our kids to get the shots with their pediatrician.

Apparently recently they had moved to a new office about 2 blocks south of where they were. Kids get their shots and all is good... until today (two months later by the way) we get a bill for $130 (or about $43 per flu shot) with a note that the pediatrician is not in our provider network anymore because they moved two blocks south. We could have got the shots through the school or just about anywhere else for $7-10 each.

Lovely.

It is this sort of nonsense that gets ignored while fixing other problems that don't exist. I used to work for an insurer. Had I known they moved offices I would have warned my wife to check again because they might need to reapply for to be part of the same networks with various insurers. After working for an insurer I never understood how provider networks actually reduced costs. The insurer I worked for just had the networks to keep out competition for their parent company. It would seem to me that any insurer could say, "These are our reimbursement rates and if you meet our standardized, quantifiable and tracked quality standards (and I know they are standardized, quantified and tracked because I set the system up while there) and accept our rates, you are part of that network."

Uhg.

[tooblue]

http://news.nationalpost.com/2014/03/12/toronto-doctor-smacks-down-u-s-senate-question-on-canadian-waitlist-deaths/


“On average, how many Canadian patients on a waiting list die each year? Do you know?” Republican Senator Richard Burr asked at the end of a prickly exchange with Dr. Danielle Martin, vice president of Medical Affairs at Toronto’s Women’s College Hospital.

“I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all,” she said.

[U-Ute]

One of the biggest gripes I have with the ACA is the fact that it does nothing to control the real problem of rising health costs. The largest influence, based on the Time article early last year, and my own personal experience, seems to be hospital costs.

Maryland is trying a new program which puts caps on hospital costs. It will be interesting to see where this goes:

http://america.aljazeera.com/articles/2014/3/18/maryland-s-all-payermodelasteptowardeuropeanstylehealthcare.html

[LA Ute]

This ad is getting a lot of attention. My guess is that it is pretty effective.


https://www.youtube.com/watch?v=MNRQMqmTmLM

[U-Ute]

This ad is getting a lot of attention. My guess is that it is pretty effective.

Effective? Probably. Truthful? Hard to say. I haven't seen any hard evidence to the claims in this political-ad which claims to be non-political. It offers no proof, just a lot of rhetoric. The last anti-Obamacare poster child the anti-Obamacare groups trotted out turned out to be a huge flop.

[tooblue]

http://www.youtube.com/watch?v=qSjGouBmo0M#t=67

[LA Ute]

Effective? Probably. Truthful? Hard to say. I haven't seen any hard evidence to the claims in this political-ad which claims to be non-political. It offers no proof, just a lot of rhetoric. The last anti-Obamacare poster child the anti-Obamacare groups trotted out turned out to be a huge flop.

It's only a 30-second ad so it's got to hit the key points. Everything in it is truthful, based on what I know. There is a response to every claim made, but Democrats do not want to get into the subject. That the source of the ad's effectiveness, IMO. It calls attention to uncomfortable subjects for those who voted for the ACA.

[Damage U]

http://www.youtube.com/watch?v=qSjGouBmo0M#t=67

From what I have seen as a health care worker their is a lot of truth to what this guy says. There is a ton of blame to go around for all involved from insurance companies and hospitals down to you and I. Yes, no one negotiates on price other than the government. The biggest thing that we as consumers can do is shop around. That knee pain that you've had for six months can wait another week while you shop for a cheaper MD. You don't need to run to the ER on Easter Sunday to have it looked at (true story today). For example, my father in-law needed a CT scan for kidney stones. His insurance company sent him to "their" hospital for the exam. The scan cost him $2,200. If he would have driven a little farther down the road to another hospital it would have cost him $1,500. Yet, if he would've come to the radiology clinic that I work at the cost would be $500 for he exact same exam. In fact, our radiologist read all the exam for the second hospital. Just because your doctor gives you a prescription for something doesn't mean you have to go their "guy".

[jrj84105]

From what I have seen as a health care worker their is a lot of truth to what this guy says. There is a ton of blame to go around for all involved from insurance companies and hospitals down to you and I. Yes, no one negotiates on price other than the government. The biggest thing that we as consumers can do is shop around. That knee pain that you've had for six months can wait another week while you shop for a cheaper MD. You don't need to run to the ER on Easter Sunday to have it looked at (true story today). For example, my father in-law needed a CT scan for kidney stones. His insurance company sent him to "their" hospital for the exam. The scan cost him $2,200. If he would have driven a little farther down the road to another hospital it would have cost him $1,500. Yet, if he would've come to the radiology clinic that I work at the cost would be $500 for he exact same exam. In fact, our radiologist read all the exam for the second hospital. Just because your doctor gives you a prescription for something doesn't mean you have to go their "guy".
This is the hard part about being a consumer. There are certainly conditions where it pays to shop around, but there are also big advantages to staying within a system. Medicine is increasingly fragmented, and it's very difficult to keep all the contributing specialists on the same page. If the condition is complex, the value of the medical care is more a function of coordination, communication, and standardization of practices than it is of the component tests/ procedures.


if a consumer does plan to use an alternate provider, the referring clinician should be notified so the appropriate communication takes place. You don't want to be the guy in renal failure due to CT contrast because in your referring doc's system radiology is responsible for checking your kidneys, but the outside radiology service views it as the referring doc's responsibility. You also don't want a medical history that reads like Johnny Cash's "one piece at a time", because that's going to buy the patient a repeat of all the studies.

[U-Ute]

From what I have seen as a health care worker their is a lot of truth to what this guy says. There is a ton of blame to go around for all involved from insurance companies and hospitals down to you and I. Yes, no one negotiates on price other than the government. The biggest thing that we as consumers can do is shop around. That knee pain that you've had for six months can wait another week while you shop for a cheaper MD. You don't need to run to the ER on Easter Sunday to have it looked at (true story today). For example, my father in-law needed a CT scan for kidney stones. His insurance company sent him to "their" hospital for the exam. The scan cost him $2,200. If he would have driven a little farther down the road to another hospital it would have cost him $1,500. Yet, if he would've come to the radiology clinic that I work at the cost would be $500 for he exact same exam. In fact, our radiologist read all the exam for the second hospital. Just because your doctor gives you a prescription for something doesn't mean you have to go their "guy".

I have tried this. Nobody will give me a quote. They hum and haw about unknown forces in the universe which preclude them from giving me an accurate quote.

[LA Ute]

https://www.youtube.com/watch?v=wmtaCZmzKWo#t=27

[LA Ute]

Poor guy getting roasted:


https://www.youtube.com/watch?v=bMb3gn3YunE#t=49

He pretty much earned it.

[U-Ute]

Another problem in the ability to show around is that each provider is on a different schedule with regards to when they renegotiate contracted rates.

I have been getting cortisone shots in my back for a pinched nerve due to a bulging disc. I went in to get a shot March and took note of the costs. When I went back to get another one in September, the cost had gone up by 15%. When I asked why, it was because the facility renegotiated their contract with my insurance company in June.

[Mormon Red Death]

http://www.msn.com/en-us/money/other/obamacares-cadillac-tax-hits-the-college-campus/ar-AAaYIHn

From another article (http://www.bloombergview.com/articles/2015-01-05/whining-harvard-professors-discover-obamacare):


they persist in our mass delusion: that there is some magic pot of money in the health-care system, which can be painlessly tapped to provide universal coverage without dislocating any of the generous arrangements that insured people currently enjoy. Just as there are no leprechauns, there is no free money at the end of the rainbow; there are patients demanding services, and health-care workers making comfortable livings, who have built their financial lives around the expectation that those incomes will continue. Until we shed this delusion, you can expect a lot of ranting and raving about the hard truths of the real world.

[Two Utes]

http://www.msn.com/en-us/money/other/obamacares-cadillac-tax-hits-the-college-campus/ar-AAaYIHn

From another article (http://www.bloombergview.com/articles/2015-01-05/whining-harvard-professors-discover-obamacare):

I paid an additional 1400 in medicare tax and was required to fill out some new tax form related to this additional money (Form 57something). In essence, my takes sneakily went up without me knowing about it. I have an undergraduate accounting degree, an MBA and a JD and I don't understand what this new tax is.

[Mormon Red Death]

I paid an additional 1400 in medicare tax and was required to fill out some new tax form related to this additional money (Form 57something). In essence, my takes sneakily went up without me knowing about it. I have an undergraduate accounting degree, an MBA and a JD and I don't understand what this new tax is.

the place where I work

2013 Premium Taxes and Reg Fees $76 Million
2014 Premium Taxes and Reg Fees $251 Million (All due to the ACA)

We posted our first loss in 20+ years due to the Tax bill. Not coincidentally my bonus went with those taxes.

[Rocker Ute]

the place where I work

2013 Premium Taxes and Reg Fees $76 Million
2014 Premium Taxes and Reg Fees $251 Million (All due to the ACA)

We posted our first loss in 20+ years due to the Tax bill. Not coincidentally my bonus went with those taxes.

Somebody is supposed to swoop in now and tell you this didn't actually happen.

[U-Ute]

Martin Shkreli, the man known right now for raising the price on a decades old drug designed to treat parasitic infections that plague mostly AIDS patients these days is now under investigation for financial issues at his former employer, Retrophin.

http://www.newsweek.com/martin-shkreli-drug-manipulation-daraprim-retrophin-375416

This guy seems like a borderline psychopath. The good that appears to be coming out of this he appears to be a poster boy for health care costs. Nobody will want to be the next "Shkreli" so they will be better at evaluating what "fair market value" really is.

Related to that, I saw an article recently about how the University Of Utah Health Care system is trying to figure that out...

http://www.nytimes.com/2015/09/08/health/what-are-a-hospitals-costs-utah-system-is-trying-to-learn.html?_r=0

Good work being done here.

[Ma'ake]

Martin Shkreli...


One thing this guy has done is revive the debate about just much greed is acceptable, in the face of human suffering.

http://www.washingtonpost.com/news/morning-mix/wp/2015/09/23/pharma-bro-martin-shkreli-and-the-very-american-debate-over-maximizing-profit/

Adam Smith asserted that through the pursuit of individual interest, the market allocates resources efficiently, and to the benefit of society.

Karl Marx saw things quite differently, of course, and predicted Capitalism's demise from collapse from within, as predators like Shkreli are so greedy the workers revolt.

(Standard history of economic thought, nothing too outlandish)

Here's the money shot: Ayn Rand, who has become somewhat of a "saint" of the ultra right, announced:

“Capitalism and altruism are incompatible; they are philosophical opposites; they cannot co-exist in the same man or in the same society.”

I've never understood how good, moral, faithful people have embraced Ayn Rand. It's just creepy.

[LA Ute]

He's an idiot.

[Mormon Red Death]

One thing this guy has done is revive the debate about just much greed is acceptable, in the face of human suffering.

http://www.washingtonpost.com/news/morning-mix/wp/2015/09/23/pharma-bro-martin-shkreli-and-the-very-american-debate-over-maximizing-profit/

Adam Smith asserted that through the pursuit of individual interest, the market allocates resources efficiently, and to the benefit of society.

Karl Marx saw things quite differently, of course, and predicted Capitalism's demise from collapse from within, as predators like Shkreli are so greedy the workers revolt.

(Standard history of economic thought, nothing too outlandish)

Here's the money shot: Ayn Rand, who has become somewhat of a "saint" of the ultra right, announced:

“Capitalism and altruism are incompatible; they are philosophical opposites; they cannot co-exist in the same man or in the same society.”

I've never understood how good, moral, faithful people have embraced Ayn Rand. It's just creepy.

As one who is somewhat of of fan of Ayn Rand I agree with a lot of what she says (I've read most of her stuff). Capitalism isnt perfect but its the best system we have. In regards to the Skrelli he does own the product. As much as its not something I would do I have a hard time forcing someone to sell their ideas/products/property/Labor for what society "thinks" is fair. One would think though that this will be a short lived gain for him as generics and similar drugs will be arriving shortly. Any social capital he has is gone as he is a pariah. Skrelli's payday better be worth it.

[NorthwestUteFan]

This isn't a product he developed, however. He merely purchased the rights to the product, after which he jacked up the price fifty fold. It would perhaps be a better argument if he (or his company) developed the product.

He is more Wesley Mouch than Hank Reardon.

[Mormon Red Death]

This isn't a product he developed, however. He merely purchased the rights to the product, after which he jacked up the price fifty fold. It would perhaps be a better argument if he (or his company) developed the product.

He is more Wesley Mouch than Hank Reardon.
I'm aware that he bought the product. Regardless he does own the product. even if I do think he is a scum

Sent from my SM-G900T using Tapatalk

[NorthwestUteFan]

He is a moocher, just like Warner Brothers Publishing and the Happy Birthday song. He was using the government to secure a significant competitive advantage against any possible competitor, including the company who developed and previously made the product.

This is especially interesting because the drug is used for a specific ailment in AIDS patients (not just HIV+ apparently), and the biggest customer is state/federal government as most people with AIDS are unable to purchase private insurance.

This dude is a frigging leach and he might just be the catalyst to greatly reform the pharmaceutical industry.

[LA Ute]

Democrats Begin the Long, Tortuous Retreat from Obamacare
http://www.thefiscaltimes.com/Columns/2015/10/01/Democrats-Begin-Long-Tortuous-Retreat-Obamacare

[U-Ute]

Democrats Begin the Long, Tortuous Retreat from Obamacare
http://www.thefiscaltimes.com/Columns/2015/10/01/Democrats-Begin-Long-Tortuous-Retreat-Obamacare

This seems weak.

Backing away from taxing "Cadillac Plans" is a far cry from going away from Obamacare. The individual mandate is the key piece.

It won't go away until someone comes up with a better way to control hospital costs.

[LA Ute]

A less biased account:

Foes of Tax on ‘Cadillac’ Health Plans Gain, but Challenges RemainDivisions among lawmakers could still stall efforts to tweak or eliminate levy
http://www.wsj.com/articles/foes-of-tax-on-cadillac-health-plans-gain-but-challenges-remain-1443742601

What bugs me about this tax is that it was promised as a means of paying for Obamacare as the law was implemented. Like so many such things, no one really expected this provision to survive, and if it goes away there will be less revenue to pay for the bill.

The other thing everyone on the GOP side knows, but no one will admit, is that there will be no "repeal and replace" of Obamacare. If (a big if) the Repubs get the White House back and keep control of Congress, they'll replace or change large parts of the ACA but most of it will remain.

[LA Ute]

This piece argues that Obamacare is failing because it has disrupted the health insurance market.

http://theweek.com/articles/589920/quiet-unraveling-obamacare


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[U-Ute]

This piece argues that Obamacare is failing because it has disrupted the health insurance market.

http://theweek.com/articles/589920/quiet-unraveling-obamacare


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That's because they tried to fix the wrong thing - insurance companies can't afford hospital prices either.

Until we can find a way to accurately price the health care market, nothing will get fixed.

[LA Ute]

That's because they tried to fix the wrong thing - insurance companies can't afford hospital prices either.

Until we can find a way to accurately price the health care market, nothing will get fixed.

You're right, it's a big problem. And because it has to do with money, a whole lot of agendas are at work. Vivian Lee at the U. Is doing some nation-leading pioneering work in that area:

http://mobile.nytimes.com/2015/09/08/health/what-are-a-hospitals-costs-utah-system-is-trying-to-learn.html?referer=&_r=0



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[U-Ute]

You're right, it's a big problem. And because it has to do with money, a whole lot of agendas are at work. Vivian Lee at the U. Is doing some nation-leading pioneering work in that area:

http://mobile.nytimes.com/2015/09/08/health/what-are-a-hospitals-costs-utah-system-is-trying-to-learn.html?referer=&_r=0



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I saw that article. I hope the trend catches on.

[LA Ute]

This is an interesting (if left-leaning) review of the ways Congress and the White House are playing games over the Affordable Care Act's funding. (Everyone knew at the time it was passed that a lot of those funding mechanisms -- not scheduled to take effect until after the 2012 election, for a law passed in 2009 -- would never become reality.)

http://thehealthcareblog.com/blog/2015/12/17/the-magical-world-of-aca-funding/

I'm interested in Mormon Red Death's perspective on this. He lives the ACA every day.

[Mormon Red Death]

Philosophically I hate this legislation. It's miss named. It should be named the access to care act instead of the the "affordable" care act.

Look its done well getting people insurance. It's done NOTHING for affordability. Hospitals revenues are up dramatically. They haven't cut any costs in fact it's worse.

Everyone hates the insurance companies but they are the only ones talking about costs. Its the biggest problem we have. Every year congress aims to cut reimbursement only to have the cuts removed at the last minute.

For example I had a benign tumor in my neck removed last Friday. Total costs for everything will probably be 4k. The procedure took 20 minutes. Until we start addressing the costs we will continue to have problems.

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[LA Ute]

Philosophically I hate this legislation. It's miss named. It should be named the access to care act instead of the the "affordable" care act.

Look its done well getting people insurance. It's done NOTHING for affordability. Hospitals revenues are up dramatically. They haven't cut any costs in fact it's worse.

Everyone hates the insurance companies but they are the only ones talking about costs. Its the biggest problem we have. Every year congress aims to cut reimbursement only to have the cuts removed at the last minute.

For example I had a benign tumor in my neck removed last Friday. Total costs for everything will probably be 4k. The procedure took 20 minutes. Until we start addressing the costs we will continue to have problems.

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It increased access by expanding Medicaid. That is the ACA's one achievement. Nothing in it restrains costs.


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[NorthwestUteFan]

A family member had non-emergency bowel surgery last year. The total bill was 37 THOUSAND GD Dollars.

The surgeons bill? (Consult, surgery, follow-up) ~ $2100
The surgeon's reimbursement? ~$1685.

I happen to have good insurance so my out of pocket was around $180 including meds. But for somebody without insurance, trying to pay for that OOP? Fugeddabout it. Even with writeoffs that would be an overwhelming amount of debt for most people.

[LA Ute]

A Single-Payer System Won't Make Health Care Cheap

http://www.bloombergview.com/articles/2014-04-30/single-payer-would-make-health-care-worse


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[U-Ute]

"Hospitalists" looking at unionizing as a reaction to hospital outsourcing doctors.

http://mobile.nytimes.com/2016/01/10/business/doctors-unionize-to-resist-the-medical-machine.html?smid=tw-nytimes&smtyp=cur&referer=

It seems to me that the administrators are trying to make predictable a business that is inherently unpredictable in order to make a buck. This is similar to what I see in my business and what we are seeing in Hollywood, which is why so many movies and TV shows are so derivative.

[Ma'ake]

A Single-Payer System Won't Make Health Care Cheap

http://www.bloombergview.com/articles/2014-04-30/single-payer-would-make-health-care-worse


A single payer system could save a lot of money, probably about $300 Billion a year, which is what the accumulated private bureaucracy and insurance overhead costs amount to. I worked for a non-profit insurance company in the 90s. We were proud of the fact our overhead costs were in the 12% range, where the industry average is closer to 16-18%. The overhead in running a single payer system is typically less than 2%. (Health insurance salesmen drive BMWs and Mercedes. Medicare administrators drive Chevys and Toyotas.)

But I don't think Americans are anywhere close to supporting a single payer model. Individualism is central to Americans' world view, to the point where people defied traffic lights when they first came out - in SLC, interestingly - because they were hampering their individual rights.

Support for the constituent parts of ACA is very strong - it's "unfair" to be denied coverage for a pre-existing condition, and it's just plain smart to offer no out-of-pocket costs for preventive treatment - but ACA is still viewed by many as a ongoing disaster. This is why Congressional Republicans were starting to crap their pants before the Supreme Court ruling last year. "What if we win? What will we do? We can't just revoke these popular parts of ACA."

[Ma'ake]

Regarding healthcare costs, my own personal experience is that lifestyle choices could put a dramatic dent in the cost problem. I feel better now than I did 15 years ago, and it's not even close. (And I was doing quite well 15 years ago.)

But telling Joe Sixpack that he should really skip the pizza after a shitty day at work and go exercise is more likely to evoke a response along the lines of "have a little chat with my Smith & Wesson!" than it is the desired response.

Healthcare costs will have to come down, and he's how - technology.

Some of the high end computing and Big Data developments are showing how technology will revolutionize healthcare... and a lot of other areas. Right now, IBM has their impressive "Watson" technology - aka the Ken Jennings nemesis on the gameshow Jeopardy! - diagnosing lung cancer at 90%+ accuracy levels, where the human physicians are about 50%. It would require the MD to read 160 hours a week, understand all the latest research findings, and correlate it with his/her existing medical knowledge...and never forget any of it. "Machine Learning" is leading the separation between human MDs and technology. Watson went from being comparable to Ken Jennings on Jeopardy!, to absolutely smoking him, as it learned from its own answers.

We really are talking about John Henry vs the Steam Engine.

In the future we'll need fewer fully trained physicians, and more Physician Assistants, who can access the diagnostic technology and work under a physician.

In healthcare research, in the history of cancer, we've found about 30 protein "pathways" to deliver treatment through, in chemotherapy. Baylor, using high end analytics, a big DNA database and a large Electronic Medical Record database, found six new pathways... in 2 months.

When I tell our researchers and physicians about this, they turn white. "This is a game changer... but what does this mean for our careers?" I tell them this means fewer 70-80 hour weeks, and more 40-50 hour weeks, being able to treat more patients, with better outcomes.

We're going from covered wagons, to the continental railroad. There's still a lot of work to do, but it will get done, and the very best thinking, from the best researchers and physicians, will get enhanced and magnified and made available to any practitioner.

The future will be very good, but getting there will be a little bumpy.

[LA Ute]

This proposal is authored by one of my colleagues, Lanhee Chen:

http://www.wsj.com/articles/instead-of-obamacare-giving-health-care-power-to-the-people-1453502774

[Rocker Ute]

I mentioned my son's accident last March and have talked about how Obamacare regulations forced us onto a much more expensive, smaller network, less coverage plan (but at least preventive care is covered!).

9 months later and I am still getting bills, and rather large ones (three days before Christmas we were happy to receive a $3000 bill, a week ago another for $2000).

Of course insurance is denying those claims and we need to resubmit everything. But it just underscores how everything that is awful about health insurance remains, and for me personally at a higher cost.

One item being denied, in the emergency surgery the Doctor recommend that they create a splint of sorts that they'd wire in with his jaw to keep things in place. They had a ER dentist available at Primary's and so he cast the splint custom to my son's mouth.

Of course, insurance denies it because they view that as dental work, which isn't covered by insurance.

I'm not blaming Obamacare for that, but these sort of issues are so rampant in healthcare and the time spent adjudicating these sort of things is massively expensive. We currently have three people 'reviewing' our appeal (when a three second look would say, "uh yeah that was part of the surgery, not standard dental work").

Meanwhile the fact that the hospital system took 9 months to bill likely means that when and if this gets resolved they'll probably try to apply it to this year's deductible and out of pocket max and I'll have to battle that.

I'm whining, but I would really love for some common sense to enter healthcare and introducing things that actually do reduce healthcare spending, which wasn't that the goal from the get-go? I can't fathom in his day and age with the technology available why the billing on this wasn't resolved and submitted, approved and sent out within a day.



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[Jarid in Cedar]

Sorry for your frustration, Rocker. As someone on the other side of the divide, our frustrations are very similar.

Of note, deductibles are based on date of service, not when the claims are submitted. So regardless of when everything gets resolved, the charges will apply to your 2015 deductible, not 2016.

[Rocker Ute]

Understood on that, let's just say my confidence they'll get it right is low.


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[mUUser]

I'm whining, but.......



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It's not whining, not by a long shot, especially when it is your kid's health at stake. At worst, you're venting, and you have good reason to......health care costs and the choking bureaucracy surrounding it is a real mess. People smarter than me have to figure this out, but, I don't have confidence the solutions will come from an entity that moves with the speed of mountains.

[Mormon Red Death]

http://thehill.com/policy/healthcare/276366-insurers-warn-losses-from-obamacare-are-unsustainable

It's more important to watch what happens with Blue Cross Blue Shield plans, which are the backbone of the ObamaCare marketplaces.
There have been some rumblings of discontent from Blue Cross plans. The plan in New Mexico already dropped off the marketplace there last year after it lost money and state regulators rejected a proposed 51.6 percent premium increase. Now, Blue Cross Blue Shield of North Carolina says that it might drop out of the marketplace because of its losses.

[LA Ute]

http://thehill.com/policy/healthcare/276366-insurers-warn-losses-from-obamacare-are-unsustainable

It's more important to watch what happens with Blue Cross Blue Shield plans, which are the backbone of the ObamaCare marketplaces.
There have been some rumblings of discontent from Blue Cross plans. The plan in New Mexico already dropped off the marketplace there last year after it lost money and state regulators rejected a proposed 51.6 percent premium increase. Now, Blue Cross Blue Shield of North Carolina says that it might drop out of the marketplace because of its losses.


But Medicaid! Medicaid was dramatically expanded and millions more people have coverage now! Let's not lose sight of that. It is the one clear accomplishment of the ACA. So if you are are hospital CEO you no longer have a lot of uninsured people. Instead you have a lot of people with terrible insurance. And they're coming to your ER! 20% more than before! Who could have seen this coming? 😉


"It's men in shorts." -- Rick Majerus

[Diehard Ute]

But Medicaid! Medicaid was dramatically expanded and millions more people have coverage now! Let's not lose sight of that. It is the one clear accomplishment of the ACA. So if you are are hospital CEO you no longer have a lot of uninsured people. Instead you have a lot of people with terrible insurance. And they're coming to your ER! 20% more than before! Who could have seen this coming? 😉


"It's men in shorts." -- Rick Majerus

You want to know who the best paying customers are in the healthcare system?

Prisoners.

Just let that sink in for a minute.


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[Rocker Ute]

After the hell of billing that I've been going through with my son's accident (we had the one year anniversary of the accident over a month ago and they are still trying to sort out the billing) I see very low hanging fruit to meaningfully bad appreciably fix health care.

I started tracking it midway of the hours I have spent getting the billing sorted out... I've spent 32.5 hours thus far (without resolution). Presuming at least that much spent by both the providers and my insurance at $20/hour that is $1300 wasted.

It isn't hard. If I have a $10k out of pocket max and I hit that in day 1 of the accident, the insurance pays everything after. Each and every person I speak to acts as if this is the first claim that has ever been made.

I wish there was an end in sight.

After we fix that, then let's tackle better utilization. Those two things alone will do more to make care 'affordable' more than anything that's been done this far.





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[LA Ute]

You want to know who the best paying customers are in the healthcare system?

Prisoners.

Just let that sink in for a minute.


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I have a tiny hospital client that would not survive if there were not a state prison next door. You're right, it's great business.

[Diehard Ute]

I have a tiny hospital client that would not survive if there were not a state prison next door. You're right, it's great business.

When I worked at the U the prison and jail paid at higher rates that even Medicare.

We obviously have some work to do when our prisoners get excellent medical care but we argue and fight over how to give it to law abiding folks.

(And if you ever want to change healthcare, start with Medicare. They get first crack at the negotiating table, and there's not a hospital in the US who will cross them, they'll be out of business if they do)


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[U-Ute]

After the hell of billing that I've been going through with my son's accident (we had the one year anniversary of the accident over a month ago and they are still trying to sort out the billing) I see very low hanging fruit to meaningfully bad appreciably fix health care.

I started tracking it midway of the hours I have spent getting the billing sorted out... I've spent 32.5 hours thus far (without resolution). Presuming at least that much spent by both the providers and my insurance at $20/hour that is $1300 wasted.

It isn't hard. If I have a $10k out of pocket max and I hit that in day 1 of the accident, the insurance pays everything after. Each and every person I speak to acts as if this is the first claim that has ever been made.

I wish there was an end in sight.

After we fix that, then let's tackle better utilization. Those two things alone will do more to make care 'affordable' more than anything that's been done this far.

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Spending 40 hours searching for a way to not pay for health care is probably still cheaper than just paying for it in the long run.

[Rocker Ute]

Spending 40 hours searching for a way to not pay for health care is probably still cheaper than just paying for it in the long run.

Nevermind. Onward and upward.

[Mormon Red Death]

http://dailycaller.com/2016/06/03/another-health-insurer-suing-feds-over-obamacare-losses/

[LA Ute]

Hillarycare: The Slow-Walk to Single-Payer (http://www.realclearhealth.com/articles/2016/06/03/hillarycare_the_slow-walk_to_single-payer_109909.html)

[Mormon Red Death]

Obama's defense of his shitty legislation (http://www.msn.com/en-us/money/healthcare/white-house-spending-millions-to-battle-obamacare-rate-hikes/ar-AAhcFBq?li=BBnbfcN). The affordable care act is ridiculous. This is politics at its worst.

[U-Ute]

Obama's defense of his shitty legislation (http://www.msn.com/en-us/money/healthcare/white-house-spending-millions-to-battle-obamacare-rate-hikes/ar-AAhcFBq?li=BBnbfcN). The affordable care act is ridiculous. This is politics at its worst.

It is ridiculous in the fact that it does nothing to fix the actual problem: hospital fees are not guided by market principles at all.

[LA Ute]

Paul Run finally unveils the Republican plan that would replace Obamacare (but only if Trump wins and the GOP keeps both houses of Congress - unless both sides decide to do something shocking and compromise, which is the only way decent health care legislation ever gets passed).

http://www.reuters.com/article/us-usa-election-healthcare-ryan-idUSKCN0Z80AQ