...aaand welcome to the real world (Obamacare)

[First]

Can I frame this when it becomes self evident in a couple years?

Expanding medicaid wouldn't have made much of a difference because the reimbursement rates are so low. You guys are... not bright.

Oy.

You're exceedingly poor at math if you can't see that the hundreds of millions and in some cases billions that Medicaid expansion would provide is arithmetically superior to no Medicaid expansion at all for these state hospitals, no matter the reimbursement rate, because by federal law, hospitals must provide care regardless of ability to pay. In one scenario, hospitals get Medicaid money from this ER care. In the other scenario, they don't. That's the gist of it. Get it? Lord I hope so.

 

[OverVolt]

Oy.

You're exceedingly poor at math if you can't see that the hundreds of millions and in some cases billions that Medicaid expansion would provide is arithmetically superior to no Medicaid expansion at all for these state hospitals, no matter the reimbursement rate, because by federal law, hospitals must provide care regardless of ability to pay. In one scenario, hospitals get Medicaid money from this ER care. In the other scenario, they don't. That's the gist of it. Get it? Lord I hope so.

Not when they have to invest $50 million into EHR's to be ACA complaint so that they can make (maybe) 1% profit margins.

 

[sandorski]

The Death Panels are so efficient, they intervene before the Patients even reach the Hospital!!

 

[umbrella39]

Geez OV... this thread isn't going to be your mic dropping moment. Best to admit you have been soundly duped and move along...

 

[UberNeuman]

Geez OV... this thread isn't going to be your mic dropping moment. Best to admit you have been soundly duped and move along...

 

[OverVolt]

Geez OV... this thread isn't going to be your mic dropping moment. Best to admit you have been soundly duped and move along...

I haven't been duped. I'm surprised you go with Eski's line of thinking considering he is brain dead.

This is a nuanced issue beyond the reasoning of ATOT.

For starters, the guy talking about for-profit hospitals doesn't realize the price gouging practices they engage in. See here: http://www.nytimes.com/2015/06/16/opinion/sticker-shock-in-for-profit-hospitals.html I've personally seen a $384 drug charged as $5,200 and thats not even that bad.

Second of all I'm in Maryland. That changes everything. Maryland has a special arrangement with medicare and charges differently than any other state. You guys are unlikely aware of this. Prices were already more regulated here before the ACA. All the prices here are reasonable. $39 to $74 for an EKG instead of $390 in California for example. Or $1,800 for a colonoscopy vs $8,000 in New York. There is nothing left here to cut. And Maryland is now in huge trouble. See here: http://www.washingtonpost.com/blogs...ls-prices-now-it-wants-to-cap-their-spending/

But after saving an estimated $45 billion for consumers over four decades, the system is in danger of running aground. Hospital expenses have risen so relentlessly in recent years that the original price controls now appear unsustainable...

But critics say the near-collapse of the state’s old system proves the perils of heavy-handed regulations...

“Hospital rate-setting clearly didn’t succeed at meaningfully slowing costs down,” said Joe Antos, who served eight years on the Maryland board that set rates...

Over the past several years, Maryland’s system began to unravel. Hospitals saw their expenses soar, and the cost controls proved too inflexible to handle the rise...

So Maryland officials came up with a new approach. On top of setting rates for individual procedures, they are proposing a cap on the growth of the total amount the hospital system spends per person in the state. The plan also allows hospitals to charge higher prices if they adopt preventive-care methods that improve patient health and reduce repeat visits, said Maryland’s health secretary, Joshua Sharfstein...

Hospitals say the plan, if approved, could be onerous, hurting the financial health of the $15 billion hospital industry that employs nearly 100,000 people in Maryland...

John M. Colmers, who chairs Maryland’s Health Services Cost Review Commission and was a key architect of the proposal, acknowledged that the proposal might be “a challenge” for hospitals. Colmers is also a top vice president at Johns Hopkins Medicine in Baltimore...

Although actually reading the whole article (too much to ask) gives a much better impression of the situation.

 

[OverVolt]

Oh look you know nothing and have nothing to contribute. Nailed it.

 

[OverVolt]

You already claimed that it is. Oh, God! Evil Obamacare driving hospitals out of business!

The mental contortions required to keep the faith are astounding.

To be honest I don't know why you post here since everything is over your head at all times.

 

[OverVolt]

Oy.

You're exceedingly poor at math if you can't see that the hundreds of millions and in some cases billions that Medicaid expansion would provide is arithmetically superior to no Medicaid expansion at all for these state hospitals, no matter the reimbursement rate, because by federal law, hospitals must provide care regardless of ability to pay. In one scenario, hospitals get Medicaid money from this ER care. In the other scenario, they don't. That's the gist of it. Get it? Lord I hope so.

Often times medicaid procedures are reimbursed below cost. It has to be made up somewhere. IE price gouging.

Private insurance is actually getting squeezed harder in states with expanded medicaid. derp. I'd expect $500 EKG's in California in no time. Are the costs under control yet? Cause Maryland had solved this problem four decades ago and the ACA is breaking it.

 

[DrDoug]

Often times medicaid procedures are reimbursed below cost. It has to be made up somewhere. IE price gouging.

Private insurance is actually getting squeezed harder in states with expanded medicaid. derp. I'd expect $500 EKG's in California in no time. Are the costs under control yet? Cause Maryland had solved this problem four decades ago and the ACA is breaking it.

What about the hospitals in states that have opted out of the Medicaid expansion? Since the government is phasing out payments to hospitals for indigent people (because of the ACA), unless the Republicans in those states change their minds on the Medicare expansion, those hospitals are screwed. Ask North Carolina hospitals how they feel about this, they are speaking out about it.

Keep trying to support the unsupportable and defend the indefensible, the Republican party is counting on fools, I mean "voters", like you!

 

[OverVolt]

What about the hospitals in states that have opted out of the Medicaid expansion? Since the government is phasing out payments to hospitals for indigent people (because of the ACA), unless the Republicans in those states change their minds on the Medicare expansion, those hospitals are screwed. Ask North Carolina hospitals how they feel about this, they are speaking out about it.

Keep trying to support the unsupportable and defend the indefensible, the Republican party is counting on fools, I mean "voters", like you!

The states eventually have to start picking up more of the tab for medicaid expansion. They get 3 years free. Its working out pretty well since they haven't had to pay up yet.

 

[DrDoug]

The states eventually have to start picking up more of the tab for medicaid expansion. They get 3 years free. Its working out pretty well since they haven't had to pay up yet.

Yes, and that will change by 2020 so that the state has to pick up 10% and the feds pick up the other 90%.

It sure beats the fuck out of the 0% they are getting right now though...lol!

Keep trying...

 

[OverVolt]

Yes, and that will change by 2020 so that the state has to pick up 10% and the feds pick up the other 90%.

It sure beats the fuck out of the 0% they are getting right now though...lol!

Keep trying...

To be honest I agree. More money flowing into the state would improve things. Even if they had to pickup 10% of the tab. Thats minor. You guys are too partisan & liberal on this board. I'm fairly centered.

You guys are painting with broad strokes just because I disagree with the ACA. Its not going to control costs. What Maryland did actually controlled costs, and the ACA doesn't follow that model. If anything all the regulation & compliance made expenses skyrocket.

I'm glad I'm not a doctor because they are basically trying to pressure healthcare salaries downward. Thats the only place I can see to cut.

 

[sportage]

Forget about right winged propaganda, which is all that this is.
The problem for hospitals is when they provide care and the uninsured cannot pay.
If you look at it as debits and credits, the hospital suffered a debit (caring for the uninsured), and the uninsured inability to pay denied the hospital their offsetting credit for services rendered.
Surely fiscal conservative republicans have not given up on the ideology of a balancing those fiscal books?
Oh, never mind. They indeed have given up on that.
Now its all about guns, God, gays, and anything that black president has done.
Ronald Reagan must be turning in his grave.

 

[OverVolt]

Forget about right winged propaganda, which is all that this is.
The problem for hospitals is when they provide care and the uninsured cannot pay.
If you look at it as debits and credits, the hospital suffered a debit (caring for the uninsured), and the uninsured inability to pay denied the hospital their offsetting credit for services rendered.
Surely fiscal conservative republicans have not given up on the ideology of a balancing those fiscal books?
Oh, never mind. They indeed have given up on that.
Now its all about guns, God, gays, and anything that black president has done.
Ronald Reagan must be turning in his grave.

You help the conservatives more than you even know...

 

[Gonad the Barbarian]

You help the conservatives more than you even know...

You're probably right here. The fact is half you guys wouldn't be around to even be conservative if it wasn't for things like social security, disability checks, and a whole host of other things from the social safety net that liberals dedicate so much effort to keep you guys from tearing down around yourselves.

 

[OverVolt]

You're probably right here. The fact is half you guys wouldn't be around to even be conservative if it wasn't for things like social security, disability checks, and a whole host of other things from the social safety net that liberals dedicate so much effort to keep you guys from tearing down around yourselves.

I'm not conservative... sigh.

ATOT in a nutshell. You either agree, or you're a Texashiker conservative.

 

[Gonad the Barbarian]

I'm not conservative... sigh.

ATOT in a nutshell. You either agree, or you're a Texashiker conservative.

You're cute, like a short, feathered, web-footed bird that quacks he's not a duck.

 

[OverVolt]

You're cute, like a short, feathered, web-footed bird that quacks he's not a duck.

And you're not even liberal!

 

[fskimospy]

Dont argue with eski this will be a 10 page thread even though he is wrong he is just incapable of realizing it.

I just wanted to quote this for irony.

 

[First]

Not when they have to invest $50 million into EHR's to be ACA complaint so that they can make (maybe) 1% profit margins.

1. $50M is your made-up number.
2. Medicaid money outstrips every cumulative regulation that's been reported.

Sorry, math wins.

Often times medicaid procedures are reimbursed below cost. It has to be made up somewhere. IE price gouging.

Private insurance is actually getting squeezed harder in states with expanded medicaid. derp. I'd expect $500 EKG's in California in no time. Are the costs under control yet? Cause Maryland had solved this problem four decades ago and the ACA is breaking it.

No, most times Medicaid reimburses above cost. I'm sorry you didn't know this. And private insurance being squeezed or not says nothing about the effectiveness of the care being delivered, so your point, like most of your posts, is moot.

 

[Slew Foot]

1. $50M is your made-up number.
2. Medicaid money outstrips every cumulative regulation that's been reported.

Sorry, math wins.



No, most times Medicaid reimburses above cost. I'm sorry you didn't know this. And private insurance being squeezed or not says nothing about the effectiveness of the care being delivered, so your point, like most of your posts, is moot.

Medi-cal, CAs version of medicaid, reimburses well below cost of care and many hospitals that have large populations of poor people, are having trouble keeping their doors open. Large hospitals in busy cities, find ways to keep the poor people away and find ways to get money out of the middle class commercially insured population, they're tending to do well.

 

[First]

Medi-cal, CAs version of medicaid, reimburses well below cost of care and many hospitals that have large populations of poor people, are having trouble keeping their doors open. Large hospitals in busy cities, find ways to keep the poor people away and find ways to get money out of the middle class commercially insured population, they're tending to do well.

That may be a problem, I'm not an expert on Medical. Of course, who knows what the true cost of care is when hospitals routinely overbill, some at outrageous sums.

 

[fskimospy]

Medi-cal, CAs version of medicaid, reimburses well below cost of care and many hospitals that have large populations of poor people, are having trouble keeping their doors open. Large hospitals in busy cities, find ways to keep the poor people away and find ways to get money out of the middle class commercially insured population, they're tending to do well.

Saying that they reimburse below the cost of care is often very misleading. They might reimburse below the AVERAGE cost of care, but that is something totally different.

For example, take MRIs. Buying an MRI machine, maintaining it, and staffing people to run it are all basically fixed costs: they are roughly the same if you do 1 MRI per day or 30. Now a hospital's ideal scenario might be all private insurance people paying high prices all day, but that often doesn't happen because there simply aren't enough people on private insurance that need MRIs. Now the hospital has a choice, they can either accept Medicare MRI patients and get lower payments for an MRI or they can get nothing. Since their costs are mostly fixed, taking Medicare patients increases the amount of revenue AND profit they make from that MRI machine.

It could be true that it was a money loser if they only took Medicare patients, but if they are using Medicare patients to soak up slack capacity (like basically all hospitals that take Medicare do), they aren't losing money, they are making more money.

This isn't true for every procedure and every case, but it's true for a lot of them. There's a reason why the vast majority of hospitals accept Medicare, and it's not out of the goodness of their hearts.

 

[DrDoug]

Richard Mayhew writes some good stuff about ACA issues over at Balloon Juice. He is particularly good at pointing out the pros and cons of various parts of medical and insurance law. He has a post up now that explains facility fees and how hospitals are screwing over patients and Medicare by buying up clinics and designating them as outpatient facilities so they can collect higher fees from the patient and government.

It doesn't matter what laws are written, when it comes to money the greedy will find a way to manipulate the system to their favor. You can write the most bullet-proof law you think you can and still greedy people will find a way to circumvent it in some novel way. Greed will never go away, it just morphs into another form and continues.

All you can do is play whack-a-mole with these greedy assholes every time they pop up.