Quietly, Obamacare is doing something even more ambitious than insurance expansion

[Zebo]

Wow. A lot of lefty masturbation going on in this thread. How about the 1.76 Trillion cost.

Yeah like the Iraq war would be 30 billion or even pay for itself.

The only way it's gonna cost 1.76 trillion is if we can't borrow anymore and program can't be paid for anymore.

I admire the noble goals and support them but it was done wrong.

 

[theeedude]

Not really. I'm talking infrastructure. Because people live in more rural areas you'll not be able to deny them modern treatments. Small hospitals servicing relatively few need most of you'd find in a city.

If that was the reason, modern treatments would be cheaper in the cities, where there are more people to amortize the infrastructure. Is there evidence of that?
I am not seeing this trend between more rural and more urban states.
http://www.statehealthfacts.org/comparemaptable.jsp?cat=5&ind=596

The biggest differentiator appears to be hospital care:
http://www.statehealthfacts.org/comparetable.jsp?ind=597&cat=5
So whatever you can do to keep people out of the hospital in the first place seems like a slam dunk investment.

 

[ohnoes]

The sad truth is that it's only a small portion of the customers that need/demand the majority of healthcare. Some people have life-long expensive to treat illnesses, and they consume much more than everyone else. Then it becomes an ethical question and should we spend $500K to extend the life of a 60 yr old or care for a newborn with a heart defect.

 

[Hayabusa Rider]

If that was the reason, modern treatments would be cheaper in the cities, where there are more people to amortize the infrastructure. Is there evidence of that?
I am not seeing this trend between more rural and more urban states.
http://www.statehealthfacts.org/comparemaptable.jsp?cat=5&ind=596

The biggest differentiator appears to be hospital care:
http://www.statehealthfacts.org/comparetable.jsp?ind=597&cat=5
So whatever you can do to keep people out of the hospital in the first place seems like a slam dunk investment.

Theres no doubt preventative care is a good thing, but I suggest that if you look at things like per capita MRI machines you'll see we're way up there. Also there is a very hard to quantify cost due to how medicine is practiced because of potential lawsuits. Note this isn't direct costs of litigation, rather how practitioners respond to a relatively hostile legal environment. Countries which practice UHC also make it quite difficult to sue. Here the problem is so profound that an internal medicine specialist will be sued over the course of their career. The incidence is over 99%. Generally, it's more likely to be litigated against than not for any physician. When faced with the realities more tests are made than is often necessary so that the "you should have tried one more" malpractice strategy has less traction. I've always thought the adversarial relationship between attorney and prescriber must be fantastically expensive but quantifying such a "what if" would be most difficult.

 

[cybrsage]

The sad truth is that it's only a small portion of the customers that need/demand the majority of healthcare. Some people have life-long expensive to treat illnesses, and they consume much more than everyone else. Then it becomes an ethical question and should we spend $500K to extend the life of a 60 yr old or care for a newborn with a heart defect.

The government will simply setup death panels to decide who gets to die.

 

[boomerang]

The government will simply setup death panels to decide who gets to die.

No way. There will be plenty enough money to go around. Why we're going to cover 3 million illegals! If there's money enough for them there's enough to give Cheney a heart.

 

[theeedude]

Theres no doubt preventative care is a good thing, but I suggest that if you look at things like per capita MRI machines you'll see we're way up there. Also there is a very hard to quantify cost due to how medicine is practiced because of potential lawsuits. Note this isn't direct costs of litigation, rather how practitioners respond to a relatively hostile legal environment. Countries which practice UHC also make it quite difficult to sue. Here the problem is so profound that an internal medicine specialist will be sued over the course of their career. The incidence is over 99%. Generally, it's more likely to be litigated against than not for any physician. When faced with the realities more tests are made than is often necessary so that the "you should have tried one more" malpractice strategy has less traction. I've always thought the adversarial relationship between attorney and prescriber must be fantastically expensive but quantifying such a "what if" would be most difficult.

I understand not everything is easy to quantify, but you keep saying stuff without any data to back it up. This bothers me as an engineer. States have tried limiting lawsuits with "tort reform" and it hasn't kept a lid on health care costs.

 

[simpletron]

The Patient Protection and Affordable Care Act (PPACA) is a United States federal statute signed into law by President Barack Obama on March 23, 2010.

The program launched in June 2009 with a checklist of quality metrics.

:hmm:

The program described in article is called ACE. It started under Bush and is unrelated to PPACA. See link below for more details.

For Immediate release Contact: CMS Office of Media Affairs
January 6, 2009 (202) 690-6145
CMS ANNOUNCES SITES FOR A DEMONSTRATION TO ENCOURAGE GREATER COLLABORATION AND IMPROVE QUALITY USING BUNDLED HOSPITAL PAYMENTS

The Centers for Medicare & Medicaid Services (CMS) today announced site selections for the Acute Care Episode (ACE) demonstration. ACE is a new hospital-based demonstration that will test the use of a bundled payment for both hospital and physician services for a select set of inpatient episodes of care to improve the quality of care delivered through Medicare fee-for-service.

Baptist Health System in San Antonio, Texas; Oklahoma Heart Hospital LLC in Oklahoma City, Okla.; Exempla Saint Joseph Hospital in Denver, Colo.; Hillcrest Medical Center in Tulsa, Okla.; and Lovelace Health System in Albuquerque, N.M., have been selected to participate in the demonstration.

https://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=cms1204388

It should be noted that PPACA does include some bundle payment ideas, but they don't take effect until this year or later.

 

[Jhhnn]

The sad truth is that it's only a small portion of the customers that need/demand the majority of healthcare. Some people have life-long expensive to treat illnesses, and they consume much more than everyone else. Then it becomes an ethical question and should we spend $500K to extend the life of a 60 yr old or care for a newborn with a heart defect.

I'm not sure that's true at all. And the moral dilemma you pose already exists, just in different terms. It now depends on the ability to pay, usually via insurance.

Many of us will end up with some sort of expensive pre-existing condition if we don't die suddenly, not to mention people who are badly injured in auto accidents & so forth. We need to recognize that individual needs change over time, and that people who've paid into health insurance their whole working lives shouldn't be squeezed out when they actually need care.

 

[Hayabusa Rider]

I understand not everything is easy to quantify, but you keep saying stuff without any data to back it up. This bothers me as an engineer. States have tried limiting lawsuits with "tort reform" and it hasn't kept a lid on health care costs.

Perhaps you understand my frustration at there being virtually no analysis of the system aa whole in the context of true national reform. We have suppositions and isolated statistics, however what do we know in absolute objective terms? Not nearly enough. The MRI statistic is easily found, however I'll let you look it up since it's a pain to do much with the phone I'm using. I'll go in to your other points when I have access to my computer.

 

[Fern]

The program described in article is called ACE. It started under Bush and is unrelated to PPACA. See link below for more details.

https://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=cms1204388

It should be noted that PPACA does include some bundle payment ideas, but they don't take effect until this year or later.

Well, you just blew the shit out of the whole premise of this thread.

Fern

 

[Zebo]

Fern - such language. eek! haha jk never seen it before is all. P&n bad influence on you me thinks.

 

[pcgeek11]

And what about the even better than expected deficit reduction!

I haven't seen any deficit reduction. Looks like it goes up to me.

Obama Deficits
FY 2010: $1,293 billion, FY 2011: $1,300 billion, FY 2012: $1,327 billion

 

[pcgeek11]

Yeah like the Iraq war would be 30 billion or even pay for itself.

The only way it's gonna cost 1.76 trillion is if we can't borrow anymore and program can't be paid for anymore.

I admire the noble goals and support them but it was done wrong.

If you are borrowing money to pay for something, you aren't really paying for it.

 

[werepossum]

I haven't seen any deficit reduction. Looks like it goes up to me.

Obama Deficits
FY 2010: $1,293 billion, FY 2011: $1,300 billion, FY 2012: $1,327 billion

Pretty common ploy. Proggies pass big government program which adds a shit ton to the debt. Then they produce some fancy calculations showing that without this big government program we'd be adding two shit tons to the debt. The beauty is that it can't be disproved; you make your assumptions, no matter how outlandish, and then the CBO crunches the numbers based on those assumptions. Pubbies do the same with tax cuts - pass the tax cut, make a bunch of rosy assumptions about the economic activity they generate, then "prove" how the government will actually take in more money.

Kudos to Simpletron for actually knowing what's going on.

 

[Generator]

Early on in Obama's presidency there was the impression he was playing Star Trek 7 level chess, now most consider him a idiot puppet. But I still don't get the politics of alot of the Healthcare Reform. Sure it played the Republican party like the rubes they are. Comically so, but there is more to it than that. Just think back how far he was willing to deal to get this passed with side deals with Liebermann and Ben Nelson. Ridiculous compromises, what the hell is in this bill that such a farce HAD to pass?!

 

[dmcowen674]

Here is a dirty little secret the Rabid Right seems to forget...that the part they "hate" the most,the individual mandate was originally a Republican idea floated by the Heritage Foundation...

Here's the proof for the RepubliTrolls

http://www.heritage.org/research/lecture/assuring-affordable-health-care-for-all-americans

Mark Levin is the biggest liar about this too.

RepubliTrolls, I like that :thumbsup:

 

[Ausm]

And what about the even better than expected deficit reduction!

+1 RepubliTrolls gloss over this fact.

 

[Ausm]

What's interesting about the Rabid Rights Jihad on the individual mandate gives the green light for "free lunch" free loaders going into the emergency room and getting UBER expensive health care in which ,they ultimately pay the bill for this will increased premiums.

Kinda funny if you think of it this way....

I guess Republicants aren't the cheap fuckers I always thought they were...they are giving out FREE healthcare.

 

[simpletron]

Well, you just blew the shit out of the whole premise of this thread.

Fern

Medicare has tried bundle payments demostrations multiple times in the past, and every demostration that I have read about has resulted in some savings for medicare. But these demostrations have been on a very small scale. Obamacare has an initiative to roll out a national pilot program for bundle payments, which should be significantly larger than any of these past demostrations. If the past performance of these demostrations continue into the obamacare national pilot programs, then we may see some decent savings on a national scale. Unfornunately these programs don't start until this year or next, so we have no data as of yet, but i'm curious on how they do. If you want to read more about the obamacare programs read this link.
http://innovations.cms.gov/initiatives/Bundled-Payments/index.html

Did anyone else notice that 90% of the saving came from negotiating with medical devices suppliers? I guess this shouldn't surpise me because I always seem to be hearing about a new biotech company to invest in with huge potential profits.

 

[hal2kilo]

The government will simply setup death panels to decide who gets to die.

Better than a for profit insurance company as is practiced now.

 

[Ausm]

Better than a for profit insurance company as is practiced now.

W0rd the Insurance companies are the TRUE "Death Panels" the rabid Right loves to demagogue.

 

[Naeeldar]

Are you sure? I'm not blaming professional 100% - These countries don't have the layers either. Half HC are skimmers off the top. Insurance, Paperwork companies, distributors etc. - but there are no 2-5 million dollar a year surgeons in those countries like here. My brother owns pharmacies and makes almost 7 figures too. The margins are outrageous, I've seen them. Compared to say selling booze which I do.

I make em sick he fixes em

Pharma Industry has a huge margin. Insurance not so much...

 

[cybrsage]

Better than a for profit insurance company as is practiced now.

Would you be fine if Santorum was president and he got to decide the makeup of the death panels? How about (God forbid), Jesse Jackson were president?

 

[hal2kilo]

Would you be fine if Santorum was president and he got to decide the makeup of the death panels? How about (God forbid), Jesse Jackson were president?

That's what elections are for.

No democracy in a for profit insurance company.