So has Obamacare worked? Has it not? Is it helping or hurting?

[umbrella39]

I don't convert anything. All of that was done back 4+ years ago system wide where I currently am at. We have been full electronic since. I am and end user who now instead of using paper has gone full electronic from ordering to medication administration documentation. That is what TH was talking about and I am disputing. Its every day use, not how long it took to take years and years of paper to be converted. I'm very thankful I got out of IT and went into direct patient care before all those years of documents and paperwork got scanned into patient electronic medical records. I stand by the fact that docs have much more time and are far more efficient now that they can pull up someone's countless trips to the ER in a second and pull up all their pertinent tests, consults, H&Ps, etc electronically...

 

[Hayabusa Rider]

I don't convert anything. All of that was done back 4+ years ago system wide where I currently am at. We have been full electronic since. I am and end user who now instead of using paper has gone full electronic from ordering to medication administration documentation. That is what TH was talking about and I am disputing. Its every day use, not how long it took to take years and years of paper to be converted. I'm very thankful I got out of IT and went into direct patient care before all those years of documents and paperwork got scanned into patient electronic medical records. I stand by the fact that docs have much more time and are far more efficient now that they can pull up someone's countless trips to the ER in a second and pull up all their pertinent tests, consults, H&Ps, etc electronically...

One of the things which I have been advocating is the real time access of medical information by all appropriate providers. As I'm sure you know there is great benefit in knowing if a patient really is taking their meds, or if a test or procedure has already been done, or what they really are diagnosed with. Access can be granted biometrically and should be done handled by a legally established trust which would lock out those not directly involved with care, and severely limit access on a need to know basis. Don't give government or industry access except perhaps for aggregate statistics and make it a criminal act to give or request personally identifiable information.

 

[Zorkorist]

Maybe when health care has money to spend.

But, as we know, they are broke.

Broke enough to socialize America.

-John {LOL!}

 

[WhipperSnapper]

What would qualify as Obamacare "working" and what would qualify as "failing"?

To a very significant extent it's almost impossible for Obamacare to fail simply because it is not a health care system itself, but rather a small band-aid placed over an already failing health care system (quasi free-market, not single payer, insurance companies, private hospitals, etc.). Our health care system was a train wreck prior to Obamacare, so if it's a train wreck afterwards it's difficult to blame the small band aid applied on top of the gaping wound.

I suppose that Obamacare's "succeeding" would mean 100% coverage and that health care costs would decrease along with medical bankruptcies. Given the underlying health care system that will probably be completely impossible. Perhaps success would merely be attaining near 100% coverage.

 

[Juddog]

At that point they will just fall on Society, ie., Medicaid, to pay.

There's no difference in who is PAYING for medical care, under ObamaCare (we the people are paying) the only difference is who is PROFITING from medical care.

It's socialism... pure and simple.

-John

Maybe when health care has money to spend.

But, as we know, they are broke.

Broke enough to socialize America.

-John {LOL!}

You sound like a broken record, just repeating "socialism" and "Obamacare" over and over. Please try to actually contribute to the thread instead of just spitting out garbage constantly.

 

[sactoking]

At that point they will just fall on Society, ie., Medicaid, to pay.

There's no difference in who is PAYING for medical care, under ObamaCare (we the people are paying) the only difference is who is PROFITING from medical care.

It's socialism... pure and simple.

-John

Except for the fact that many (most) people don't qualify for Medicaid...

 

[Hayabusa Rider]

What would qualify as Obamacare "working" and what would qualify as "failing"?

To a very significant extent it's almost impossible for Obamacare to fail simply because it is not a health care system itself, but rather a small band-aid placed over an already failing health care system (quasi free-market, not single payer, insurance companies, private hospitals, etc.). Our health care system was a train wreck prior to Obamacare, so if it's a train wreck afterwards it's difficult to blame the small band aid applied on top of the gaping wound.

I suppose that Obamacare's "succeeding" would mean 100% coverage and that health care costs would decrease along with medical bankruptcies. Given the underlying health care system that will probably be completely impossible. Perhaps success would merely be attaining near 100% coverage.

You are more right than not.
Obamacare is a diversion from what is needed. Further it is impossible for any system which exists to prevent fantastic increases in cost. None.

That doesn't mean that things can't be done which will be incredibly beneficial but it's beyond "how do we get cheap pills" and I have not seen a realization of that.

 

[Juddog]

You are more right than not.
Obamacare is a diversion from what is needed. Further it is impossible for any system which exists to prevent fantastic increases in cost. None.

That doesn't mean that things can't be done which will be incredibly beneficial but it's beyond "how do we get cheap pills" and I have not seen a realization of that.

I agree; what is needed is going to be close to impossible to accomplish with the current political climate. It boils down to:

* Break up the medical insurance industries; we have all this overhead for billing that is essentially just wasted money. We should be just paying the hospitals directly for services, not paying some other company that soaks up money that pays the hospital.

* Bring the hospital fees for various services in line and standardized for what those services accomplish. There is no reason hospitals should be charging $75 for a gauze pad, and there is no record of what they charge that's easy to get to, for people to use a truly free-market system.

* Introduce more doctors into the system, as far as how many graduates the AMA allows; this will stop the need to constantly import doctors from other countries and drive the cost down

* Put a cap on the ridiculous lawsuits cropping up for malpractice for doctors; lawsuits in the tens of millions are ridiculous, same goes for some of the lawsuits against big pharms.

* Put a cap on medicine costs and increase oversight for big pharm; there's no reason we need big pharm spending hundreds of millions on ads every year for prescription medicine. It's ridiculous that americans have to pay $100 a month for the same exact medicine you can get somewhere else for $10 a month. The cost wouldn't be so high in the first place if it wasn't for the combination of money sunk into ads and the extreme money that has to be saved to fend of lawsuits in the hundreds of millions, which prevents pharms from developing more interesting drugs

* Continue with the conversion to EMR, and put incentives out there for more data analytics, so that we can discover which procedures are generally the best and which procedures are wastes of money, plus nail down the humongous amounts of fraud, waste, and abuse

* Create a single payer / national medical system; with the above changes, the overall cost for people paying into the system already via health insurance would decrease, everybody would be covered, and preventative care can get more focus to stop people from waiting until the last second before showing up in the emergency room and costing tax payers hundreds of thousands of dollars

To do all that in one sweeping bill would be close to impossible though, but this is what I see as the natural progression of something we have to do as a nation to tackle this issue, from both sides of the fence (R & D need to work together on this issue instead of the current atmosphere of gridlock that we see in Washington).

 

[Hayabusa Rider]

Some good ideas but the problem remains, even untalked about.

I can name four things which would cut the cost of insurance, rates of disease, and increase the he health and longevity of virtually everyone. Can you name any? Not a knock btw

 

[Juddog]

Some good ideas but the problem remains, even untalked about.

I can name four things which would cut the cost of insurance, rates of disease, and increase the he health and longevity of virtually everyone. Can you name any? Not a knock btw

Off of the top of my head - fraud, waste and abuse affect almost all of those things, I would think. Insurance costs go up from people scamming the system, health and longevity go up from abuse being nipped in the bud.

I won't even begin to get into some of the stuff that's been uncovered in terms of what I've directly seen via data analytics of EMR.

One of the main issues is that politicians don't want to run with Fraud, Waste & Abuse because the companies getting caught with their pants down tend to line the pocketbooks of politicians.

 

[EagleKeeper]

Was just notified of the benefits of ObamaCare.

A 53 person plating facility in Wisconsin is canning three people to get to the 50 person limit as relates to insurance coverage.

Two employees were hired this Feb after graduation from college.

Unknown if low ones on the pole are going first

 

[Hayabusa Rider]

Off of the top of my head - fraud, waste and abuse affect almost all of those things, I would think. Insurance costs go up from people scamming the system, health and longevity go up from abuse being nipped in the bud.

I won't even begin to get into some of the stuff that's been uncovered in terms of what I've directly seen via data analytics of EMR.

One of the main issues is that politicians don't want to run with Fraud, Waste & Abuse because the companies getting caught with their pants down tend to line the pocketbooks of politicians.

Here they are.

Move around more
Eat better
Get proper sleep
Manage stress


See the disconnect?

"But that's not health care." Yes it is. Health care is about keeping people healthy, preventing illness and when that fails how to correct things.

Those four things will do miracles. They will completely change the future making things cheaper more than any UHC.

It's so simple and basic that it has completely escaped the discussion. Diabetes, mental illness including Alzheimer's, cancer, heart disease and on and on.

What are we focusing on? Everything but that.

 

[vi edit]

Here they are. Move around more Eat better Get proper sleep Manage stress See the disconnect? "But that's not health care." Yes it is. Health care is about keeping people healthy, preventing illness and when that fails how to correct things.

- I was going to say personal accountability which would have included almost all of those points. But that's just not cool. Or easy. And what people want. Even if it's what they need.

- Accountability of physicians (I don't care if that's how you did something 40 years ago, the data now says this is a) cheaper, and b) more effective)

- Sticking a free or reduced cost ($20 or something flat fee) prompt care in front of an emergency department. Instead of paying an ER physican $200 an hour to diagnose a flu swab, stick a $35 an hour mid-level out front to weed out non-critical cases and not suck up resources and likely never pay anyway the ED tab anyway.

- Reduction of unnecessary/risky procedures. Should an 80 year old really be getting their chest cracked open for an open heart procedure? Kinda goes back to the accountability of physicians and not pushing things that are either unneeded or statisically "bad" to do.

 

[First]

I was speaking of premiums. Some individuals and families can expect an increase of 20 to 200% in the next year or two if they hope to purchase coverage from the exchanges that is comparable to the plans they've had for the last decade.

Those are speculative premium increases, they haven't happened. But note that even if premiums increase significantly (say, double digits), what matters is the net difference in cost to the healthcare consumer from everything from drugs to deductables to coverage beyond deductables to the big cost savings from subsidies to people with pre-existing conditions. Premiums could go up 100%, and it doesn't matter if your net cost goes down with subsidies, better drug coverage after meeting your deductable, etc.

 

[First]

Here they are.

Move around more
Eat better
Get proper sleep
Manage stress


See the disconnect?

"But that's not health care." Yes it is. Health care is about keeping people healthy, preventing illness and when that fails how to correct things.

Those four things will do miracles. They will completely change the future making things cheaper more than any UHC.

It's so simple and basic that it has completely escaped the discussion. Diabetes, mental illness including Alzheimer's, cancer, heart disease and on and on.

What are we focusing on? Everything but that.

Um, pray tell, how can the government make people "get sleep" and "manage stress"? That's personal responsibility. There's no program for that. That's something we prioritize as a society, privately and with public speaking and community organizing I suppose.

So your point is true that basic things like sleep and stress management does wonders. But achieving that is simply not possible via legislation. Gov't has limits, and they end far before reaching into the bedrooms and homes of Americans to force them to manage stress sleep better.

 

[vi edit]

With all due respect, your point is true that basic things like sleep and stress management does wonders. Achieving that is simply not possible via legislation. Gov't has limits, and they end far before basic stress management and sleeping.

I think that's his point. All the focus on "fixing" healthcare when there are many solutions under our nose that don't require legislature, endless debates, and all the hysteria. All of this talk and fluff does nothing until real issues are addressed and overall public health improves and high cost reactionary treatment is reduced.

 

[Juddog]

I think that's his point. All the focus on "fixing" healthcare when there are many solutions under our nose that don't require legislature, endless debates, and all the hysteria. All of this talk and fluff does nothing until real issues are addressed and overall public health improves and high cost reactionary treatment is reduced.

Wouldn't most of those issues fall under the umbrella term "preventative care" though? Managing stress, getting more exercise, and eating better are all things that could potentially be advocated by a personal physician, as well as incorporated into health classes which are taught in school.

 

[Hayabusa Rider]

I think that's his point. All the focus on "fixing" healthcare when there are many solutions under our nose that don't require legislature, endless debates, and all the hysteria. All of this talk and fluff does nothing until real issues are addressed and overall public health improves and high cost reactionary treatment is reduced.

He's thinking in too common terms. "How can we use government to threaten or punish people to make them do things".

That limited approach is bound to fail.

Instead create tax incentives for companies that create working conditions which benefit the health of workers. Fun medical facts. First, no matter how healthy or how much you exercised, the body begins to respond pathologically to sitting after 4 hours and this is cumulative. Second obesity does not cause disease. Weight is not a metric of health. That's impossible! No it's not. Obesity is a result of making hunter gatherers live in a box. That drives our whole metabolism wild dumping very unhealthy hormones into our systems. But we hear about the obesity crisis. It is a result not a cause. In fact measurable parameters of fitness are the determinant of health. You won't find a study that says that people who have high levels of cardiovascular fitness who don't fit within the BMI "good" zones are more likely to be less healthy than leaner folks. The problem has been knowing causation from correlation.

So besides financial incentives what is needed and what to do? How about having mindslike those found at the CDC and NIH figure that out unfettered by Obama or Reid or their partisan political bretheren? But we can't trust scientists and other experts. Only our favored party is qualified to tell us what must be.

And they say the religious are irrational.

 

[Hayabusa Rider]

Wouldn't most of those issues fall under the umbrella term "preventative care" though? Managing stress, getting more exercise, and eating better are all things that could potentially be advocated by a personal physician, as well as incorporated into health classes which are taught in school.

That has never worked.

 

[vi edit]

Wouldn't most of those issues fall under the umbrella term "preventative care" though? Managing stress, getting more exercise, and eating better are all things that could potentially be advocated by a personal physician, as well as incorporated into health classes which are taught in school.

That's where things get interesting and some of the things (Accountable Care Organizations) I talked about earlier come into play. Historically "healthcare" made money off of reactionary services. Surgery, inpatient visits, diagnostic procedures, consults, ect. They fixed things when they went wrong and got paid for that.

They aren't getting reimbursed nearly as much for that now, and those revenue streams are drying up. The entire industry is being forced into a preventative and managed model where you get reimbursed based upon outcomes.

Raise their hand...how many people have even heard of an ACO? The point is to look at data, populations of people and be more proactive in the management and prevention of high cost, critical care needs. These things started going into play in 2011 and are rapidly gaining health systems that sign up for them. Reimbursement from payors (Medicare/insurance) is shifting to this model and you will see more progress moving forward in preventative care and counseling on lifestyle choices.

 

[First]

I think that's his point. All the focus on "fixing" healthcare when there are many solutions under our nose that don't require legislature, endless debates, and all the hysteria. All of this talk and fluff does nothing until real issues are addressed and overall public health improves and high cost reactionary treatment is reduced.

Legislation is necessary to bring down costs in an industry that by its nature has incentive to deny care to people. Because they're a business that needs to make money, which I have no problem with, they'll deny care; except that's bad for Americans' financial and personal health. Hence the pre-existing condition in ACA. Or the 80% cap on healthcare spending. Or the mandate itself. This all makes plenty of sense to bend the cost curve.

So just because you can't legislate sleeping well or managing stress doesn't mean you should do nothing, as some others here have suggested. That's stupid, makes no sense, and is akin to throwing the baby out with the bathwater.

 

[Hayabusa Rider]

Legislation is necessary to bring down costs in an industry that by its nature has incentive to deny care to people. Because they're a business that needs to make money, which I have no problem with, they'll deny care; except that's bad for Americans' financial and personal health. Hence the pre-existing condition in ACA. Or the 80% cap on healthcare spending. Or the mandate itself. This all makes plenty of sense to bend the cost curve.

So just because you can't legislate sleeping well or managing stress doesn't mean you should do nothing, as some others here have suggested. That's stupid, makes no sense, and is akin to throwing the baby out with the bathwater.

And this is why we will fail. You have no idea what can be done because you are limited to how you can beat people into compliance and have completely dismissed seeking rational, scientific approaches for political demigods.

In fact you have no idea what can be done and haven't suggested an interest in finding out. That is our problem.

 

[First]

And this is why we will fail. You have no idea what can be done because you are limited to how you can beat people into compliance and have completely dismissed seeking rational, scientific approaches for political demigods.

In fact you have no idea what can be done and haven't suggested an interest in finding out. That is our problem.

Uh huh. Surrre.

 

[Hayabusa Rider]

Uh huh. Surrre.

Then prove me wrong. Alzhemers. What will its peak annual cost be with and without Ocare, hoprecisely how will it, and what does it do to reduce the incidence by say two-thirds?

 

[First]

Then prove me wrong. Alzhemers. What will its peak annual cost be with and without Ocare, hoprecisely how will it, and what does it do to reduce the incidence by say two-thirds?

You can't prove something that hasn't happened yet. You can prove, however, that since ACA was passed, nationwide healthcare costs have increased barely 3% annually, and that ACA is almost certainly part of the reason for that (the other reason being the recession).