The trouble I see in Obamacare

[Hayabusa Rider]

So you just expect people to take 70% pay cuts so that you can give out "free" care.


Whats your income? maybe it should be cut by the same amount, so that whatever you do can be given away for 'free' too.

Step back a bit. He's talking about possible changes and I'm OK with that provided that there's an understanding that realities of such changes and their relevance is properly understood. Slashing pay won't save a significant percentage to costs, but it will create an environment that no one in their right mind would deal with. I think he can get that.

 

[AViking]

snip for less scrolling

The lack of a good computer system is an interesting observation. Here all my prescriptions are in the computer no matter which pharmacy I go to and all my medical history is available at any doctor.

During my college years I was moving a lot in the USA and each time I moved my new dentist insisted that I needed all new xrays and an initial consultation. This despite me actually bringing my xrays with me from my old dentist. No matter what I did they needed more tests and had to start over from scratch. To make a buck no doubt since I had to pay for it.

I have a friend who has a serious drug problem in the US. He has chronic pain and pops really strong pills like you wouldn't believe. To get all these drugs he just goes to different doctors, gets a prescription, and CVS fills them all out. After a serious car accident while on drugs his family went to CVS and threatened to sue them if they filled out anything else without their permission. My friend then went to another pharmacy instead and his family caught him. I have no idea what happened since then but that can't happen if you have a good centralized computer system and pharmacists that don't just fill out everything that is sent to them. That guy had bottles of multiple pain pills, muscle relaxers, and who knows what else that any reasonable person would recognize at once was overkill.

How much does this contribute to our inflated costs though? No clue.

So far it has been mentioned that malpractice and compensation are not the significant costs. What are they then? What does the breakdown look like?

 

[AViking]

Before ranting about 70% paycuts we could explore other possibilities. First all new hires are at the new salary. Second if the doctor is part of a union or pension plan offer him early retirement. Third we could just fire them.

 

[fskimospy]

I thought he had the votes for a while. I could be wrong. I could have sworn he could have pushed it through with zero republican support.

Obama never had the ability to push for UHC. Not only could he not have overcome the 60 vote threshold, he probably couldn't have gotten 50 votes. There are plenty of Democrats that weren't willing to go that way either.

You can blame the Democrats for not passing UHC when they had the chance, but the blame goes on the senators that wouldn't support it.

 

[senseamp]

He could have, he got the ACA through with zero republican support.

Which means he had to get Lieberman's vote, and Lieberman said No to public option, much less UHC. Unless of course you believe Obama would have gotten GOP votes for UHC to get it over 60 vote threshold.

 

[Hayabusa Rider]

The lack of a good computer system is an interesting observation. Here all my prescriptions are in the computer no matter which pharmacy I go to and all my medical history is available at any doctor.

During my college years I was moving a lot in the USA and each time I moved my new dentist insisted that I needed all new xrays and an initial consultation. This despite me actually bringing my xrays with me from my old dentist. No matter what I did they needed more tests and had to start over from scratch. To make a buck no doubt since I had to pay for it.

I have a friend who has a serious drug problem in the US. He has chronic pain and pops really strong pills like you wouldn't believe. To get all these drugs he just goes to different doctors, gets a prescription, and CVS fills them all out. After a serious car accident while on drugs his family went to CVS and threatened to sue them if they filled out anything else without their permission. My friend then went to another pharmacy instead and his family caught him. I have no idea what happened since then but that can't happen if you have a good centralized computer system and pharmacists that don't just fill out everything that is sent to them. That guy had bottles of multiple pain pills, muscle relaxers, and who knows what else that any reasonable person would recognize at once was overkill.

How much does this contribute to our inflated costs though? No clue.

So far it has been mentioned that malpractice and compensation are not the significant costs. What are they then? What does the breakdown look like?

I have absolutely no doubt that duplication of services are among the most costly of things in our system. As far as the xrays go, yes it may be a financial motivation, but there are others. If someone has a problem with a treatment the lawyers are going to go after every possible "fault" arguing that due diligence wasn't applied. What if things changed since they were taken? What if they weren't done right? What if what if. Consequently a lot of tests are done for this reason. Cover your ass. That's the beauty of what I'm suggesting. Have a standardized resource and set of data that all rely on and make legal changes that what is in the data base constitutes due diligence. If a provider determines that a test needs to be repeated he can do so, however it must be for clearly defined medical reasons subject to review by an independent body. In the case of emergency it can be done retrospectively since need is paramount. If it were to be found that tests were superfluous, then there is a chargeback plus a substantial penalty, perhaps triple fee.

You see at the moment there is no metric, no gold standard. There's no universally accessible pool of knowledge and information. Everyone getting a comprehensive patient history is problematic. Once something serviceable is in place then you have a basis for rational billing practices and a uniform standard of expectations with consequences.

As far as what thing really cost and why? I submit there is no authoritative answer. No one as done a comprehensive and impartial investigation. Someone will say "this study this or that study that" but finding something not done by someone with an agenda other than determination of facts in context for a purpose like we discuss? I don't believe it's ever happened, at least not without a predetermined agenda.

 

[IGBT]

why are the main elements of obamaCare delayed / rescheduled?? If this thing is the end all why not fully implement all of it now??

 

[fskimospy]

why are the main elements of obamaCare delayed / rescheduled?? If this thing is the end all why not fully implement all of it now??

The main elements of it aren't delayed. The main elements of the ACA are:

1.) Community rating - in effect
2.) Individual mandate - in effect (with some exceptions)
3.) Subsidies - in effect.

That's Obamacare in a nutshell.

 

[Franz316]

Does anyone know if there have been any studies having to do with the theoretical cost of universal coverage in America? I'd be curious to see the cost vs the amount of savings when the bureaucratic and greedy BS is cut out. I couldn't really find anything in my searches.

 

[Hayabusa Rider]

Does anyone know if there have been any studies having to do with the theoretical cost of universal coverage in America? I'd be curious to see the cost vs the amount of savings when the bureaucratic and greedy BS is cut out. I couldn't really find anything in my searches.

Such a thing does not exist.

 

[chucky2]

Obama never had the ability to push for UHC. Not only could he not have overcome the 60 vote threshold, he probably couldn't have gotten 50 votes. There are plenty of Democrats that weren't willing to go that way either.

You can blame the Democrats for not passing UHC when they had the chance, but the blame goes on the senators that wouldn't support it.

BS. The Dems could have gotten it through, they just lacked the gumption to push their on the fence/non-supportive members hard enough. It's not even Bummers fault, it's Pelosi and Reid. Blaming O'Bummer for lack of UHC is dishonest.

 

[fskimospy]

BS. The Dems could have gotten it through, they just lacked the gumption to push their on the fence/non-supportive members hard enough. It's not even Bummers fault, it's Pelosi and Reid. Blaming O'Bummer for lack of UHC is dishonest.

I don't see a lot of evidence that Reid had the ability to whip an extra 10 votes+ on the issue. What makes you think that he did?

 

[fskimospy]

Such a thing does not exist.

See this is why when you claim that research hasn't been done into health reform it's hard to take you seriously.

A quick sampling of the studies on costs associated with UHC in America here:

http://www.pnhp.org/facts/single-payer-system-cost

Included are 8 separate studies on the costs and benefits associated with switching to a universal system at a federal level and close to 20 separate ones on state level universal health care effects.

So here are about 30 examples of what you say doesn't exist.

Note: Due to the fact that it's an advocacy site this is only a sampling of pro-uhc studies that have been done. I'm quite sure that there are a great deal more studies out there that they didn't find favorable enough to mention.

In short: there are REAMS of studies on this topic representing thousands and thousands of man hours of research.

 

[michal1980]

Before ranting about 70% paycuts we could explore other possibilities. First all new hires are at the new salary. Second if the doctor is part of a union or pension plan offer him early retirement. Third we could just fire them.

yes yes, lets ignore the elephant in the room...

In your bubble world the ends justify the means. You want to totally socials and centrally control 10% of the USA GDP. And you want us to just ignore how you get there?


Lets humor your current insane proposal. If I graduate in 2014 (before insane AV insurance) I can make 500k, if I somehow fall back a year, in 2016 (after insane AV insurance). I make 150k. Wow, thanks buddy.

If I'm old, or make too much, just fire the DR.

Your nuts. completely totally nuts.

 

[michal1980]

See this is why when you claim that research hasn't been done into health reform it's hard to take you seriously.

A quick sampling of the studies on costs associated with UHC in America here:

http://www.pnhp.org/facts/single-payer-system-cost

Included are 8 separate studies on the costs and benefits associated with switching to a universal system at a federal level and close to 20 separate ones on state level universal health care effects.

So here are about 30 examples of what you say doesn't exist.

Note: Due to the fact that it's an advocacy site this is only a sampling of pro-uhc studies that have been done. I'm quite sure that there are a great deal more studies out there that they didn't find favorable enough to mention.

In short: there are REAMS of studies on this topic representing thousands and thousands of man hours of research.

Do all these studies that use Medicare as baselines, ever go back and add in all the DR. fixes passed by congress yearly?

Or do they work under the assumption that those medicare spending restraints/cuts, will actually kick in?

Because we all know that politicians like to cut medicare - 10 years from now.

 

[Incorruptible]

yes yes, lets ignore the elephant in the room...

In your bubble world the ends justify the means. You want to totally socials and centrally control 10% of the USA GDP. And you want us to just ignore how you get there?


Lets humor your current insane proposal. If I graduate in 2014 (before insane AV insurance) I can make 500k, if I somehow fall back a year, in 2016 (after insane AV insurance). I make 150k. Wow, thanks buddy.

If I'm old, or make too much, just fire the DR.

Your nuts. completely totally nuts.

What else do you expect from him? It takes a pathetic individual to advocate cutting salaries like this.

 

[rudder]

Legal costs from torts and preventative medicine comprise a very tiny fraction of US health costs.

http://www.cbo.gov/budget-options/2013/44892

Other specialties like obstetrics are taking a hard hit.

http://www.samj.org.za/index.php/samj/article/view/7233/5278

 

[fskimospy]

http://www.cbo.gov/budget-options/2013/44892

Other specialties like obstetrics are taking a hard hit.

http://www.samj.org.za/index.php/samj/article/view/7233/5278

Right. To take one year from there as an example, projected spending for Medicare in 2020 is ~$720 billion. Savings from tort reform are expected to be $8.5 billion (in both reduced costs and increased revenues). That's a bit over 1% of costs. Like I said, that's a very tiny amount.

 

[Matt1970]

See this is why when you claim that research hasn't been done into health reform it's hard to take you seriously.

A quick sampling of the studies on costs associated with UHC in America here:

http://www.pnhp.org/facts/single-payer-system-cost

Included are 8 separate studies on the costs and benefits associated with switching to a universal system at a federal level and close to 20 separate ones on state level universal health care effects.

So here are about 30 examples of what you say doesn't exist.

Note: Due to the fact that it's an advocacy site this is only a sampling of pro-uhc studies that have been done. I'm quite sure that there are a great deal more studies out there that they didn't find favorable enough to mention.

In short: there are REAMS of studies on this topic representing thousands and thousands of man hours of research.

I like the June, 1998, Economic Policy Institute.

"Universal coverage could be financed with a 7 percent payroll tax, a 2 percent income tax, and current federal payments for Medicare, Medicaid, and other state and federal government insurance programs. A 2 percent income tax would offset all other out-of-pocket health spending for individuals."

 

[shortylickens]

The solution is so damn simple.

1. Raise taxes
2. Universal healthcare
3. Join the rest of the modern world

/thread

The rest of the "modern" world borrows OUR trillion dollar military so they can keep costs down to the price of two jets and a broken tank.

The rest of the "modern" world doesnt have a huge chunk of its population on welfare and in prison, sucking away money while providing nothing. Nor does it keep bailing out all its failed billion-dollar businesses.

And the U.S. donates assloads of straight up cash to the rest of the "modern" world on top of all that.

 

[shortylickens]

Oh, the rest of the "modern" world doesnt enforce a medicine cartel either.
The AMA's legally enforced monopoly is the biggest problem and the one NO politician has ever addressed. Ever wonder why?

 

[Hayabusa Rider]

See this is why when you claim that research hasn't been done into health reform it's hard to take you seriously.

A quick sampling of the studies on costs associated with UHC in America here:

http://www.pnhp.org/facts/single-payer-system-cost

Included are 8 separate studies on the costs and benefits associated with switching to a universal system at a federal level and close to 20 separate ones on state level universal health care effects.

So here are about 30 examples of what you say doesn't exist.

Note: Due to the fact that it's an advocacy site this is only a sampling of pro-uhc studies that have been done. I'm quite sure that there are a great deal more studies out there that they didn't find favorable enough to mention.

In short: there are REAMS of studies on this topic representing thousands and thousands of man hours of research.

That's nice. Someone figures out how much things will cost at the end in an ideal world. No idea how to get there. No idea about the political realities on the ground. No addressing care proper.

1. Propose legislation
2. ?????
3. Profit!

If these boys and girls who you would have handle this are so smart then why are the programs they already manage becoming increasingly difficult to work through? Things have gotten worse over time as more regulation has come into play in terms of trying to provide care. That's not a hypothetical. If they are so smart then why are they screwing people for their supplies? Is that an intentional abuse or are they just stupid? Reams of hypothetical hopefuls.

There isn't a reliable cost estimate because no one has figured out how to do it and you don't seem to have much interest in that at all.


So with your expertise why don't you share how all this gets done, what patients and providers need, specifically, and how it doesn't get hacked to pieces by your favored entities, the political parties?

Why not do something at least as easy like fix the economy?

 

[senseamp]

If Obamacare is so bad, why haven't the Republicans proposed anything better in 5 years?

 

[Hayabusa Rider]

If Obamacare is so bad, why haven't the Republicans proposed anything better in 5 years?

Because they are politicians and politicians haven't the first clue about health care and how to implement real reform. Asking why one idiot doesn't come up with something great because another didn't isn't very smart.

 

[fskimospy]

That's nice. Someone figures out how much things will cost at the end in an ideal world. No idea how to get there. No idea about the political realities on the ground. No addressing care proper.

1. Propose legislation
2. ?????
3. Profit!

If these boys and girls who you would have handle this are so smart then why are the programs they already manage becoming increasingly difficult to work through? Things have gotten worse over time as more regulation has come into play in terms of trying to provide care. That's not a hypothetical. If they are so smart then why are they screwing people for their supplies? Is that an intentional abuse or are they just stupid? Reams of hypothetical hopefuls.

There isn't a reliable cost estimate because no one has figured out how to do it and you don't seem to have much interest in that at all.


So with your expertise why don't you share how all this gets done, what patients and providers need, specifically, and how it doesn't get hacked to pieces by your favored entities, the political parties?

Why not do something at least as easy like fix the economy?

That whooshing sound I just heard must have been the goal posts blowing by.