Unions no likey Obamacare now

[fskimospy]

I used to be a big supporter of giving the poor and uninsured Medicare. Tennessee did just that, and it damned near bankrupted the state within a few years. When people get something expensive and desirable for free, they consume a lot more of it.

That's not what Tennessee did at all really, it had third parties act as administrative bodies that approved the dispensation of care while the state assumed all financial risk. That created a massively perverse fee structure that should have been visible a mile away.

Thankfully, the ACA does none of that, and Medicare doesn't do that either.

 

[DeadFred]

So who is left that supports and likes the ACA now that the unions want out?

Other than the bootlicking bastards who were exempt from it anyhow.

 

[fskimospy]

No, as it is now people over 65 (who get most of the care in America) get medicare. Private insurance is the "premium option" compared to Medicare. The floor is Medicare, and most reimbursement is tied to Medicare (IE "We pay Medi rates plus 30%").

If Medicare was a shadow of itself, the private market would create a new floor. I think that floor would be lower than medicare is today.

I'm sorry, but this just isn't accurate. Medicare Advantage is a private sector equivalent to Medicare where Medicare pays the premiums for a private health plan. This is private insurance covering the exact same cohort of people. Medicare Advantage is not a "premium option", it is simply a private alternative. Still, Medicare controls costs about 7% better than Medicare Advantage programs do.

There is simply no evidence that private insurance markets control costs better than the government does, the evidence actually points to the contrary.

 

[werepossum]

That's not what Tennessee did at all really, it had third parties act as administrative bodies that approved the dispensation of care while the state assumed all financial risk. That created a massively perverse fee structure that should have been visible a mile away.

Thankfully, the ACA does none of that, and Medicare doesn't do that either.

LOL Well, obviously no private sector person could ever be as wise, knowledgeable, caring and conscientious as a government employee. One must look no further than the DMV and the IRS to understand why government employees are so universally admired, so in demand as role models. This is why no health care solution can prosper until it is 100% public sector employees. Only once all employees are better paid, with better benefits, than the private sector and are virtually unfirable can we have accountability. But it's also important to remember that controlling costs by having government be responsible for approving care does not mean that government will approve less care; government will approve even more care, but it will still cost less because the one thing government does well is everything.

Honestly, dude, you are the encyclopedia of excuses for why the things you advocate fail.

 

[fskimospy]

LOL Well, obviously no private sector person could ever be as wise, knowledgeable, caring and conscientious as a government employee.

Straw man.

One must look no further than the DMV and the IRS to understand why government employees are so universally admired, so in demand as role models. This is why no health care solution can prosper until it is 100% public sector employees.

Straw man.

Only once all employees are better paid, with better benefits, than the private sector and are virtually unfirable can we have accountability.

Straw man.

But it's also important to remember that controlling costs by having government be responsible for approving care does not mean that government will approve less care; government will approve even more care, but it will still cost less because the one thing government does well is everything.

All evidence points to the government being better at controlling costs for health care.

Honestly, dude, you are the encyclopedia of excuses for why the things you advocate fail.

Honestly, dude, you are just raving like a lunatic.

 

[werepossum]

Straw man.



Straw man.



Straw man.



All evidence points to the government being better at controlling costs for health care.



Honestly, dude, you are just raving like a lunatic.

Perhaps you should contact M. Night Shyamalan with his next great movie:
"I see straw people."

Obviously this great government wondrousity is why virtually everyone on Medicare has a supplemental private health insurance policy, whereas virtually no one on private health insurance policies has supplemental insurance. Government is soooo great at controlling costs that its insured have extra money they need to burn . . .

 

[fskimospy]

Perhaps you should contact M. Night Shyamalan with his next great movie:
"I see straw people."

Obviously this great government wondrousity is why virtually everyone on Medicare has a supplemental private health insurance policy, whereas virtually no one on private health insurance policies has supplemental insurance. Government is soooo great at controlling costs that its insured have extra money they need to burn . . .

I don't think you understood the comparison between Medicare and Medicare Advantage, which should have tipped you off right away.

Furthermore, when Medicare and private insurance is compared they do so through common benefit comparison, that way the difference in amount of coverage between Medicare and private insurance is accounted for. Private insurance costs have increased much faster.

Why don't you try and discuss this like an adult?

 

[werepossum]

I don't think you understood the comparison between Medicare and Medicare Advantage, which should have tipped you off right away.

Furthermore, when Medicare and private insurance is compared they do so through common benefit comparison, that way the difference in amount of coverage between Medicare and private insurance is accounted for. Private insurance costs have increased much faster.

Why don't you try and discuss this like an adult?

Of course private sector insurance costs have increased much faster. Government has the ability to set Medicare costs low and force private insurance to make up the losses.

 

[fskimospy]

Of course private sector insurance costs have increased much faster. Government has the ability to set Medicare costs low and force private insurance to make up the losses.

Now who is making excuses for their failed ideas?

If providers aren't making money off Medicare patients they don't need to accept Medicare. Nobody forces them. Furthermore, there is scant empirical evidence for significant cost shifting.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1788128

 

[werepossum]

Now who is making excuses for their failed ideas?

If providers aren't making money off Medicare patients they don't need to accept Medicare. Nobody forces them. Furthermore, there is scant empirical evidence for significant cost shifting.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1788128

Doctors have been shedding Medicaid and to a lesser extent Medicare for the last decade. Here's just a couple.
http://www.texastribune.org/texas-h...-doctors-drop-medicaid-and-medicare-patients/

Jones is still the exception, not the rule. But his decision is becoming increasingly common. The proportion of Texas doctors accepting all new Medicaid patients has tumbled in the last decade — falling from 67 percent to 42 percent, according to a Texas Medical Association survey. Medicare acceptance took a similar spill in that study, dropping from 78 percent to 64 percent. (Medicare is federally run and serves senior citizens; Medicaid is state-run and covers children, the disabled and some poor adults.)

With health care reform expected to place up to 1 million more Texans on state rolls in the next several years, experts predict an almost certain surge in low-income Texans seeking long-overdue doctors appointments. With federal and state reimbursements well below private-payer rates, that will drive more physicians to opt out of the programs, experts say.

“In essence, physicians are donating their services every time they see someone on Medicare or Medicaid,” said Dr. Susan Bailey, a Fort Worth allergist and the incoming president of the Texas Medical Association. “It just becomes a matter of whether or not you can keep your bottom line healthy.”

http://www.kaiserhealthnews.org/Daily-Reports/2010/November/12/Medicaid-Woes.aspx

A shortage of specialists in Medicaid managed-care networks is making it hard for people like Tonya Bauserman, who is enrolled in HealthCare USA -- "one of dozens of private managed health care plans providing care" to almost half of "the nearly 50 million Americans on Medicaid" — to find providers in their area who will see them. By 2014, 16 million more people will become eligible for Medicaid under the new health care law as eligibility rules are widened. Insurance carriers like UnitedHealthcare and Aetna that run Medicaid managed-care plans stand to benefit, but "the coming boom is sparking debate about whether Medicaid managed care is best for patients."

While enrollees in traditional fee-for-service Medicaid "can go to any doctor willing to participate in the program," scarce as those doctors may be; managed care enrollees can only see providers in their plans' networks. The managed care plans often refuse to approve expensive services "such as CT scans and some surgeries." But "cash-strapped states, hoping to control costs, are increasingly turning to managed care — and requiring Medicaid recipients to leave the traditional program and enroll in the plans"

Of course, obviously people who make their livings providing health care are not a reliable source compared to a bureaucrat charged with investigating the efficacy of the bureaucracy, but still.

 

[PokerGuy]

possum, how dare you question the unbridled greatness that is government! Blasphemy! Expect an extra thorough IRS audit and other assorted friendly government types to help you see the error of your ways

 

[poofyhairguy]

I'm sorry, but this just isn't accurate. Medicare Advantage is a private sector equivalent to Medicare where Medicare pays the premiums for a private health plan. This is private insurance covering the exact same cohort of people. Medicare Advantage is not a "premium option", it is simply a private alternative. Still, Medicare controls costs about 7% better than Medicare Advantage programs do.

I am not talking about MA. Those programs were ruined from the start:

http://economix.blogs.nytimes.com/2012/10/16/why-private-medicare-plans-dont-cost-less/

What I am saying is that if you compare private insurances across the board they are the premium option- they have higher reimbursements (aka incentives for the doctor to slot you in over a Medicare/caid patient) and often cover procedures Medicare won't.

The closest comparison is comparing private prisons to public ones.

There is simply no evidence that private insurance markets control costs better than the government does, the evidence actually points to the contrary.

As long as cutting benefits is a political decision that could cost you a job, then at the end of the day private health insurance companies (a long time bad guy already) have more wiggle room.

The problem is that any number you pull up on the current system is suspect. The problem is that we can't even afford "efficient" Medicare. The only way to survive financially is to roll back care substantially: aka offer less care.

Private insurances have shown they will implement the things needed (caps, high deductibles, etc.). Politicians have shown they will throw out the cost savings if, for example, Florida might lose them the next election (that is why Medicare Advantage is a mess).

I trust the markets to cut the flesh to the bone when the time comes.

 

[Nebor]

I expect that in time, doctors will be compelled by law to accept Medicare, and Medicaid.

 

[poofyhairguy]

I expect that in time, doctors will be compelled by law to accept Medicare, and Medicaid.

Yeah, licencing might be tied to it.

 

[BoberFett]

All evidence points to the government being better at controlling costs for health care.

No, evidence points to the US government being better at telling private corporations how much they'll pay for care, and if they don't like it too bad.

If I went to the gas station, filled up the empty tank on my Hummer, threw a $5 bill on the counter and left, would you say I'm good at controlling the price of gas?

Medicare does nothing to control the cost of healthcare, only the reimbursement rate. You clearly don't understand the difference between cost and price.

 

[werepossum]

possum, how dare you question the unbridled greatness that is government! Blasphemy! Expect an extra thorough IRS audit and other assorted friendly government types to help you see the error of your ways

LOL No doubt.

I expect that in time, doctors will be compelled by law to accept Medicare, and Medicaid.

In time, doctors will be government employees and we can all enjoy the level of care provided in our prison system.

 

[Jhhnn]

I am not talking about MA. Those programs were ruined from the start:

http://economix.blogs.nytimes.com/2012/10/16/why-private-medicare-plans-dont-cost-less/

What I am saying is that if you compare private insurances across the board they are the premium option- they have higher reimbursements (aka incentives for the doctor to slot you in over a Medicare/caid patient) and often cover procedures Medicare won't.

The closest comparison is comparing private prisons to public ones.



As long as cutting benefits is a political decision that could cost you a job, then at the end of the day private health insurance companies (a long time bad guy already) have more wiggle room.

The problem is that any number you pull up on the current system is suspect. The problem is that we can't even afford "efficient" Medicare. The only way to survive financially is to roll back care substantially: aka offer less care.

Private insurances have shown they will implement the things needed (caps, high deductibles, etc.). Politicians have shown they will throw out the cost savings if, for example, Florida might lose them the next election (that is why Medicare Advantage is a mess).

I trust the markets to cut the flesh to the bone when the time comes.

In other words, the market, the Sacred Free market, will keep moving in the same direction it has gone for the last 30 years, covering fewer people for more money & less care while dumping who they don't want off on the govt.

What sort of end game should we expect in the face of accelerating inequality?

Why should we let them skim the cream off the top, increasing costs for the rest of us?

 

[werepossum]

In other words, the market, the Sacred Free market, will keep moving in the same direction it has gone for the last 30 years, covering fewer people for more money & less care while dumping who they don't want off on the govt.

What sort of end game should we expect in the face of accelerating inequality?

Why should we let them skim the cream off the top, increasing costs for the rest of us?

Covering fewer people because of global arbitrage and the loss of much of our wealth-producing jobs. Covering them for more money due (among other things) due to vastly increased government regulation. The free market does not exist in a vacuum, if only because that would be too noisy.

 

[marvdmartian]

Gasp... who could have possibly foreseen such things? Oh, just about anyone who wasn't a complete gullible moron.

Hopefully the GOP doesn't give them the opportunity to "tweak" or change anything to suit their base. You made your bed, now lie in it.

Or someone that had read the damn thing, before voting on it!

 

[BoberFett]

In other words, the market, the Sacred Free market, will keep moving in the same direction it has gone for the last 30 years, covering fewer people for more money & less care while dumping who they don't want off on the govt.

What sort of end game should we expect in the face of accelerating inequality?

Why should we let them skim the cream off the top, increasing costs for the rest of us?

I'll say it again for the learning impaired.

There is no free market for medical care in the US.

 

[Jhhnn]

I'll say it again for the learning impaired.

There is no free market for medical care in the US.

I was just ridiculing the whole notion that markets know best, as if they were ever truly free. Markets have always existed under the protection & direction of the state, even in ancient times. W/O that, the strong merely prey on the weak & markets fail.

So I'll ask the question again-

Why should we allow insurance providers to skim the cream off the top so that the rest of us can actually pay more?

To privilege the already over-privileged, the financial elite?

 

[Jhhnn]

Covering fewer people because of global arbitrage and the loss of much of our wealth-producing jobs. Covering them for more money due (among other things) due to vastly increased government regulation. The free market does not exist in a vacuum, if only because that would be too noisy.

So you're saying that American Capitalism fails to deliver on its promises to the American people?

 

[poofyhairguy]

I was just ridiculing the whole notion that markets know best, as if they were ever truly free. Markets have always existed under the protection & direction of the state, even in ancient times. W/O that, the strong merely prey on the weak & markets fail.

So I'll ask the question again-

Why should we allow insurance providers to skim the cream off the top so that the rest of us can actually pay more?

To privilege the already over-privileged, the financial elite?

You know regular people can buy stock of publicly traded health insurance companies right? On a smartphone even. I bet many have some of that stock in 401k portfolios or mutual funds for retirement.

As I have been saying- you get them to hold the gun because our politicians lack conviction or public support to do it. If someone doesn't do it we go bankrupt when the baby boomers hit full retirement.

 

[Jhhnn]

You know regular people can buy stock of publicly traded health insurance companies right? On a smartphone even. I bet many have some of that stock in 401k portfolios or mutual funds for retirement.

So what? That answers the question not at all.

Median net worth has fallen through the floor while average net worth has skyrocketed

http://washington.cbslocal.com/2012/11/30/study-american-households-hit-43-year-low-in-net-worth/

http://www.washingtonpost.com/blogs...-incomes-have-collapsed-during-the-recession/

As I have been saying- you get them to hold the gun because our politicians lack conviction or public support to do it. If someone doesn't do it we go bankrupt when the baby boomers hit full retirement.

Our politicians only lack the desire to shift the distribution of wealth, income and societal benefit into a more equitable mold, that's all.

 

[Incorruptible]

So you're saying that American Capitalism fails to deliver on its promises to the American people?

Capitalism is the only system that works. If you like socialism then go to Europe.