Obamacare - practical discussion

Obamacare - practical discussion
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#328

What would you then presume is the reason for it ?
As for the ‘IF’, you really can not have read much about the subject if you have not seen the results of the many studies that show that in countries with socialized medicine healthcare is better for less cost.

So anecdotal. Useless for a general policy discussion.
If you find somebody claiming that socialized medicine will always lead to better outcomes for all people you can refute their claims with your anecdotes. I haven’t seen anybody (reasonable) claiming that.

All systems limit resources to control cost, or are you claiming the US system doesn’t ?
And you fail to show how your MRI example lead to - on average - worse outcomes for patients.


#329

A more homogeneous society, less violence, shorter work weeks, more vacations, healthier lifestyle, more manual labor, more red wine, blah, blah. I’m sure there are lots of other possible guesses / reasons.

As for the “IF”, I haven’t read squat on the subject since the 90’s. Nor have I read the results of the many studies that show that in countries that eat less peanut butter that healthcare is better for less cost. Nor have I read the results of the many studies that show that in countries that drink less bottled water that healthcare is better for less cost.

Whoa there 'lil doggie. Did I say that it was fact? Did I even imply it? I stated that it was my desire, opinion or preference.

I’m too modest (or sober, currently) to think that I know which is better. I also don’t think that I have the right to force my opinion on anyone. However, I am familiar with and believe in the “grass is greener” theory. Thus, my wish for people who’ve never exprerienced govt run healthcare to have the opportunity to experience it. Is that so wrong?

I was under the impression that if you could pay for a healthcare service or procedure in the U.S., you could readily get it. Is that incorrect? [edit] - Other than for things like transplants where a donor organ may not be available.

I can’t speak to the MRI outcomes, other than common sense - why would a doctor (in a govt run system) want one if it wouldn’t improve the patient’s outcome? I came back to the U.S. for mine, so my outcome was unaffected. Besides, it’s only anectodal. :slight_smile:

Although not specific to MRIs, but … In the late nineties to mid oughts, at least two Canadian provinces (Ontario and I believe BC) outsourced a portion of their breast cancer patient treatment to the U.S. I don’t know details of the BC issue, but Ontario did not send their patients to Buffalo until after a series of negative articles appeared in a Toronto paper. I expect that you will concede that delayed or no treatment for breast cancer - on average - leads to worse outcomes for patients.

I’m sure there are other situations where - on average - the delays and / or lack of facilities have lead to worse outcomes for patients.


#330

Arguably this is true for nearly all medical conditions - prompt treatment helps, at least if there’s any effective treatment, either by avoiding a worsening condition or resolving the problem sooner and leading to better quality of life (barring edge cases like risks from over-testing for conditions you might but don’t actually have). Cancer is a very obvious case for this, but it’s true of joint replacements, organ transplants, getting your high blood pressure or diabetes under control, etc, etc.

To a large extent, all these HMOs and government run managed care programs run you through hoops to get your problem actually treated by the appropriate specialist are doing cost control at the expense of the patient’s health. Look at the VA for a classic and fairly bad example - hidden waiting lists and interminable delays before you can get seen, etc. if you were paying full price out of pocket for the whole thing, someone in a free market (or even the current US system) would be happy see you promptly. It’s only because of all these intermediaries like the government single payer provider or private insurance companies with conflicts of interest result in these imposed delays, multiple required referrals, deductibles to discourage seeking treatment, etc. none of that is good for the patient, but the party paying cares more about their profit or cost control, and doesn’t have much incentive (aside from maybe shame or a little bad PR) to get you good prompt health outcomes.


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Suggestions and feedback
#331

Good news for short term plans - these are going to be allowed under new HHS guidance to be up to a year and renewable without additional underwriting for up to 3 years. Yes, they have pre-existing exclusions and some limited drug benefits, but they also cost 1/3 of ACA plans and typically have decent nationwide networks.

https://www.wsj.com/articles/cheaper-health-plans-with-less-coverage-move-forward-1533121200
https://www.wsj.com/articles/short-term-obamacare-relief-1533162922

The rule would loosen restrictions on a type of coverage known as short-term medical insurance—low-cost plans that cover a limited period with less-expansive benefit offerings, which are subject to fewer consumer protection regulations.

Such plans now can only be carried up to 90 days. The new rule would allow the plans to last for a year and be renewed for a total coverage period of 36 months.

The administration said the average monthly premium for such a plan has been about $124, less than a third the cost of an unsubsidized plan in the ACA markets.

These will be a great option for relatively healthy people in between jobs, or even those who don’t get enough subsidies to make the so-called ACA plans affordable.

Being able to buy a full year of short term coverage means you’ll be able to guarantee you’re covered until the next open enrollment period if you buy your short term coverage at the same time. This makes these plans much more attractive.


#332

You can read his assumptions here. They seem pretty generous, for example assuming the government halves drug costs and pays only 60% of standard rates to healthcare providers. In short, it seems like it’s so crazy expensive it’s basically infeasible.

https://www.wsj.com/articles/even-doubling-taxes-wouldnt-pay-for-medicare-for-all-1533163559
.
Of course once you cut the doctors salaries by 30-40%, you’ll be left with the best the VA can offer and wait lists to match, and that’s before you get to overconsumption of the consumers problem from them not having to pay.

“If you think health care is expensive now, wait until you see what it costs when it’s free.” (From 1993 and just as true now)


#333

I completely agree. I was living with govt run healthcare while reading all of these stories of “horrendous” HMOs and how people were dying due to the wait times and denial of services. It seems like a lot of the coverage of govt run healthcare implies it is a panacea. It is not, and I can readily state that as fact.


#334

And leads to further deterioration of the Marketplace risk pools, much of which gets picked up by taxpayers in higher premium subsidies (in a less efficient way than eliminating this risk pool cherry-picking nonsense with M4A). It’s sabotage, not improvement.


#335

Looking at pharmaceutical spending in other G7 countries, the drug price reductions don’t seem unreasonable to me. Start with the NICE formulary and pricing, and make drug companies justify higher pricing than that.

On the provider reimbursements, I’d like to see a better analysis of that issue. I think simply pointing out it’s a 40% reduction is an oversimplification of the issue. A full M4A implementation would dramatically reduce providers’ administrative costs, eliminate uncompensated care, and increase current Medicaid patient reimbursements to Medicare rates. It’s possible that some increase in Medicare reimbursements is justified, but matching current private insurance reimbursement rates would amount to a windfall for providers given the other M4A advantages.

In the end, every other developed country is able to provide some form of universal care at a much lower cost than we do. I’ve not heard any convincing explanation for why such a thing would be impossible here. Some respond with anecdotes about triage-based wait lists in other systems and cost controls, but we already have wait times (if you can’t pay for something considered non-emergency, your wait time is effectively infinity, since you’re not getting the care) and utilization management by private insurers, most of which are either for-profit themselves and/or hired by a for-profit plan sponsor whose financial interest is in denying care (at least to the extent the denial wouldn’t result in higher emergency costs for them later). Some may find it strange, but I trust a government that I have at least nominal control over – a vote – more than a for-profit company who will profit more by denying care.

The overconsumption point is something else I have to take issue with. There are a few reasons “overconsumption” (whatever you want to define it as) may occur.

First, “for fun” – but I’m skeptical. I can’t speak for others, but going to any medical provider doesn’t appear anywhere on my list of favorite things to do, and I’d wager that I’m not alone in this regard. I’ve been lucky enough to have reasonably good insurance coverage (by US standards) and the means to pay for any cost-sharing, such that cost-sharing isn’t a deterrent to me seeking care, and I’ve never once been tempted to seek medical care for giggles. Is there any data showing this to be a significant issue in other systems?

Second, overusing doctors or hospitals for minor ailments (like colds) that most reasonable people would know do not require medical attention, or using higher-cost care (ER) instead of a PCP or urgent care clinic when a reasonable person would know the situation doesn’t warrant an ER visit. The first part falls into the “for fun” category I mentioned above, and I’m skeptical it presents a significant issue. For the second part, we have to consider why someone would be inclined to overuse ER care, and the biggest reason I can think of is convenience: you can walk in after work or on the weekend, when many PCPs are closed. But urgent care clinics can do the same at a lower cost. A good way to combat this is probably to prohibit ERs from feeding into it by providing and advertising wait times and wait time guarantees, which have no place in true emergency care; who would do this if they knew they were risking waiting 6 hours behind more severely ill patients? Another good way would be to encourage PCPs (with higher payments) to work around patients’ usual 9-5 M-F schedules.

Third, homeless that use the ER as a shelter – but this happens anyway and is passed onto paying patients already; for obvious reasons, these bills tend to go unpaid. M4A wouldn’t affect this behavior.

Fourth, health anxiety, Munchausen, etc. These are actual medical issues, not overconsumption, IMO, but I know some consider them overconsumption. And I’m not convinced cost-sharing deters sufferers of these conditions from seeking medical care anyway, some of which undoubtedly is uncompensated and paid for by everyone else already.

My thoughts, and I’m open to data showing otherwise: the “overconsumption” supposedly inherent in an M4A plan due to the lack of cost-sharing is mostly necessary care that wasn’t obtained in the past due to cost. That’s not overconsumption.


#336

These are the reasons why HC will not be ‘reformed’ anytime soon and why M4A has no shot nationally. I think the Megacorps have a vested interest in maintaining the status quo knowing that they can use their HC benefits as a weapon and shield against employees looking to leave.

I know that when I retired from my Megacorp it was the #2 reason why folks wouldn’t leave even if a buyout was offered, the #1 of course being that they didn’t have enough money saved up.

Nothing serious will happen until corps get on an even playing field with HC insurance, right now as mentioned above most employees are happy to have tax-free bennies (with usually better insurance at a cheaper price than the ACA). And employers get to write all of it off etc.

So in other words nothing serious will happen, even if the Dems get control. Money will talk.


#337

Something serious happened the last time the Dems got control. I won’t comment on whether it was good or bad, but it sure seemed serious.


#338

Yeah, we’ll see. M4A has a much larger mountain to climb than the ACA did. Much larger.


#339

All they need is a super majority in the Senate and a decent margin in the House. That’s what got us Obamacare, among other things. :slightly_frowning_face:


#340

WSJ article on high healthcare costs, citing among many factors:

https://www.wsj.com/articles/why-americans-spend-so-much-on-health-carein-12-charts-1533047243

  • hospital consolidation and monopoly pricing power
  • numerous intermediaries (government programs, insurance)
  • opaque pricing
  • tax breaks for healthcare, esp employer tax deduction
  • rising drug prices, including PBMs who negotiate discounts and keep the profits
  • lobbying by increasingly large healthcare industry to preserve the status quo

In particular, they show the US does not consume a meaningfully different amount of healthcare per capita compared to other developed countries, it’s just that the care we do use is more expensive.


#341

It’s funny to see the WSJ implicitly making the case for single-payer.


#343

Not really news. Serious people on both side who study health care been talking about it for decades.


#344

This is no way pushes for single payer. It explains how backroom deals and bilk whoops i mean bill the govt … runs amok.
If anything its the opposite … get govt OUT OF HEALTHCARE


#345

Including Medicare?


#346

Id like to see the govt out of all healthcare. Yes including medicare. Since weve already paid in that money should goto insurance or even cash to use at doctors offices.


#347

You dont realize how expensive conforming to those rules n procedures is …
FW had an article on a dr who went cash only. No insurance no medicare. Fired most of his office staff and cut his prices IN HALF.
Why would this work ? Because numping thru a bunch of hoops to get a small percentage isnt worth it when u have to do real volume in order to make any kind of money.


#348

Usual utopian (i.e. libertarian) view where we can all get cheap, high-quality medical care simply by cutting the gubmint out of it.

Rand always loved it when only the strong (i.e. rich) survived.