Defending Obamacare (Page 4)

How much healthcare innovation comes out of Canada?

The US is the healthcare beacon of the world and most well to do people in Canada come to America for the important healthcare stuff. 

America could do a Canada like healthcare system, but we would have to drastically reduce our care and that will go over like a lead balloon.  You have to either have "free" healthcare (get what you pay for) or you have to have a free market system with the benefits that come with it.  You can't have it both ways.
I'd say it's analogous to wanting free HUD housing from the government, but you expect the house to be 4500 square feet with a pool in a nice suburb.

BTW, I totally agree with you on individuals purchasing healthcare like car/auto/home and I think it should be that way.  Get it out of the companies.

CEO's are always going to make a lot of $ at a large company.  His total comp is .27% of the companies total profit of $4.1B on revenue of $102B.  So company profit is 4% of earnings and CEO total comp is .27% of that profit.  I don't see anything wrong with that personally.
BTW, his base pay is $832,692 and the vast majority of his earnings were form stock value increases.  His total comp in 2010 was $2.2M.  (ironically, I would bet money that the stock surge resulting in his increased compensation was a result of Obamacare passing)

Even if you took his entire comp and passed it to all 70M of their customers, it would result in a net reduction in annual premiums of approximately 20 cents per year.  If you went even further and took the entire $4.1B in profit and gave it to their 70M customers it would result in approximately $58 per year in decreased premiums or $4.83/mo.  So when you hear talk of the greedy insurance companies jacking up your $1000+ premium it's simply not true.

the problem with high deductible plans is that no one does preventive care - we have tried that.

so you need to incentivize the preventive care

sorry but things they count as "administrative overhead" are ridiculous. and the executive salaries are also outrageous.

BCBS, not having shareholders to answer to, instead will do things like internal studies - costing MILLIONS that then get thrown out or stopped before done (had a friend consulting there when I lived in Boston)

and the games they play with reimbursement that cost are unbelievable - setting computers to automatically reject claims with statements like diagnosis and procedure don't match (I had one that the diagnosis was menopause and the procedure was office visit). Took my staff HOURS on the phone to get to a human who said oh that should not have happened resubmit - which we did - again rejected.  Try 3 we got that we were filing 'beyond a timely filing limit' - happily we could prove them wrong on that but a whole lot of work to get $60 probably cost us more chasing it - and that is ONE example.

I'm not sure what the percentages are, but I would respectfully disagree that no one does, because I'm on an HSA and have been for years.  I always do preventative care and my family does as well.
(On a complete side note, it's noticeably challenging to do preventative care.  I call the doctor and say I want a physical and they say why.  I tell them I just want to make sure everything is ok, and they ask why again.  lol)

I'm being a little facetious above if it doesn't come across because I know you're not saying that 100% of people don't do preventative care on HSA's, but I'm curious where the percentages are.  Also, my understanding with the bronze plans with ACA is that they have a deductible as well, so I'm curious if an increased percentage of preventative care will result from those plans.

I don't disagree that insurance companies could use some improvements.  I've experienced the same thing you describe on the patient side where the insurance keeps kicking it back for whatever stupid reason they can think of and it's pretty obvious that they're trying to get out of paying.

I feel these kinds of things get sorted out with employee choice in insurance and increased competition across state lines.  If I'm using Verizon and my phone cuts out all the time and doesn't work I drop them and go somewhere else that works.
With insurance if I can't get a claim through or they keep jacking me around I drop them and go elsewhere with my money.  However, with employers making the provider decision, we the employee/patient lose all control and are stuck with whatever crappy insurance provider our employer decides to go with.

I know it's not a simple problem and there most certainly aren't any simple solutions.  With most topics involving the government it always boils down to the simple question; is the proposed/passed law going to fix the problem?
The ACA does attempt to fix some of the problems with healthcare, but IMHO they're trying to fix the symptoms and ignoring the problem.  Even the problem you just described could potentially get worse because they're forcing insurance companies to be more efficient now so they'll look for other ways to make that money back by jacking with providers/patients claims.  I could be wrong, but just hypothesizing.

Wonderful timing, just got a letter in today's mail explaining that they were authorized an 8.6% increase in premiums for this year. I should be happy, they asked for 10%.

It was 8.2% last year, and a whopping 66% when I went from age 49 to 50 the year before that.

But I got even, I crashed my bike and had $18,000 in medical expenses.

But if those doctors need to be there for you, I'm not certain it's a bad idea to fill the rest of their time up.  Why have the resources just sitting waiting for an emergency when they can fill their time with runny noses.  I bet some of the non-emergency people paid something - thus potentially they actually subsidized your need for 24 hour emergency care being available for when something bad happened.

I wonder how much your sports stars are paid a year in playing contracts and endorsements??

Why does no one ever call them evil and say they make outrageous money and that we should cap their pay?

Two reasons I can think of right off the bat. First, they staff to anticipated need, so if most of that is non-critical need patients, you have additional staff that is not there just for critical care. Second is that these people are trained specifically to deal with critical care and trauma. Any GP could treat a runny nose.

And in an urban hospital, many of those patients didn't pay enough to cover expenses, which is why my bill was so high.

I'm sure there are trauma doc's on here who would be better able to respond.

I went to the ER once when my throat hurt so bad I couldn't swallow.  I knew there was something very wrong with me, but all the traige nurse knew was that I had a sore throat.  She told me we'll call you shortly. Sat for three hours waiting for them to work their way through all the other sore throats, and runny noses, and fevers, etc.  Didn't see a single car accident or gun shot wound or any other bloody mess come rushing through the doors.  I'm sure there were a few legitimate emergency cases in front of me, I'm also sure most were not.

Finally got my turn to have a doc look at me.  30 seconds later I was being rushed to the ICU where I spent a solid week (on a side note, intravenous morphine is awesome).  So yeah, I would prefer that ER doctors are sitting around and actually available for emergencies instead of filling their time with the runny noses of the uninsured.

While Medicare does run with lower overhead, there I think you must also acknowledge the increased rate of fraud that is also has.

Interesting - so a few questions-  What kept you from pursuing medical care prior to this (since that has to do with the whole if people had preventative care/ early intervention costs would be lower) and how much more would you be willing to pay in premiums annually to limit your ER wait to say less than 30 minutes- IE how much would you pay to have doctors under utilized so they would be ready when you came in?  (I'm and econ geek, so the whole costs part fascinates me.)

already in effect - preventive care has NO cost sharing - thanks to the ACA

For my personal experience, there was nothing to prevent.  I boarded a plane feeling fine, by the time we landed I asked my wife to take me straight to the ER.  Something was very wrong, turns out my throat was just about swollen shut.  I don’t know why it happened (I’m not allergic to anything), just a freak thing. 

There’s two main reasons why ER’s treating non-emergency cases is a bad idea.  The economic answer is the easiest.  These patients are not going to pay their bill.  If a patient with a runny nose intended on paying their bill, they wouldn’t be at the ER in the first place.  Urgent care facilities are much cheaper than an ER, general practitioners are much cheaper than that.  But both of those places have the ability to send you away if you don’t pay up front.  (Most) ER’s can’t, they’re bound by EMTALA to screen anyone who walks through the door.  So for someone who can’t afford to have a doctor look at their runny nose and don’t mind ignoring debt collector phone calls, trips to the ER are free.

The second reason is one of practicality.  My wife’s gynecologist is perfectly capable of diagnosing and prescribing the right medication for my runny nose.  And if he has an open spot on some random afternoon, it would make financial sense for him to see me and bill me for the visit.  But if he is forced to start treating every guy with a runny nose that calls him up and my wife can’t get an appointment time to have her lady parts checked out, then he’s no longer a gynecologist.  He would be prevented from providing the service that he’s supposed to be providing. 

That’s basically what happened to me at the ER.  I ended up having a life threatening emergency, but the triage nurse didn't realize it.  When the doc finally took a look, he said my trachea was so swollen that he wasn't sure how I was able to breath.  But I wasn't gasping for breath and all the triage nurse knew was that I had a sore throat.  Didn't matter that I told her that my pain was a 10 out of 10, it was still just a sore throat.  So I got sent to the back of the line behind all the other sore throats.  It’s not about paying more to ensure that my wait time is less than 30 minutes.  It’s about ensuring that someone with a life threatening emergency gets prompt care and treatment. 

I’ll admit that I’m fairly biased and passionate about this.  Not just because of my own experience, my mother was a nurse in the ER for her entire career.  I heard a lot of stories.

You obviously didn't read the fine print...

That's cool.  I'm sitting back and bracing for what my company gets hit with next year.  We shall see.

Ruh Roh Raggy

Unions break ranks on ObamaCare

Just got my open enrollment package too and my premiums are going up 4% with no change in benefits.  After all the numbers being tossed around, I'm pretty relieved to see that.  

Firstly, how can you take Ungar (a man who's byline is "I write from the left") as an impartial journalist on this issue?  If your argument is essentially "If you disagree with me I don't want to talk to you" then you're not exactly the most talented debater now are you?

Secondly, I'll see your Forbes article with another Forbes article.  Ungar did not compare apples to apples (see the article for details).  Individual plan rates in CA are going up double and triple digit %s.

"As California goes, so goes the nation." As an individual plan customer in FL I expect to see these same double and triple digit % increases.

http://www.forbes.com/sites/theapothecary/2013/05/30/rate-shock-in-california-obamacare-to-increase-individual-insurance-premiums-by-64-146/

Preventative services are a SMALL fraction of the costs for most people.  Getting checked for diabetes vs a heart attack.  Just a wee difference in price there wouldn't you agree?

Competition is a good thing.  But we don't need the ACA to achieve that.  All you need to do is open the market and stop creating regulations that protect the insurance companies.

The cool part is we all get to see it come to life.  So far, the reality is that more and more people do not like the ACA as it gets closer to implementation and I suspect that will continue.  Preventative care is important for overall healthcare, but 20 somethings and 30 somethings could give a rats butt about preventative care.  What they're going to experience is being forced to buy into a healthcare plan they don't want or pay a new tax.  I'm thinking that will go over like a lead balloon personally.

The 30 hour workweek reality has already begun to hit and the poor are getting jacked the worse because the majority of their jobs are hourly.

There are hundreds and hundreds of unintended consequences that will ripple through the country due to ACA.  We've just begun to see the tip of the iceberg.  So, yes there are good things, and nobody (who is sane) can deny there aren't good things in the ACA.  However, there are far more bad things that the supporters like to pretend don't exist.