Healthcare Content (Protest Instructions) >>>>>

[ytowndan]

Also, while we're calling out liars (OBAMA!), I'm sure all those people talking about Death Panels are fixing to stand up and apologize for lying to America now, aren't they?

Dude, that's totally different. They were lying in the name of freedom, he was lying in the name of socialism.

[sls.stormyrider]

as if that automakers would suddenly start selling cars without safety features but for the infinite wisdom of our federal benefactors)

Really???
in my lifetime, cars came without seatbelts. and headrests. and airbags (auto manufacturers wanted no part of air bags - fought it for years).  there were no emissions standards. cars used leaded gasoline.
Just because a reg comes from the govt, doesn't mean that it's bad or stupid.

One of the many frustrating things about this to me, is that pts ask and or complain about ACA on a regular basis. I try not to discuss politics in the office, among other things it sets me back.  I tell pts that on a regular basis, paitients have to decide between medication and food, or can't come to the doctor because they lost their insurance, or won't go to the hospital when they're sick because of no insurance (yes, all of this really happens), and I don't think that should happen in this country. As much as they may hate Obamacare or whatever, they all agree with that.
If you ask people in general if they think people should be excluded for pre exisiting conditions, or adult children should be covered by their parents if needed, most will agree with the actual changes that have been made (just don't tell them that they actually agree with ACA)

I don't know the answers, but I don't think covering the population is affordable without everyone buying in, and I don't think you can do that without the govt.
Other than that, I don't think anyone has the answers. I see ACA as a starting point to be tinkered with and adjusted, not a final product. Of course, I don't think that congress can do anything at this point, so I'm not sure how much tinkering can be done.
Yes, the opponents of ACA are blowing everything out of proportion to make Obama, ACA, and the Dems look bad
but, there are problems, the WH should have known that everyone and his brother were going to be loaded for bear, and they should have been better prepared. Much better prepared.
Considering all the the stock Obama put in this law, and that he wants it to be his legacy (other than being the 1st African American pres), this is a significant fuck up.

[mbw]

as if that automakers would suddenly start selling cars without safety features but for the infinite wisdom of our federal benefactors)

Really???
in my lifetime, cars came without seatbelts. and headrests. and airbags (auto manufacturers wanted no part of air bags - fought it for years).  there were no emissions standards. cars used leaded gasoline.
Just because a reg comes from the govt, doesn't mean that it's bad or stupid.

Paging Ralph Nader.

[mbw]

As for your last bit, I guess you are saying that since I oppose the law, I am either a racist or I'm too stupid to see that I am being manipulated by right-wing billionaires. Thanks for the tip. Got it.

C'mon.  I know its not as simple as those 2 reasons.  There is a 3rd, of course:  Having great coverage and not giving a fuck about anyone else.  It's the Ron Paul way.  What's his solution for the poor and uninsured?  Oh yeah, doctors to magically treat people for free out of the goodness of their hearts.

So now I'm a racist moron who doesn't know what's good for him AND I don't give a fuck about anyone else. Thanks for clearing that up.

PS - how do know whether or not my coverage is "great?"

Ah, some self realization.  That's good.  now the healing can begin.
Seriously though, you'd don't think that a large proportion of the who are against the ACA have one of these 3 things affecting their mindset?

PS - how do know whether or not my coverage is "great?"

I don't know, try getting bone cancer and see if your insurance company drops you or denies the needed care.
Oh, thats right, they can't do that now. Terrible consequence of this law.
They wouldn't have done that before though, right? Right??
Private business will always do whats right if only the government would leave them alone.
No one profits off other people's misery.   :wink:

[runawayjimbo]

Also, while we're calling out liars (OBAMA!), I'm sure all those people talking about Death Panels are fixing to stand up and apologize for lying to America now, aren't they?

Dude, that's totally different. They were lying in the name of freedom, he was lying in the name of socialism.

Are you guys really saying a statement (on a cable news show) by Sarah Palin carries the same weight as one from the President of the US? I get it, everyone lies (that's my defult position, actually). But one of those people was a crazy lady from Alaska, and the other was Sarah Palin. :sad trombone:

as if that automakers would suddenly start selling cars without safety features but for the infinite wisdom of our federal benefactors)

Really???
in my lifetime, cars came without seatbelts. and headrests. and airbags (auto manufacturers wanted no part of air bags - fought it for years).  there were no emissions standards. cars used leaded gasoline.
Just because a reg comes from the govt, doesn't mean that it's bad or stupid.

Sure, and I didn't ride in a carseat as a child. Seems crazy now. But what I was saying was that there wouldn't be a market for those deathtraps now so automakers wouldn't produce them no matter how much they could save on production costs.

Do you think that cars wouldn't have gotten safer as technology improved? Yes, industry fought back against mandated change as they always do. But I don't believe that it wouldn't have happened without federal regs. People didn't become awakened to climate change because the gov't started restricting emmission standards. Science built that.

As for your last bit, I guess you are saying that since I oppose the law, I am either a racist or I'm too stupid to see that I am being manipulated by right-wing billionaires. Thanks for the tip. Got it.

C'mon.  I know its not as simple as those 2 reasons.  There is a 3rd, of course:  Having great coverage and not giving a fuck about anyone else.  It's the Ron Paul way.  What's his solution for the poor and uninsured?  Oh yeah, doctors to magically treat people for free out of the goodness of their hearts.

So now I'm a racist moron who doesn't know what's good for him AND I don't give a fuck about anyone else. Thanks for clearing that up.

PS - how do know whether or not my coverage is "great?"

Ah, some self realization.  That's good.  now the healing can begin.
Seriously though, you'd don't think that a large proportion of the who are against the ACA have one of these 3 things affecting their mindset?

Yes, some most certainly do. I have no idea if it's a large proportion, but I would seriously doubt it's a majority.

PS - how do know whether or not my coverage is "great?"

I don't know, try getting bone cancer and see if your insurance company drops you or denies the needed care.
Oh, thats right, they can't do that now. Terrible consequence of this law.
They wouldn't have done that before though, right? Right??
Private business will always do whats right if only the government would leave them alone.
No one profits off other people's misery.   :wink:

You've gotten a lot of mileage out of that one. You should be thanking me.

[sls.stormyrider]

the auto industry was pushed to safer cars by federal regs and fear of liability lawsuits. Laws, written by - the G word.  they would have made some progress in the name of safety alone (see volvo). They want to do well on the crash tests. Who runs those crash tests anyway? Oh, that's right, the feds.

So - you don't like ACA. Fine, it's flawed. You don't like single payer. That's OK too. Do you think that people who can't afford insurance shouldn't get coverage? If not, what do we do about it? Do you think that the free market alone will take care of it?

[rowjimmy]

Also, while we're calling out liars (OBAMA!), I'm sure all those people talking about Death Panels are fixing to stand up and apologize for lying to America now, aren't they?

Dude, that's totally different. They were lying in the name of freedom, he was lying in the name of socialism.

Are you guys really saying a statement (on a cable news show) by Sarah Palin carries the same weight as one from the President of the US? I get it, everyone lies (that's my defult position, actually). But one of those people was a crazy lady from Alaska, and the other was Sarah Palin. :sad trombone:

You are aware that she's not the only one to make that claim, right?

the auto industry was pushed to safer cars by federal regs and fear of liability lawsuits. Laws, written by - the G word.  they would have made some progress in the name of safety alone (see volvo). They want to do well on the crash tests. Who runs those crash tests anyway? Oh, that's right, the feds.

So - you don't like ACA. Fine, it's flawed. You don't like single payer. That's OK too. Do you think that people who can't afford insurance shouldn't get coverage? If not, what do we do about it? Do you think that the free market alone will take care of it?

Free market takes care of the market, not the customers.

[runawayjimbo]

So - you don't like ACA. Fine, it's flawed. You don't like single payer. That's OK too. Do you think that people who can't afford insurance shouldn't get coverage? If not, what do we do about it? Do you think that the free market alone will take care of it?

Obviously it's an extremely complex problem with no easy solutions (which is why it never gets fixed). But the underlying issue - that health care is too expensive in this country (for reasons good and bad) - will not be fixed by trying to make incremental changes to a broken system. So while IMO the ideas I believe in (not solutions, more like a framework) would help lower the overall cost of care, they would also be politically untenable. I've probably mentioned some or all of these before, but since you asked, it would entail some combination of the following:

1. Get rid of employer provided coverage - this is an archaic notion that only became popular to get around wage controls imposed in WWII. It encourages complacency on the part of the end-user and makes proper risk classification (and thus pricing) impossible. Remove state boundaries for marketing plans and allow people to shop for plans that best suit their needs, including plans with a la carte options. I think there could be support for this although I'm sure Congress would find a way to F it up. It also, as I've mentioned before, would be a far more reaching structural change to the health insurance market than anything in the ACA.

2. Make prices more transparent - people need to be encouraged to understand the true cost of health care, which is currently shielded from them in the third party/managed care environment. I don't know if higher deductible plans are the answer or not because I concede they may encourage people not to seek care when they should (although I haven't seen any empirical evidence this is true, only anecdotal). But I think people should take more of a stake in the cost of their care as it would create better aligned incentives. To do this, though, people would have to be given the tools to compare prices and shop accordingly. To be sure, you are not always given a choice in the type of care you need, but many procedures and nearly all preventative care (which is one of the major benefits of universal coverage, right?) should be more consumer driven. I'd also eliminate the idea of provider networks and rely on more choice and competition to help lower prices. There's a reason Lasik prices have declined so dramatically (there's also a reason why elective procedures can be much more unregulated than life threatening ones).

3. High risk pools - not everyone would be offered or could afford the coverage they needed in this system. High risk pools would address this problem. Funded jointly by the entire health care complex (insurers, pharma, device, hospitals, etc.) and contributed to by the policyholder, these pools would cover people insurance companies deem too risky or who couldn't afford the premiums charged. Would this cover everybody? No, but even the CBO estimates something like 30M people still won't have coverage under the ACA. I think (with no data behind me to back it up) that high risk pools could help achieve at least the same results.

4. Reduce administrative burden - one problem the ACA correctly diagnoses is that administrative costs are way too high in health care. Insurers should not have to spend $0.30 of every premium dollar on administration. But where the ACA gets it wrong (IMO) is in trying to eliminate those costs through the medical loss ratio mandate. Simply dictating a "reasonable" MLR won't lower premiums by itself and could actually have the opposite effect (insurers raise rates to meet MLR requirements while maintaining the same absolute level of profits). The reason administrative costs are so high (across the health care industry, not just for insurers) is that there is a lot of duplicative effort just to process all the paperwork (as I'd imagine you are acutely aware). Contrary to popular belief, insurers don't spend so much money on overhead just to deny claims; selling, processing, and maintaining policies costs money because of the complexity of the health insurance market (as the WH is undoubtedly discovering). This need to be more efficient, but I would take a bottom-up approach as opposed to the ACA's top-down mandate.

5. Patent reform - pharma makes about 20% in profit for every dollar of sales; insurance makes about 2.5%. Now, I am totally cool with a higher profit margins for higher risk businesses, and I am also cautious to make changes that would stifle innovation. But I don't see how anyone can justify the manipulation that goes on in the patent/exclusivity space. Ending gov't sanctioned monopolies would help reduce one of the most costly drivers of health care spending and would (hopefully) have the indirect and bonus benefit of reducing the influence of one of the most powerful lobbies in the country. Win-win.

6. Medical malpractice reform - this is something that the GOP has been harping on for years and while I don't believe this would have a significant impact on total health care spending, it doesn't mean we shouldn't do it. Med mal premiums are outrageous (again, don't have to tell you that), but more importantly, it should lead to a reduction in the practice of defensive medicine. Quality of care tradeoffs must be considered, but I don't see how you can lower total spending without providing some sort of protection for the people providing the care.

7. MOAR doctors - you'll know more about this than me, but I have heard there is a de facto self-imposed shortage in doctors due to overly stringent admission standards. Again, quality must be considered as you don't want an army of Dr. Nicks running around. But I gotta believe that getting through medical school should be harder than getting in, not the other way around. More doctors (especially in the not-so-hot and critically important fields like Family Medicine) means more choices means lower prices. Period. RNs are also fabulous resources as well.

I'm sure I'm forgetting some stuff that would be on my wish list but I have to get back to work. Is the above an oversimplification? Probably (like I said, this shit is complex). But do I believe it would lead to better outcomes in a more efficient manner? Absolutely. You'll also notice nothing I said above mentions telling the old or the poor to go screw (although I do believe the Medicare/SGR fiasco illustrates quite clearly how gov't intervention distorts costs and contributes to rising spending). I do believe gov't has a role to play in the health care market, but I think it is one that should be significantly diminished from its current form. But again, it would have to be done in an very gradual fashion to ensure an orderly transition. On the other hand, I also believe if the problem of rising costs is not addressed soon, we will be forced to make a change very quickly and it will be chaotic, making the "just a website" affair seem like goddamn child's play.

BaBaBooey, BaBaBooey, BaBaBooey

Also, while we're calling out liars (OBAMA!), I'm sure all those people talking about Death Panels are fixing to stand up and apologize for lying to America now, aren't they?

Dude, that's totally different. They were lying in the name of freedom, he was lying in the name of socialism.

Are you guys really saying a statement (on a cable news show) by Sarah Palin carries the same weight as one from the President of the US? I get it, everyone lies (that's my defult position, actually). But one of those people was a crazy lady from Alaska, and the other was Sarah Palin. :sad trombone:

You are aware that she's not the only one to make that claim, right?

Yes, but she was the main proponent. But even if you take everyone who ever uttered the phrase combined, they have far less influence than the president.

the auto industry was pushed to safer cars by federal regs and fear of liability lawsuits. Laws, written by - the G word.  they would have made some progress in the name of safety alone (see volvo). They want to do well on the crash tests. Who runs those crash tests anyway? Oh, that's right, the feds.

So - you don't like ACA. Fine, it's flawed. You don't like single payer. That's OK too. Do you think that people who can't afford insurance shouldn't get coverage? If not, what do we do about it? Do you think that the free market alone will take care of it?

Free market takes care of the market, not the customers.

Obvious exaggeration is obvious.

[Hicks]

So being out of work I'm looking around at my options and it looks like I can buy a personal plan with a $500 deductible and $5000 out of pocket max for $258 a month.

That seems pretty reasonable.

Admittedly I've always had employer healthcare before, but it seems to me that the prices are in fact dropping as a a result of the ACA.

That's a pretty big step in the right direction.

Wait, what?

Oregon Health Care Exchange Has Yet To Enroll A Single Person

Yeah I wasn't using the exchange it was a private plan, but I have to assume their rates are affected by the anticipated effects of the ACA.   

In any event, it don't matter no more to me, lasers will be picking up my tab.

So I guess that means I'm a Republican now.   

[rowjimmy]

You sure can run on at the keyboard.

tl;dc
(too long; don't care)

Here's the deal:

1) You can argue against reforming health care, and you'd be on the wrong side of morality and history (eventually).

2) You can argue that the ACA is not the solution to the problem and you'd be right. Single payer, public healthcare is the solution. The "free market" had its chance and it kills people.

C) You can say that the ACA isn't movement in the correct direction. But you'd be wrong. Covering more people is the right direction. And, when this phase of changing healthcare in the country proves out its imperfections, the nation will know which way to push. (see point 2)

[runawayjimbo]

You sure can run on at the keyboard.

tl;dc
(too long; don't care)

He asked, I answered (while putting off actual work I have to do). I honestly didn't expect you to read, nor do I care (but thanks for making it clear).

1) You can argue against reforming health care, and you'd be on the wrong side of morality and history (eventually).

Since I just spelled out how I'd reform heath care, I am obviously not against it. Not sure what this point means.

2) You can argue that the ACA is not the solution to the problem and you'd be right. Single payer, public healthcare is the solution. The "free market" had its chance and it kills people.

Ooh, shock value, that's a good way to win an argument.

C) You can say that the ACA isn't movement in the correct direction. But you'd be wrong. Covering more people is the right direction. And, when this phase of changing healthcare in the country proves out its imperfections, the nation will know which way to push. (see point 2)

Covering people for the sake of covering people does not reduce costs. Unfortunately for your side, when this phase ends, people will be going the other way. Because for as much as people dislike GOP, more of their predictions about the consequences of the ACA are proving true than the WH's. Single payer is not an option this country will entertain. And thank goodness for that. Otherwise you wouldn't be able to use your "death panels are stupid" line. Among other things.

[sls.stormyrider]

I agree with almost everything that you said. Those things will help to control costs.
We also need to reduce overutilization (on everyone's part) - easier said than done.

what is left out, though, is universal coverage, something that I think we need and won't happen if the system got reformed the way you said it. That is, unless you make people buy catastrophic insurance (an idea that got floated in the 70s and didn't get very far)

I have very mixed feelings about single payer - I've seen what the feds have done to the VA system so I'm a skeptic.
Regardless, I think that single payer is not a political reality in this country.
I also think that removing the ties between insurance and employer (historical vestige that the tax system has helped prolong) is almost as policitally unrealistic as single payer.

[rowjimmy]

You sure can run on at the keyboard.

tl;dc
(too long; don't care)

He asked, I answered (while putting off actual work I have to do). I honestly didn't expect you to read, nor do I care (but thanks for making it clear).

1) You can argue against reforming health care, and you'd be on the wrong side of morality and history (eventually).

Since I just spelled out how I'd reform heath care, I am obviously not against it. Not sure what this point means.

That point is a general position. After the TL,DC, my post was directed to the universe not just you.
You are not the only person out there.

2) You can argue that the ACA is not the solution to the problem and you'd be right. Single payer, public healthcare is the solution. The "free market" had its chance and it kills people.

Ooh, shock value, that's a good way to win an argument.

I'm not trying to win an argument. What would be the point, no one on this board has any interest in being or capacity to be swayed.

Also, if the truth shocks you, you aren't paying attention.

C) You can say that the ACA isn't movement in the correct direction. But you'd be wrong. Covering more people is the right direction. And, when this phase of changing healthcare in the country proves out its imperfections, the nation will know which way to push. (see point 2)

Covering people for the sake of covering people does not reduce costs. Unfortunately for your side, when this phase ends, people will be going the other way. Because for as much as people dislike GOP, more of their predictions about the consequences of the ACA are proving true than the WH's. Single payer is not an option this country will entertain. And thank goodness for that. Otherwise you wouldn't be able to use your "death panels are stupid" line. Among other things.

"Covering people for the sake of covering people"? What the fuck?
It's called covering people so that they have an opportunity to live and even thrive without the burden of going bankrupt for or being denied  what should be a given right: good health.

I don't know where in your ideology you find "let 'em fight it out" but it doesn't fit into mine.

Health care should not be a business.

[sunrisevt]

Well said, rj.

[antelope19]

I'm not trying to win an argument. What would be the point, no one on this board has any interest in being or capacity to be swayed.

Also, if the truth shocks you, you aren't paying attention.

I disagree with this statement.  Personally, my own opinions and stances have been altered(swayed) numerous times over the years based on useful content and discussions I have found on this board.