ObamaCare - exchanges ,report your states options!

[WILLIAMS5232]

i hate boondoggling

i'm sure there is enough money in our govt currently to pay for free healthcare for all. if they could just work on eliminating waste, instead of devising new ways to tax workers.

[thegreekdog]

i hate boondoggling

i'm sure there is enough money in our govt currently to pay for free healthcare for all. if they could just work on eliminating waste, instead of devising new ways to tax workers.

I would have understood actual socialized healthcare, where hospitals and healthcare generally, are run by the government (similar to the military or the post office). I would not have agreed with it, but it would make more sense than the Affordable Care Act in doing something to solve the problem of the high cost of healthcare.

[Metsfanmax]

There is no way that you can demonstrate to me that, prior to the Affordable Care Act, health care and health insurance were part of a free market system.

I wasn't arguing that they were. I don't know why you're hung up on this point. I said that this particular facet of the health insurance industry was not regulated. I then went on to explicitly state that the health insurance industry is not, in general, a free market system. So, drop it.

You've identified a problem with health insurance: the exclusion of individuals from coverage. Two thoughts come to mind. First, and less important, health insurance providers are rarely engaged in fair competition. Second, and more important, why do people need health insurance in the first place? Healthcare is expensive, but why is healthcare so expensive? Why is it more expensive now than it was one hundred years ago? One of the least talked about, but most imporant, criticisms of the Affordable Care Act is that it does not solve the problem of healthcare costs and the reason for rising healthcare costs.

The issue of health care costs is indeed important but it doesn't actually address the issue of the uninsured, except perhaps tangentially. We do live in a society where a substantial portion of the population cannot afford or is refused access to insurance. Ensuring that they get insurance does not have to be mutually exclusive with decreasing healthcare costs overall. Calling this a criticism of the ACA is a red herring that distracts from the main issue rather than coming up with ways to solve it.

The easiest solution in the short term, politically and otherwise, to the problem of making sure people with preexisting conditions can get healthcare is to make sure they get affordable health insurance, which is ostensibly what the Affordable Care Act does (I'm not sure it makes healthcare affordable, so it may not do that). In my mind, the more effective solution, although much more difficult in the short term, is reduce the cost of healthcare itself.

I agree, and basically everyone looking at the problem agrees. For the short term, government subsidies are what are needed to make sure that most people are insured. The ACA is surely a bandage and not a full scale surgical operation, but that doesn't make it a bad idea. Furthermore, it's not clear whether it's government action that will ultimately be able to lower healthcare costs, is it?

How many more people have access to basic medical care that did not have access to basic medical care prior to the passage of the Affordable Care Act? How much more, incrementally, will the Affordable Care Act cost? These are the two questions that must be asked that people who support and don't support the Affordable Care Act do not ask.

I do not know why you suggest this. Perhaps the most important justification for the law during its formative stages was the raw number of uninsured Americans, and it has been made clear (e.g., analysis by the CBO) that the ACA is expected to insure about 30 million people over the next several years, which (besides being a rather large number) is the majority of the uninsured. 50 million uninsured is very clearly a "wide swath" of the population. It's possible that there are some supporters that do not know of this analysis, but that does say anything about the value of the legislation.

In supporting the Affordable Care Act, you are also now supporting government (read tax dollar) support of others' purchase of health insurance who could previously afford health insurance but will now choose, or be forced to choose by their employers, to purchase health insurance through exchanges where the price is not regulated.

There are strict regulations on the plan pricing on the health insurance exchanges. Furthermore, the establishment of the tier system for health care plans is argued (by some) to possibly decreases prices. Even if they can't do that, at least the prices are very well managed by the government. Furthermore, the health insurance exchanges generally result in better competition, and I would expect a fiscal conservative to approve of this.

As a final word, the Affordable Care Act is very similar to health care fixes put forward by Republicans during the Clinton administration, which begs the question as whether this is an effective solution to an existing problem or an ineffective corporate boondoggle to insurance companies.

Yes, and here again Republicans in Congress precluded the much more radical possibilities that could have truly overhauled the healthcare system. They're obviously not completely to blame, but they did a pretty good job of throwing a wrench in the works.

[thegreekdog]

The whole point of my post is that when there is no regulation regarding individual access to healthcare, which would be the default free market principle, people who need health insurance do not get it. That is a failure, if we believe that health insurance for all is a desirable goal.

I wasn't arguing that they were. I don't know why you're hung up on this point. I said that this particular facet of the health insurance industry was not regulated. I then went on to explicitly state that the health insurance industry is not, in general, a free market system. So, drop it.

I cannot reconcile these two statements, so I probably can't drop it.

The issue of health care costs is indeed important but it doesn't actually address the issue of the uninsured, except perhaps tangentially. We do live in a society where a substantial portion of the population cannot afford or is refused access to insurance. Ensuring that they get insurance does not have to be mutually exclusive with decreasing healthcare costs overall. Calling this a criticism of the ACA is a red herring that distracts from the main issue rather than coming up with ways to solve it.

The stated purpose of allowing people access to health insurance was to ensure they had access to healthcare. People that do not have insurance did have access to healthcare prior to the Affordable Care Act. So the stated purpose of the Affordable Care Act is the actual red herring.

I agree, and basically everyone looking at the problem agrees. For the short term, government subsidies are what are needed to make sure that most people are insured. The ACA is surely a bandage and not a full scale surgical operation, but that doesn't make it a bad idea. Furthermore, it's not clear whether it's government action that will ultimately be able to lower healthcare costs, is it?

When the bandage costs as much as it does, it becomes a bad idea.

I do not know why you suggest this. Perhaps the most important justification for the law during its formative stages was the raw number of uninsured Americans, and it has been made clear (e.g., analysis by the CBO) that the ACA is expected to insure about 30 million people over the next several years, which (besides being a rather large number) is the majority of the uninsured. 50 million uninsured is very clearly a "wide swath" of the population. It's possible that there are some supporters that do not know of this analysis, but that does say anything about the value of the legislation.

I think you're confusing being insured with receiving healthcare (or not being insured with not receiving healthcare).

[stahrgazer]

Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)
- Citizens not enrolled in Medicaid despite being eligible
- Citizens opting not to be insured (mostly young people)
- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people.

Whoaaaaaaaaaaah! You're missing a wide swath of adults who could not afford health insurance/care, but did not qualify for Medicaid.
Working adults: because their jobs did not provide it, or did not subsidize it, or are so small that the pool is too small to give them a reasonable rate.
Non-working adults because they don't get the advantage of any sort of pool at all assuming they have sufficient income from some source or other to purchase health insurance.

My mother, for example, worked for an independent contractor as one of two full-time employees. The rate they would have paid was the same as the rate for an individual, and far higher than the rate of a large construction company that employs thousands of people, for exactly the same policy that provides exactly the same care.

At my local hospital, if you have Humana insurance you/Human will be billed less for a service than an individual walking in to procure the exact same service.

If the service is worth $100 for an individual, why isn't it worth $100 for an insurance company? Is it that individuals and those insured in non-favored pools of insurance were already subsidizing the costs for those in the more-favored pools of insurance?

[Phatscotty]

Wisconsin legislators call for arrest of federal officials implementing Obamacare

Nine members of the Wisconsin state legislature say they plan to back a bill to arrest federal officials who try to implement Obamacare.

The state’s Republican Gov. Scott Walker must decide by Friday whether the state will draft a health care exchange plan under Obamacare or surrender the task to the federal government.

“Just because Obama was re-elected does not mean he’s above the Constitution,” Republican state Rep. Chris Kapenga told the Milwaukee Journal-Sentinel.

Of the nine Republicans who advocated arresting federal officials, eight have also said on record that they want to write a law that would permit prosecuting TSA agents who physically search passengers with sexual assault.

Additionally, all nine told a tea party-aligned group that they supported the passing of legislation that would allow people to carry guns without first acquiring a permit, allow people to buy raw or unpasteurized milk, allow people to carry guns without state permits and block state funding for federal Real ID laws that require states to develop more secure driver’s licenses.

Kapenga said that he doesn’t think “right-to-work” laws, which bar private-sector labor contracts from including provisions that require employees to join unions as conditions of employment, will be passed in the upcoming congressional session, even with Republican majorities in the state assembly and senate.

“I very much support right to work, but do I think it’s realistic? No. I don’t think we’ll have the political capital to do it,” Kapenga said.

Republicans were able to pass a bill in the last session allowing people to get permits from the state to carry concealed weapons, ending Wisconsin’s lengthy ban on the practice.

Read more: http://dailycaller.com/2012/11/14/wisco ... z2CF5IpOVo[/quote]


Scott Walker, Wisconsin Governor, Rejects Key Health Care Reform

Wisconsin won't create a health insurance exchange, Gov. Scott Walker (R) announced Friday, making it the latest state to reject a key component of President Barack Obama's health care reform law.

Wisconsin was one of the few remaining holdouts until Friday, the original deadline for states to declare whether they would run a health insurance exchange, before an extension to Dec. 14. The exchanges are online marketplaces where uninsured people and small business will shop for coverage and find out if they qualify for financial assistance or Medicaid benefits beginning in 2014. More than half of states have declared they would leave the operation of the exchanges to the federal government, or partner with federal authorities rather than take charge themselves, as the law intended.

Walker decided to turn the health insurance exchange in his state over to the federal government rather than implement it himself, citing in a letter to Health and Human Services Secretary Kathleen Sebelius his opposition to Obamacare and his belief that states like Wisconsin still wouldn't have enough say over their health care markets even if they manage their own exchanges under federal guidelines.

"No matter which option is chosen, Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents," Walker wrote. "If the state option is chosen, however, Wisconsinites face risk from a federal mandate lacking long-term guaranteed funding."

Earlier Friday, Maine Gov. Paul LePage (R) reiterated that his state wouldn't create an exchange. "We are not going to assist in implementation of this bill in its current form," LePage wrote Sebelius. "In the end, a state exchange puts the burden onto the states and the expense onto our taxpayers, without giving the state the authority and flexibility we must have to best meet the needs of the people of Maine.”

Ohio Gov. John Kasich (R) announced later Friday that his state would also not establish its own exchange. "Turning down a state-based health exchange and saying no to federal regulation of Ohio’s health insurance industry and Medicaid eligibility determination is the best approach for Ohio," Kasich's office said in a press release. The announcement conforms with earlier comments made by Lt. Gov. Mary Taylor (R) on Tuesday.

Idaho Gov. C.L. "Butch" Otter (R) said in a press release Friday afternoon that he will postpone a decision on creating a health insurance exchange until the new Dec. 14 deadline. "This extension gives us more time to get answers from [the Department of Health and Human Services] about what the federal requirements will be,” Otter said. “I don’t want us buying a pig in a poke, so with this extension I’m hoping we’ll get answers to the questions and concerns we’re hearing from legislators and the public.” Last month, a working group of Idaho legislators and health care industry representatives appointed by Otter recommended the state run its health exchange rather than let the federal government do so.

New Jersey Gov. Chris Christie (R) told reporters he also would hold off on making a decision, PolitickerNJ reported Friday. “I need answers from the Obama administration,” Christie said at a press conference, according to the website. “I hope they don’t back us into a decision by not giving me an answer.”

In a letter to Sebelius posted online Friday, Florida Gov. Rick Scott (R) requests a meeting with the secretary to "discuss possible solutions for Florida families at your earliest opportunity." Scott has been one of Obamacare's most outspoken critics and spent $5 million of his own money fighting it in Congress, but he has attempted to sound a conciliatory note in recent days. Scott's letter doesn't suggest he's ready to embrace the health care reform law, however.

"I am hopeful it is possible for us to work together to lower costs and improve access and quality," he wrote. "Under the current regulatory requirements and the information we have been provided, however, Florida does not have evidence that a [health insurance] exchange can accomplish these goals."

Another undecided Republican governor, Mary Fallin of Oklahoma, also will wait to take a position on an exchange, the Tulsa World reported Friday. Fallin's office received more than 1,000 constituent phone calls on the issue Thursday, according to the newspaper.

Arizona Gov. Jan Brewer (R) said Thursday she too would postpone an announcement until next month.

Most governors already had declared their positions on health insurance exchanges through official statements or public comments well before Friday. In recent days, a slew of Republican governors including Texas' Rick Perry, Alabama's Robert Bentley, Nebraska's John Heineman, Louisiana's Bobby Jindal and Alaska's Sean Parnell also restated their opposition to state-run health insurance exchanges under federal guidelines. New Mexico Gov. Susana Martinez (R) confirmed Thursday that her state would run its exchange.

A handful of states hadn't made a decision as of Friday, such as Pennsylvania.

Eighteen states and the District of Columbia are likely to have their own exchanges in place by Oct. 1, 2013, when people will begin using them to buy health insurance, according to Avalere Health, a consulting company. The remainder will either let the federal government do the work or collaborate with Health and Human Services, Avalere Health predicts.

http://www.huffingtonpost.com/2012/11/1 ... 44605.html

[Night Strike]

Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)
- Citizens not enrolled in Medicaid despite being eligible
- Citizens opting not to be insured (mostly young people)
- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people.

Whoaaaaaaaaaaah! You're missing a wide swath of adults who could not afford health insurance/care, but did not qualify for Medicaid.
Working adults: because their jobs did not provide it, or did not subsidize it, or are so small that the pool is too small to give them a reasonable rate.
Non-working adults because they don't get the advantage of any sort of pool at all assuming they have sufficient income from some source or other to purchase health insurance.

My mother, for example, worked for an independent contractor as one of two full-time employees. The rate they would have paid was the same as the rate for an individual, and far higher than the rate of a large construction company that employs thousands of people, for exactly the same policy that provides exactly the same care.

At my local hospital, if you have Humana insurance you/Human will be billed less for a service than an individual walking in to procure the exact same service.

If the service is worth $100 for an individual, why isn't it worth $100 for an insurance company? Is it that individuals and those insured in non-favored pools of insurance were already subsidizing the costs for those in the more-favored pools of insurance?

Sounds like perfect reasons for getting rid of employer-paid insurance (which the government caused) instead of proving to a government-run system. Besides, who decides what a "reasonable rate" is? The government that doesn't even pay the full cost of treating Medicare patients and will cut it even further under Obamacare?

[thegreekdog]

Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)
- Citizens not enrolled in Medicaid despite being eligible
- Citizens opting not to be insured (mostly young people)
- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people.

Whoaaaaaaaaaaah! You're missing a wide swath of adults who could not afford health insurance/care, but did not qualify for Medicaid.
Working adults: because their jobs did not provide it, or did not subsidize it, or are so small that the pool is too small to give them a reasonable rate.
Non-working adults because they don't get the advantage of any sort of pool at all assuming they have sufficient income from some source or other to purchase health insurance.

My mother, for example, worked for an independent contractor as one of two full-time employees. The rate they would have paid was the same as the rate for an individual, and far higher than the rate of a large construction company that employs thousands of people, for exactly the same policy that provides exactly the same care.

At my local hospital, if you have Humana insurance you/Human will be billed less for a service than an individual walking in to procure the exact same service.

If the service is worth $100 for an individual, why isn't it worth $100 for an insurance company? Is it that individuals and those insured in non-favored pools of insurance were already subsidizing the costs for those in the more-favored pools of insurance?

How many is in your wide swath?

Just a point of reference, I went to four different websites.

[GreecePwns]

It's around 50 million people prior to the act (specifically 2010), if my Google-fu is working correctly, TGD.

It boils down to this, really: if you believe a free market health insurance system will be "better" (which is defined using a mix of three categories: # of people insured, quality of care for the average citizen and spending), then the burden of proof is on you to prove so. This is mostly because there hasn't ever truly been a fully free market health insurance system in an industrialized country.

The pre-2010 US system does come closest to free market when compared to every other industrialized nation and their systems in the past half century. And in all three of the above categories it empirically performs worse than its French, Dutch and comparable counterparts. The usual retort is that quality of care here is better than other nations and that rich foreigners come here for care instead of staying in their own country. My response to that is that the aim of a health insurance system, be it free market or employer-provided or government-owned or whatever, is to provide quality care for as many people as possible, not only a select few. The quality of care argument falls on deaf ears when you compared the type of care the average American citizen gets to other countries.

Another popular retort is that the other countries' diets are better, therefore they naturally should be spending less per capita on health insurance. Well, not 3 or 4 times less, and that's even true for the fattest country in Europe (Greece). Sure, diets play a big role in the deteriorating health of America, but not nearly that big a role.

So, libertarians, ball is in your court. If you don't count pre-2010 US as a free market system, please provide a relevant example that is and prove that it empirically performed better (or would perform better in the current circumstances). If there is no such example, please argue why one would perform better than the current systems used by certain countries.

[thegreekdog]

if you believe a free market health insurance system will be "better" (which is defined using a mix of three categories: # of people insured, quality of care for the average citizen and spending), then the burden of proof is on you to prove so. This is mostly because there hasn't ever truly been a fully free market health insurance system in an industrialized country.

I don't agree with this for two reasons. First, I cannot possibly prove something is better if it has never existed. Second, there is nothing to be incrementally done by the government in a free market healthcare system (i.e. I'm not asking for money from the government). So, unfortunately, I cannot look at some point in history where our healthcare was a free market system because it does not exist. The closest we can come is to the time before health insurance where doctors made housecalls and apple pie and stuff. So, I have to use common sense and some financial acumen.

The history of health insurance is a fascinating one. Health insurance was not invented until the late 19th century and did not evolve into what we know today until the latter part of the 20th century. In any event, health insurance is a concept that begets rising costs. If a company will pay for my medical care, why would my doctor not charge as much as he/she could possibly get paid? And if the government is backing the health insurance, would not costs skyrocket?

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

And your response is going to be "so what, more people are insured." And my response to you is "who cares if people are getting shitty care and it's costing more and more money."

As for the US healthcare industry being "more" free market than other countries' systems and performing worse, my only response is that being less free market than France or the Netherlands does not make it free market. It's like saying Greece is less financially stable than Portugal. Health insurance is highly regulated, true. But that's not where I'm going with this. Where I'm going with this is that there is no incentive for health insurance companies to lower costs because there is no competition. There is no incentive for healthcare providers to lower costs or provide better care because the system, regulated in this fashion by the governments of the vairous states, rewards them for increasing costs. The Affordable Care Act just pours another layer of cement on the problem, making sure that it will be that much harder to provide affordable care to everyone.

One final note - Most people regularly and happily pooh-pooh the concept that anyone can get free medical care. I don't understand the pooh-poohs. From the age of 18 to the age of 25, I did not have health insurance. I regularly received what medical care I desired and for the most part was not charged anything for it. I know there are people that cannot afford health insurance or healthcare, just like I coudn't afford it when I was younger. And I know there are people with preexisting conditions who cannot get health insurance. I have no problem with the government trying to help those people (I would prefer other people help those people without government intervention, which, by the way, already happens at non-profit hospitals). I read the Affordable Care Act and various summaries on the law, and I cannot understand how anyone who can think for themselves thinks this is anything more than a boondoggle for the health insurance industry and something that will, in the long run, greatly hurt healthcare and the fiscal status of the US government to a staggering degree.

[GreecePwns]

The history of health insurance is a fascinating one. Health insurance was not invented until the late 19th century and did not evolve into what we know today until the latter part of the 20th century. In any event, health insurance is a concept that begets rising costs. If a company will pay for my medical care, why would my doctor not charge as much as he/she could possibly get paid? And if the government is backing the health insurance, would not costs skyrocket?

That's the theory, but the exact opposite is happening, TGD.

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

And your response is going to be "so what, more people are insured." And my response to you is "who cares if people are getting shitty care and it's costing more and more money."

As for the US healthcare industry being "more" free market than other countries' systems and performing worse, my only response is that being less free market than France or the Netherlands does not make it free market. It's like saying Greece is less financially stable than Portugal. Health insurance is highly regulated, true. But that's not where I'm going with this. Where I'm going with this is that there is no incentive for health insurance companies to lower costs because there is no competition. There is no incentive for healthcare providers to lower costs or provide better care because the system, regulated in this fashion by the governments of the vairous states, rewards them for increasing costs. The Affordable Care Act just pours another layer of cement on the problem, making sure that it will be that much harder to provide affordable care to everyone.

One final note - Most people regularly and happily pooh-pooh the concept that anyone can get free medical care. I don't understand the pooh-poohs. From the age of 18 to the age of 25, I did not have health insurance. I regularly received what medical care I desired and for the most part was not charged anything for it. I know there are people that cannot afford health insurance or healthcare, just like I coudn't afford it when I was younger. And I know there are people with preexisting conditions who cannot get health insurance. I have no problem with the government trying to help those people (I would prefer other people help those people without government intervention, which, by the way, already happens at non-profit hospitals). I read the Affordable Care Act and various summaries on the law, and I cannot understand how anyone who can think for themselves thinks this is anything more than a boondoggle for the health insurance industry and something that will, in the long run, greatly hurt healthcare and the fiscal status of the US government to a staggering degree.

And I'm not defending the Affordable Care Act at all, as you may have seen in my previous posts on the subject. Thinking I am has influenced your admittedly well-written post, and I should have been more clear about that.

EDIT: I'll try to salvage it, however, because you put a lot of time into it.

First off, not every country pays its doctors based on # of treatments, nor must it be that way.

http://content.healthaffairs.org/content/22/3/89.full.html
Exhibit 5 of this study counters some of your concerns about state-run healthcare. As I've pointed out above, healthcare spending per capita is much higher here than in other countries. You'd think that we'd be getting at least proportionately more treatments, more examinations and more everything than other countries do as a result, but the fact is utilization rates are similar across the board. The current system is inefficient and I'll display below why a free-market system is also inefficient.

It's often said that the healthcare industry needs more competition, and that removing all restrictions is the way to more competition, which inherently means lower costs apparently (hint: it doesn't).

In fact, however, we can't even assume perfect competition in the healthcare industry (or probably any industry, for that matter). Because companies are not allowed to compete across state lines, market shares for the top health insurance companies are significantly lower than those of other industries (some of the biggest companies like Aetna, UnitedHealth, Humana etc. have around 10 percent market share). But within individual states, we often see one or two companies controlling a 60%+ market share (still relatively low compared to other highly concentrated industries).

With these borders removed, it's quite obvious that these top companies would take larger shares putting the health insurance industry in the state of permanent oligopoly. And oligopoly has proven to be a pretty bad form of competition for consumers (see: cell phone service providers, the media [and not just news, but music, books, nearly everything is in the hands of 7 companies], one can also include the film industry here)

[jj3044]

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

The law does much more than create more "freeloaders". It also tries to change the healthcare delivery system, which today is VERY ineffective. Here's how:

-Make preventive well-visits free (fully insurance paid) annually, allowing for much earlier identification of diseases and conditions such as hypertension, diabetes, and yes, cancer, which in early stages typically do not have many symptoms. By the time symptoms are noticed, usually damage has already been done. By identifying and treating these conditions earlier, the condition costs much less, and will over all reduce the burden of treatment in the system today.

-Encourage a performance-based fee structure from insurers to providers. I currently live in Rhode Island, and "Patient centered medical homes" are the new buzz word... meaning that most of the resources needed to treat a patient are located within the practice (dietician, physical therapist, nurse case manager) to facilitate better care. When the patient meets better-than-average outcome measures, the practice gets paid more. Also, electronic health records are being installed so that if a patient goes to a different doctor, they can pull up the patient's information, see that they had a CT scan last month that was negative, and NOT order an unnecessary, duplicate test.

-Encourage employers/insurers to utilize value-based benefit designs. Basically these designs encourage proper use of the healthcare system by rewarding plan participants for being proactive in their health such as having an annual physical, taking a health risk assessment, or speaking to a health coach.

[DoomYoshi]

This thread has some impressive girth. I can't believe I never posted here yet.

[thegreekdog]

The history of health insurance is a fascinating one. Health insurance was not invented until the late 19th century and did not evolve into what we know today until the latter part of the 20th century. In any event, health insurance is a concept that begets rising costs. If a company will pay for my medical care, why would my doctor not charge as much as he/she could possibly get paid? And if the government is backing the health insurance, would not costs skyrocket?

That's the theory, but the exact opposite is happening, TGD.

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

And your response is going to be "so what, more people are insured." And my response to you is "who cares if people are getting shitty care and it's costing more and more money."

As for the US healthcare industry being "more" free market than other countries' systems and performing worse, my only response is that being less free market than France or the Netherlands does not make it free market. It's like saying Greece is less financially stable than Portugal. Health insurance is highly regulated, true. But that's not where I'm going with this. Where I'm going with this is that there is no incentive for health insurance companies to lower costs because there is no competition. There is no incentive for healthcare providers to lower costs or provide better care because the system, regulated in this fashion by the governments of the vairous states, rewards them for increasing costs. The Affordable Care Act just pours another layer of cement on the problem, making sure that it will be that much harder to provide affordable care to everyone.

One final note - Most people regularly and happily pooh-pooh the concept that anyone can get free medical care. I don't understand the pooh-poohs. From the age of 18 to the age of 25, I did not have health insurance. I regularly received what medical care I desired and for the most part was not charged anything for it. I know there are people that cannot afford health insurance or healthcare, just like I coudn't afford it when I was younger. And I know there are people with preexisting conditions who cannot get health insurance. I have no problem with the government trying to help those people (I would prefer other people help those people without government intervention, which, by the way, already happens at non-profit hospitals). I read the Affordable Care Act and various summaries on the law, and I cannot understand how anyone who can think for themselves thinks this is anything more than a boondoggle for the health insurance industry and something that will, in the long run, greatly hurt healthcare and the fiscal status of the US government to a staggering degree.

And I'm not defending the Affordable Care Act at all, as you may have seen in my previous posts on the subject. Thinking I am has influenced your admittedly well-written post, and I should have been more clear about that.

EDIT: I'll try to salvage it, however, because you put a lot of time into it.

First off, not every country pays its doctors based on # of treatments, nor must it be that way.

http://content.healthaffairs.org/content/22/3/89.full.html
Exhibit 5 of this study counters some of your concerns about state-run healthcare. As I've pointed out above, healthcare spending per capita is much higher here than in other countries. You'd think that we'd be getting at least proportionately more treatments, more examinations and more everything than other countries do as a result, but the fact is utilization rates are similar across the board. The current system is inefficient and I'll display below why a free-market system is also inefficient.

It's often said that the healthcare industry needs more competition, and that removing all restrictions is the way to more competition, which inherently means lower costs apparently (hint: it doesn't).

In fact, however, we can't even assume perfect competition in the healthcare industry (or probably any industry, for that matter). Because companies are not allowed to compete across state lines, market shares for the top health insurance companies are significantly lower than those of other industries (some of the biggest companies like Aetna, UnitedHealth, Humana etc. have around 10 percent market share). But within individual states, we often see one or two companies controlling a 60%+ market share (still relatively low compared to other highly concentrated industries).

With these borders removed, it's quite obvious that these top companies would take larger shares putting the health insurance industry in the state of permanent oligopoly. And oligopoly has proven to be a pretty bad form of competition for consumers (see: cell phone service providers, the media [and not just news, but music, books, nearly everything is in the hands of 7 companies], one can also include the film industry here)

This is going to sound like I'm blowing you off, but I'm really not. If hospitals were run by and hopsital employees and doctors paid by the federal or state governments, it would make more sense to me for statists, socialists, and others, to support such a program. I would probably support such a program, given that it is probably easier to go that way than to the free market way (Ron Paul will strike me down for that). However, the Affordable Care Act is not such a program and makes, what I think is a bad situation, much worse.

In other words, while I will argue that free market is better than socialized medicine, I will not argue that socialized medicine is not better than the status quo. At least not in this thread and probably not in others.

[thegreekdog]

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

The law does much more than create more "freeloaders". It also tries to change the healthcare delivery system, which today is VERY ineffective. Here's how:

-Make preventive well-visits free (fully insurance paid) annually, allowing for much earlier identification of diseases and conditions such as hypertension, diabetes, and yes, cancer, which in early stages typically do not have many symptoms. By the time symptoms are noticed, usually damage has already been done. By identifying and treating these conditions earlier, the condition costs much less, and will over all reduce the burden of treatment in the system today.

-Encourage a performance-based fee structure from insurers to providers. I currently live in Rhode Island, and "Patient centered medical homes" are the new buzz word... meaning that most of the resources needed to treat a patient are located within the practice (dietician, physical therapist, nurse case manager) to facilitate better care. When the patient meets better-than-average outcome measures, the practice gets paid more. Also, electronic health records are being installed so that if a patient goes to a different doctor, they can pull up the patient's information, see that they had a CT scan last month that was negative, and NOT order an unnecessary, duplicate test.

-Encourage employers/insurers to utilize value-based benefit designs. Basically these designs encourage proper use of the healthcare system by rewarding plan participants for being proactive in their health such as having an annual physical, taking a health risk assessment, or speaking to a health coach.

I need more details (e.g. links). I've read the law at least twice, and I don't remember seeing anything like this in it.

[jj3044]

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

The law does much more than create more "freeloaders". It also tries to change the healthcare delivery system, which today is VERY ineffective. Here's how:

-Make preventive well-visits free (fully insurance paid) annually, allowing for much earlier identification of diseases and conditions such as hypertension, diabetes, and yes, cancer, which in early stages typically do not have many symptoms. By the time symptoms are noticed, usually damage has already been done. By identifying and treating these conditions earlier, the condition costs much less, and will over all reduce the burden of treatment in the system today.

-Encourage a performance-based fee structure from insurers to providers. I currently live in Rhode Island, and "Patient centered medical homes" are the new buzz word... meaning that most of the resources needed to treat a patient are located within the practice (dietician, physical therapist, nurse case manager) to facilitate better care. When the patient meets better-than-average outcome measures, the practice gets paid more. Also, electronic health records are being installed so that if a patient goes to a different doctor, they can pull up the patient's information, see that they had a CT scan last month that was negative, and NOT order an unnecessary, duplicate test.

-Encourage employers/insurers to utilize value-based benefit designs. Basically these designs encourage proper use of the healthcare system by rewarding plan participants for being proactive in their health such as having an annual physical, taking a health risk assessment, or speaking to a health coach.

I need more details (e.g. links). I've read the law at least twice, and I don't remember seeing anything like this in it.

I am assuming you just mean the second and third point, as the free well-visits has been highly publicized, and I'm sure it was communicated to you when your plan renewed (assuming you are in the USA).

For the other two points, I doubt I'll have time to actually go through to find the sections (although, I may in the next few days... let's see how Thanksgiving goes and how many tasks my wife gives me ). For the third point, I am specifically referencing the grants for businesses to start a wellness program, and the law allowing employers/insurers to now use up to 30% of the premium as a wellness incentive (i.e. the aforementioned well visits, coaching programs, etc).

[Lootifer]

Question: what does frer market healthcare look like? (High level question)

[Symmetry]

Question: what does frer market healthcare look like? (High level question)

Tough one for free marketeers, fantasists that they are. Look for the phrase "crony capitalism" in responses. It's kind of a get out clause for them when their ideas screw up against reality.

[Lootifer]

Shoosh. Push ur rhetoric elseware Scot... I mean sym

[Symmetry]

Shoosh. Push ur rhetoric elseware Scot... I mean sym

The Symmetry commune apologizes, by order of our governing wing.

[aad0906]

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

Healthcare costs increased also DUE to technological advance. 200 years ago, if you had cancer, you'd never find out and simply die. No cost. 30 years ago if you had cancer, they put you and a machine that radiates a very large part of your body and your survival chances increased tremendously, but it did cost a lot of money and the therapy also damaged healthy tissue. Of course you would now get older and... the older we get the more healthcare we need (simple math plus older people generally need more healthcare than younger people). Nowadays we have machines that can treat tumors with pinpoint precision. Higher chances of survival and less damage to healthy tissue but... exponentially more expensive as these high precision machines can cost in excess of $1 million each. The mere fact that we can now discover more and more diseases/ailments and also treat them lease to higher healthcare cost.

[Symmetry]

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

Healthcare costs increased also DUE to technological advance. 200 years ago, if you had cancer, you'd never find out and simply die. No cost. 30 years ago if you had cancer, they put you and a machine that radiates a very large part of your body and your survival chances increased tremendously, but it did cost a lot of money and the therapy also damaged healthy tissue. Of course you would now get older and... the older we get the more healthcare we need (simple math plus older people generally need more healthcare than younger people). Nowadays we have machines that can treat tumors with pinpoint precision. Higher chances of survival and less damage to healthy tissue but... exponentially more expensive as these high precision machines can cost in excess of $1 million each. The mere fact that we can now discover more and more diseases/ailments and also treat them lease to higher healthcare cost.

Early diagnosis is pretty key here too, and that does require regular visits to a doctor, or at least not putting off a problem until you need to visit a hospital emergency room.

Catching stuff early, especially when it comes to cancer or heart disease (the biggest killers), reduces cost. A health system that focuses on the most severe cases will always cost more. Early diagnosis is good, but if the financial incentive is to avoid ruinous testing until you need to visit an emergency room, then general healthcare costs will increase.

[Night Strike]

Question: what does frer market healthcare look like? (High level question)

A system where everyone buys the policies and coverages that they need for themselves and their families instead of it being provided through an employer. A system where the government doesn't mandate such mandatory coverage as paying for hair implants or sex-specific coverage when the buyer is of the opposite sex.

[Symmetry]

Question: what does frer market healthcare look like? (High level question)

A system where everyone buys the policies and coverages that they need for themselves and their families instead of it being provided through an employer. A system where the government doesn't mandate such mandatory coverage as paying for hair implants or sex-specific coverage when the buyer is of the opposite sex.

Dude, chicks are kinda different from dudes, medically and such. You don't need to worry yourself. Or at least, not so fervently.

Of course, I'm not implying that you have a deep degree of interest in Gay sex, perhaps even prurient, that you find difficult to acknowledge, I just wanted to point that out in legalese, as, of course, neither of us are talking about how ridiculous your fear of gay people might possibly be relevant.

[Lootifer]

Question: what does frer market healthcare look like? (High level question)

A system where everyone buys the policies and coverages that they need for themselves and their families instead of it being provided through an employer. A system where the government doesn't mandate such mandatory coverage as paying for hair implants or sex-specific coverage when the buyer is of the opposite sex.

So the insurance model is the free market model? Interesting. Because the insurance model still places distorted incentives on the providers.