ObamaCare - exchanges ,report your states options!

[jj3044]

I wouldn't call the involuntary payment of $600 an "incentive program".

Whether it is a $600 hike in premiums, or a $600 reduction in premiums, it is still an incentive to participate. It is a more heavy handed approach, yes, but spinning it as a penalty often results in higher compliance.

[jj3044]

Because I don't realistically see that the cost of running an office practice declining. I don't think it has to go up either... say more than inflation... what makes you think these services would cost less in the system proposed?

I can think of a few factors that could decrease costs under the system proposed. First, competition between insurance companies should generally drive down the cost of insurance. Second, competition between licensed doctors and licensed "other medical professionals" should generally drive down the cost of healthcare. Third, there is some substantial evidence that the government regulation of insurance and control of government insurance contributes to rising costs. This would be eliminated for the most part.

While I don't disagree that free market systems usually do bring costs down, I'm not as sure as you are that it would help in the health insurance market. Example 1) Insurer competition. Competition is wonderful, but because they are already limited to spend at least 85% of all premium dollars on paying claims, many insurers are already operating on razor thin margins. That 15% has to include overhead. A common misconception is that the cost of healthcare is rising so fast because of the insurer profits. THis isn't the case. Premiums are rising because we are sicker than before, have to pay for better technology to treat these sicker people, etc. 2) Providers. If they all significantly reduced what they were charging, people wouldn't be able to afford to become a doctor, because what you would get paid would be dwarfed by the hundreds of thousands of dollars of student loan debt. Our national shortage of practitioners would get worse.

A mixture of these professionals, and for the low hanging fruit (such as administering shots), I agree that a doctor doesn't have the be the one to do it. In fact a lot of the "retail clinic" models popping up (like MinuteClinic for example) work with nurse practitioners. They can handle a lot of the lower hanging fruit and refer the more serious/complicated cases to a doctor. I think this is a great model of care where you are seeing the appropriate person with the appropriate level of skill. That still doesn't mean that I want a nurse or a pharmacist deciding one day that they are going to pick up a knife and operate on me just because they can...

My children have seen nurse practitioners and my insurance company gets charged around the same amount (and my healthcare costs and health insurance costs don't decrease), despite that they have seen doctors. I'm certainly not suggesting you see a nurse practitioner or pharmacist to get your brain surgery, but for preventative care or for routine checkups or even for fixing broken bones, why would you pay for a doctor when you can pay less money for someone equally effective?

I agree with this point, as stated above. As long as the practitioner is qualified and licensed to treat your specific ailment, I am all for them going to a retail clinic that is typically much less expensive.

Because it would be a disincentive to get your preventive tests done, especially in the younger population, and the low-income population (and hell, most middle class that are still living paycheck-to-paycheck). The health disparity among the low income population compared to higher income is already ridiculous...we are trying to bridge that gap, not make it wider. What IS working is incenting people to do things like get their preventive screenings (like the CVS program that is getting a lot of press). In these companies, they have a significantly higher rate of preventive screenings, and generally, lower total healthcare expenditures because of it.

I don't think I understand your point. Let me try to sum up my understanding:

- Right now people are not likely to engage in preventative medicine.
- Right now people pay for health insurance.

- Under a "free market system" people are not likely to engage in preventative medicine.
- Because under a "free market system" people would have to pay for preventative medicine.

I guess I still don't understand what you're asserting.

In any event, CVS screenings and the like can still be done under a free market system, I'm not sure why companies would stop incentivizing employees.

I hesitate to say "right now" on your two points above, because more and more employers are moving towards, or have moved to, an incentive based benefit. I just don't see any difference in people getting screenings under the "old" model and what has been proposed, because there still isn't an incentive to do so.

"Right now" companies are where CVS is, in building these programs to encourage these screening programs, saving costs in the long run.

In the proposed system where you had to pay out of pocket for preventive screenings, an employer based incentive program could nullify that, but it would basically just make the care free again. There still wouldn't be any financial incentive to get the screenings.

There are a lot of extrinsic motivators out there... people that need a gentle push, or a kick in the pants (wallet) in order to break through the barriers.

I'm pretty tired, so I hope that all made sense. If not, I can try again tomorrow!

[PLAYER57832]

Licensing is allowable on a free market. There would be more than one license agency per state, so it would be much more competitive, thus more open to customer preferences, innovation, higher quality, lower prices, etc.

See, this I wouldn't have an issue with, but TGD made it sound that he wanted to go to some schmuck with a camera and butterknife to do a knee replacement...
Are there any examples of how the licensing process today inhibits these things?

Actually, yes.... and we have posted them previously, but we have to be very careful.
As you say, medicine is one of those things where people do not always want the cheapest option. Quality really does matter. However, there is a lot of push about whehter, say PA's (Physician assistants) and Nurse practitioners should do more or are doing too much of basic exams. Midwivery is another area where this happens. In the case of midwives they have a very different approach, so its not just a matter of not having the same skills, its also a different way of doing things. Many modern hospitals are embracing midwives, trying to form relationships so that moms can use a midwive, but still have the full medical staff if something goes wrong. (just as an example).
So, there are cases where things can be simplified and costs reduced.
HOWEVER, there are 2 other issues. Medicine, ironically enough, is one of those things that responds negatively to competition. I posted a couple of articles on this before, specifically a stuffy of back care in Texas, but could not find that link again. Here is a journal article on the topic. Its orientation is how to prevent this from happening.
http://www.ncbi.nlm.nih.gov/pubmed/9952205

Abstract
The United States has experienced dramatic growth in both the technical capabilities and share of resources devoted to medical care. While the benefits of more medical care are widely recognized, the possibility that harm may result from growth has received little attention. Because harm from more medical care is unexpected, findings of harm are discounted or ignored. We suggest that such findings may indicate a more general problem and deserve serious consideration. First, we delineate 2 levels of decision making where more medical care may be introduced: (1) decisions about whether or not to use a discrete diagnostic or therapeutic intervention and (2) decisions about whether to add system capacity, eg, the decision to purchase another scanner or employ another physician. Second, we explore how more medical care at either level may lead to harm. More diagnosis creates the potential for labeling and detection of pseudodisease--disease that would never become apparent to patients during their lifetime without testing. More treatment may lead to tampering, interventions to correct random rather than systematic variation, and lower treatment thresholds, where the risks outweigh the potential benefits. Because there are more diagnoses to treat and more treatments to provide, physicians may be more likely to make mistakes and to be distracted from the issues of greatest concern to their patients. Finally, we turn to the fundamental challenge--reducing the risk of harm from more medical care. We identify 4 ways in which inadequate information and improper reasoning may allow harmful practices to be adopted-a constrained model of disease, excessive extrapolation, a missing level of analysis, and the assumption that more is better.

I won’t reiterate the abstract, it explains the points well.
The other issue you eluded to above and is very controversial. In most hospitals you have maybe 1-2 RNs who will supervise several Nursing Assistants. The nurse, either RN or LPN have degrees. The practitioners have certificates. They do a lot of the day-to day, labor-intensive care, such as bathing and feeding, moving patients, etc. Depending on the location and training they may do other things. The tendency of administrators is to cut back on Nurses and use more aids. On the one had, it makes sense to not have an RN or LPN just bathing a patient, but it also means that the nurses and doctors don’t see the patients as much as they used to… that means they are more likely to miss things, particularly in elderly patients, some other situations where things can change very rapidly. Further, the aids are often way overworked. One aid having to take care of 15 patients is not uncommon. Just think about trying to hand feed 6-7, never mind 10-12 patients in an hour and a half! Regulations mandating patient coverage ratios are being suggested and, I would say, are warranted, but they mean higher costs.
One factor making hospital costs particularly hard to manage are widely varying patient counts. Most hospitals have part-time people who work more when required and less when not required. That works, to a point, for them, but wreaks havoc on families. It is hard enough to get childcare on a nursing schedule (our area, for example, has no certified night care and very, very limited care after ), but when you don’t know when or if you will work from one day to the next, it can be impossible. Basically, you need to have a family member or friend willing to take your child or you are out of luck. The local hospitals and care homes each are understaffed, but they just laid off 3 Nurse Aids because they kept calling off, mostly for childcare issues. This is less of a problem in the bigger cities, but it is still a problem there.

[thegreekdog]

While I don't disagree that free market systems usually do bring costs down, I'm not as sure as you are that it would help in the health insurance market. Example 1) Insurer competition. Competition is wonderful, but because they are already limited to spend at least 85% of all premium dollars on paying claims, many insurers are already operating on razor thin margins. That 15% has to include overhead. A common misconception is that the cost of healthcare is rising so fast because of the insurer profits. THis isn't the case. Premiums are rising because we are sicker than before, have to pay for better technology to treat these sicker people, etc. 2) Providers. If they all significantly reduced what they were charging, people wouldn't be able to afford to become a doctor, because what you would get paid would be dwarfed by the hundreds of thousands of dollars of student loan debt. Our national shortage of practitioners would get worse.

Again, the question is not necessarily whether a free market health insurance system would bring costs down. The question is whether it would make costs lower than the current system (i.e. the Affordable Care Act system). There has been and will continue to be a discussion on what effect the Affordable Care Act will have on, well, no pun intended, but affordable insurance. There are some (and an increasing number) who predict that healthcare costs will rise dramatically. There are others who still believe healthcare costs will decrease.

I'm also not sure I agree with your conclusion that insurance companies operate on razor thin margins, although I'm not going to vehemently push it because you are more of an expert here than me.

As for providers, again, we're talking about licensing and the like. So there wouldn't have to be many providers. Furthermore, I'm not sure I agree with your presumption that people wouldn't be able to afford to become a doctor.

I hesitate to say "right now" on your two points above, because more and more employers are moving towards, or have moved to, an incentive based benefit. I just don't see any difference in people getting screenings under the "old" model and what has been proposed, because there still isn't an incentive to do so.

"Right now" companies are where CVS is, in building these programs to encourage these screening programs, saving costs in the long run.

In the proposed system where you had to pay out of pocket for preventive screenings, an employer based incentive program could nullify that, but it would basically just make the care free again. There still wouldn't be any financial incentive to get the screenings.

There are a lot of extrinsic motivators out there... people that need a gentle push, or a kick in the pants (wallet) in order to break through the barriers.

I'm pretty tired, so I hope that all made sense. If not, I can try again tomorrow!

Assuming under a free market system the employer still provides for a portion of health insurance, the employer would still be incentivized to provide an incentive for you to get preventative screenings. That's what my point is.

For example, a few years ago my firm started to pay for us to get physicals (on an interim depending upon our age). They did this to save health insurance costs. I'm not sure I understand why they would stop doing this under a free market system where insurance didn't pay for preventative screenings or physicals. Insurance would still pay for heart surgery, so my firm would still have incentive to get us free physicals.

[thegreekdog]

http://blogs.wsj.com/washwire/2013/03/2 ... _uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.

The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.

Higher insurance premiums AND more taxes? Where do I sign up?

[PLAYER57832]

http://blogs.wsj.com/washwire/2013/03/26/sebelius-some-could-see-insurance-premiums-rise/?mod=rss_mobile_uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.

The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.

Higher insurance premiums AND more taxes? Where do I sign up?

What you are missing is that the bill is moving a lot of very sick people BACK onto insurance instead of government programs. Neither I nor my husband are terribly sick, but we do have a couple of pre-existing conditions. (mine are minor, by husbands more serious orthopedic stuff). As a result, we could ONLY get government insurance up until the Affordable care act. Similarly, we wound up enrolling my kids in Medicaid becuase insurance companies would not cover them after we had a 30 day break in coverage.

Now, because of the affordable care act, we are all on the regular employer plan. The kids still get back-up coverage still from Medicaid, but that just picks up some of what the regular policy doesn’t cover.

This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)

To counter this is the fact that more people are covered than before in the system as a whole, a lot of whom have “built up” needs because they have not seen doctors for such a long time.

However, the biggest reason why savings might not be realized has nothing at all to do with the bill itself. It is because so very many people are moving into the disability program. Disability has become the default for people, particularly those over 50, who get laid off and who don’t have ready skills to move into the jobs available today. Along with that disability, of course, comes government insurance coverage.

[Night Strike]

This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)

So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

However, the biggest reason why savings might not be realized has nothing at all to do with the bill itself. It is because so very many people are moving into the disability program. Disability has become the default for people, particularly those over 50, who get laid off and who don’t have ready skills to move into the jobs available today. Along with that disability, of course, comes government insurance coverage.

Precisely the problem with the disability system: once people exhaust their unemployment income (that lasts way too long anyway), they just make up an ailment to get put on disability and no longer have to work. Yet the government refuses to cut out such fraud and abuse and actually require able-bodied people to work.

[PLAYER57832]

This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)

So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

Your comment makes no sense.

Some people (not all) are paying more in insurance, but taxes will go down – or at least more will go to things other than healthcare.

However, the biggest reason why savings might not be realized has nothing at all to do with the bill itself. It is because so very many people are moving into the disability program. Disability has become the default for people, particularly those over 50, who get laid off and who don’t have ready skills to move into the jobs available today. Along with that disability, of course, comes government insurance coverage.

Precisely the problem with the disability system: once people exhaust their unemployment income (that lasts way too long anyway), they just make up an ailment to get put on disability and no longer have to work. Yet the government refuses to cut out such fraud and abuse and actually require able-bodied people to work.

Your statement mixes truth and fiction. The real problem is that we don’t have a good way to deal with older Americans who can no longer do the well paid, but menial labor type jobs they had in factories. AND that the disability system was just rolled into the Social Security system without any real added input.

The reason “the government” refuses to cut it is because a lot of those people actually vote (as opposed to younger Americans) and politicians find it convenient to complain about the abuse, but not really cost-effective politically to make cuts.

You keep wanting to pretend that there is some kind of unified “government mind”. It makes most of your arguments ridiculous. Agencies and branches of the government all work against each other as much or more than with each other.

At any rate, that is outside of the Affordable Care Act.

[Night Strike]

This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)

So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

Your comment makes no sense.

Some people (not all) are paying more in insurance, but taxes will go down – or at least more will go to things other than healthcare.

You would think that if not all people were paying more in insurance, the liberal media would be eagerly searching out those people and doing stories on them in order to push the narrative that the law is good. We know they've done stories on people now getting insurance who couldn't previously, so stories on people paying less for insurance should be prime news if they exist. However, we continue to see story after story about people and businesses having to pay more and more for their insurance, so it appears that health insurance is not actually becoming "affordable" to the citizens as we were promised. And the mandate to purchase government approved plans hasn't even started yet.

And where will taxes go down? We've already highlighted the dozens of new taxes and thousands of new regulations that directly drive up taxes and costs.

[BigBallinStalin]

JJ, when you examine a particular market to do, you need to ask, "how does government constrain their options?" The reason people use the free market concept is to understand the fundamentals of market activities. Once that's clear, then you can compare it with mixed economies (e.g. the US).

[Metsfanmax]

http://blogs.wsj.com/washwire/2013/03/26/sebelius-some-could-see-insurance-premiums-rise/?mod=rss_mobile_uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.

The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.

Higher insurance premiums AND more taxes? Where do I sign up?

Down the road, at the Department of Being a Decent Person and Helping Out Those Less Fortunate Than You.

[BigBallinStalin]

http://blogs.wsj.com/washwire/2013/03/26/sebelius-some-could-see-insurance-premiums-rise/?mod=rss_mobile_uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.

The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.

Higher insurance premiums AND more taxes? Where do I sign up?

Down the road, at the Department of Being a Decent Person and Helping Out Those Less Fortunate Than You.

So, if insurance rates increase on average and/or the quality decreases due to Obamacare, what would your position be?

Something like: "well, be a 'nice' person by paying your taxes which allegedly 'helps' the less fortunate'" ??

[thegreekdog]

http://blogs.wsj.com/washwire/2013/03/26/sebelius-some-could-see-insurance-premiums-rise/?mod=rss_mobile_uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.

The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.

Higher insurance premiums AND more taxes? Where do I sign up?

Down the road, at the Department of Being a Decent Person and Helping Out Those Less Fortunate Than You.

Oh, you got me there. I'm such a horrible person...

[Night Strike]

Down the road, at the Department of Being a Decent Person and Helping Out Those Less Fortunate Than You.

So the only way to be and do those things is to turn over your individual freedom to the government? There are no options to do those things outside of the government?

[thegreekdog]

NS, BBS, seriously... Mets got us but good. We've never heard such an argument. We should just give up now.

[Metsfanmax]

NS, BBS, seriously... Mets got us but good. We've never heard such an argument. We should just give up now.

Ask a snarky question, get a snarky answer.

Regarding NS' question: I don't know if it can be done by institutions other than the government. I only know that it wasn't being done.

[PLAYER57832]

This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)

So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

Your comment makes no sense.

Some people (not all) are paying more in insurance, but taxes will go down – or at least more will go to things other than healthcare.

You would think that if not all people were paying more in insurance, the liberal media would be eagerly searching out those people and doing stories on them in order to push the narrative that the law is good.

Give it a rest already. the savings were NEVER projected to be immediate. Your arguments are like a child pouting because summer is not here.

[PLAYER57832]

Down the road, at the Department of Being a Decent Person and Helping Out Those Less Fortunate Than You.

So the only way to be and do those things is to turn over your individual freedom to the government? There are no options to do those things outside of the government?

Healthcare is too massive and no, no place on Earth has accomplished what you claim... definitely not here.

[thegreekdog]

Your arguments are like a child pouting because summer is not here.

Oh, the irony.

[PLAYER57832]

Your arguments are like a child pouting because summer is not here.

Oh, the irony.

Nice try, but no.

[thegreekdog]

During the legislative debate over the law, Democrats promised Obamacare would create jobs, lower health-care costs, and allow people to keep their current plans if they chose to. Those vows, Republicans argue, are already being broken.

The Congressional Budget Office, the Hill's nonpartisan scorekeeper, estimated that the health care law would reduce employment by about 800,000 workers and result in about 7 million people losing their employer-sponsored health care over a decade. The CBO also estimated that Obamacare during that period would raise health care spending by roughly $580 billion.

http://www.theatlantic.com/politics/arc ... re/274441/

[BigBallinStalin]

NS, BBS, seriously... Mets got us but good. We've never heard such an argument. We should just give up now.

Ask a snarky question, get a snarky answer.

Regarding NS' question: I don't know if it can be done by institutions other than the government. I only know that it wasn't being done.

Depending on what "it" will mean to you later ITT, "it" was being done by mutual aid societies, charitable organizations, religious organizations, and private insurance companies since the 1800s and likely before that.

Since the 1910s and especially the 1930s, the government provision of welfare and government-sanctioned monopolization of medical licenses have crowded out these local forms of community and for caring about each other and have curtailed competition, thereby slowing innovation and increasing costs. You'll only get more of that with your Obamacare and national regulatory agencies, but don't let that get you down! Just keep 'knowing' that nothing else but Big Government will do.

[Metsfanmax]

NS, BBS, seriously... Mets got us but good. We've never heard such an argument. We should just give up now.

Ask a snarky question, get a snarky answer.

Regarding NS' question: I don't know if it can be done by institutions other than the government. I only know that it wasn't being done.

Depending on what "it" will mean to you later ITT, "it" was being done by mutual aid societies, charitable organizations, religious organizations, and private insurance companies since the 1800s and likely before that.

Since the 1910s and especially the 1930s, the government provision of welfare and government-sanctioned monopolization of medical licenses have crowded out these local forms of community and for caring about each other and have curtailed competition, thereby slowing innovation and increasing costs. You'll only get more of that with your Obamacare and national regulatory agencies, but don't let that get you down! Just keep 'knowing' that nothing else but Big Government will do.

I feel that we are ethically obligated to help those who are less fortunate, and so I am not going to argue with any government policy that does just that on a large scale. It may result in increased prices for me, but you can't often get something for nothing.

[BigBallinStalin]

NS, BBS, seriously... Mets got us but good. We've never heard such an argument. We should just give up now.

Ask a snarky question, get a snarky answer.

Regarding NS' question: I don't know if it can be done by institutions other than the government. I only know that it wasn't being done.

Depending on what "it" will mean to you later ITT, "it" was being done by mutual aid societies, charitable organizations, religious organizations, and private insurance companies since the 1800s and likely before that.

Since the 1910s and especially the 1930s, the government provision of welfare and government-sanctioned monopolization of medical licenses have crowded out these local forms of community and for caring about each other and have curtailed competition, thereby slowing innovation and increasing costs. You'll only get more of that with your Obamacare and national regulatory agencies, but don't let that get you down! Just keep 'knowing' that nothing else but Big Government will do.

I feel that we are ethically obligated to help those who are less fortunate, and so I am not going to argue with any government policy that does just that on a large scale. It may result in increased prices for me, but you can't often get something for nothing.

That belief is great yet does not exclusively support government provision of welfare.

So what else lurks behind your reasoning which shifts you to government provision?

[Metsfanmax]

NS, BBS, seriously... Mets got us but good. We've never heard such an argument. We should just give up now.

Ask a snarky question, get a snarky answer.

Regarding NS' question: I don't know if it can be done by institutions other than the government. I only know that it wasn't being done.

Depending on what "it" will mean to you later ITT, "it" was being done by mutual aid societies, charitable organizations, religious organizations, and private insurance companies since the 1800s and likely before that.

Since the 1910s and especially the 1930s, the government provision of welfare and government-sanctioned monopolization of medical licenses have crowded out these local forms of community and for caring about each other and have curtailed competition, thereby slowing innovation and increasing costs. You'll only get more of that with your Obamacare and national regulatory agencies, but don't let that get you down! Just keep 'knowing' that nothing else but Big Government will do.

I feel that we are ethically obligated to help those who are less fortunate, and so I am not going to argue with any government policy that does just that on a large scale. It may result in increased prices for me, but you can't often get something for nothing.

That belief is great yet does not exclusively support government provision of welfare.

So what else lurks behind your reasoning which shifts you to government provision?

I don't exclusively support government provision of welfare. I donate my own money to charity as well, and I hope other people would not rely solely on government for this. But ultimately what shifts me to government provision is the nudging effect it has; most people do actually want to help out those less fortunate than them, but don't do it, perhaps because of forgetfulness or other factors. Having the government collect mandatory taxation for this purpose can often be a way to get people to do what they want to do anyway. To that end, I would prefer a solution that respected freedom of choice. One solution would be an opt-out scheme where taxes are automatically withheld at the higher rate necessary to collect money for the welfare provision, but where people could voluntarily choose not to pay the higher tax rate, say by some easily accessible internet form.