ObamaCare - exchanges ,report your states options!

[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.

[DoomYoshi]

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.

Night strike is high as a kite.

A free market model would have no insurance at all. Health insurance would be illegal. Right now if you have an insurance plan and you go to the doctors, the doctor determines that the insurance company can afford to pay $800 per visit, and charge that. Because the consumer has no idea of the costs, they can't ever make a rational choice about cost and benefit. If the consumer had to pay that $800 per visit directly, they would look for a cheaper doctor and the cost would enter a free market bidding war.

Until, of course, some doctors banded together and started price fixing.

[Night Strike]

A free market model would have no insurance at all. Health insurance would be illegal. Right now if you have an insurance plan and you go to the doctors, the doctor determines that the insurance company can afford to pay $800 per visit, and charge that. Because the consumer has no idea of the costs, they can't ever make a rational choice about cost and benefit. If the consumer had to pay that $800 per visit directly, they would look for a cheaper doctor and the cost would enter a free market bidding war.

Until, of course, some doctors banded together and started price fixing.

That's true. I just pointing out an area where free market principles would be better than the current system without completely removing the current mechanisms.

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.

Your point? Of course people of different sexes are different, yet insurance policies aren't written to take that into account. Under group insurance plans, people have to pay for treatments that would be applicable to only people of the opposite sex (or even to people who want to change their sex). If a person is never going to use such options, why are they paying for them?

[Night Strike]

Don't worry, the REALITIES of Obamacare keep showing up as complete opposites of what the government promised when they passed it. Today we mention the lie of "getting to keep your doctor if you want" while also sprinkling in a prime example of how more governmental regulations put small, local businesses (that liberals are supposed to love) out of business while benefiting the big corporations (that liberals love to hate in their rhetoric) that can eat the costs of regulations and survive while competition closes.

SPRINGFIELD, Mo.-- A longtime Springfield doctor in private practice says he can't afford to keep his doors open. Dr. Shelby Deckard says government regulations are leading to the end of his 37-year practice.

Deckard and his employees say every day is a sad one, as they prepare to say farewell to their patients and friends.

Spending time with patients is one of Deckard's priorities.

"He's pretty laid back," said patient Stan Coffman.

It's likely what's kept many coming back.

"I think at least 20 years," Coffman said.

But Deckard believes taking his time has actually gone against what he calls the secret to survival.

"You've got to see twice as many people or you've got to do twice as many things that may be unnecessary," Deckard said.

Deckard took the road less traveled more than 15 years ago, choosing to stay in private practice.

"My partners became employees of the hospital, and I just came in on my own, and was able to get a young partner with me," said Deckard.

Now, Deckard says more fees, lower reimbursements, and time consuming regulations have made having his own office too costly.

"We have the business; that's not the issue. It's just a matter of trying to combat the overhead. This Obama stuff this year has totally destroyed us with all the expenses," Deckard said.

He says he and his partner each made only $2,300 in September, and $3,000 last month.

"My young partner has had to work a second job the last year and a half," Deckard said.

Deckard and Dr. Brian Neely sent a letter out to patients, telling them, "It has become impossible to sustain a viable private practice."

They'll close Dec. 28.

"Oh, I was shocked. I guess it's due to this Obama healthcare deal," says Jean Borgmeyer, a patient of nearly 30 years.

"Unfortunately, it's sad every day, because we get reminded, dealing with the patients," Deckard says.

"Now, I have to find a doctor, and I'll never find another one like him that you can call and get a prescription for cough syrup," says Borgmeyer.

For Dr. Deckard, it's a farewell to longtime friends and the end of a dream.

"I'm done, because I can't do what I want to do, as far as taking care of people," says Deckard.

The White House says the Affordable Care Act, signed in 2010, aims to improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices.

http://www.ky3.com/news/ky3-springfield-mo-doctor-dr-shelby-deckard-private-practice-closing-20121119,0,3622284.story

[AndyDufresne]

Strike's again!


--Andy

[Symmetry]

Stuff that NS may have missed- the doctor is 67 years old, so well past retirement, I doubt that healthcare reform is why he's shutting down.

But then again, we have the patient addicted to prescription strength cough syrup to think about:

"Oh, I was shocked. I guess it's due to this Obama healthcare deal," says Jean Borgmeyer, a patient of nearly 30 years.

"Unfortunately, it's sad every day, because we get reminded, dealing with the patients," Deckard says.

"Now, I have to find a doctor, and I'll never find another one like him that you can call and get a prescription for cough syrup," says Borgmeyer.

Hmm. This sounds a bit dodgy to me.

[Phatscotty]

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

I don't know. Health care, in general, has never experienced the free market, not in my lifetime. My grandpa tells me stories though, about my 5 other aunts and uncles.

They just paid the doctor the money when they needed the doctor.

[Lootifer]

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

I don't know. Health care, in general, has never experienced the free market, not in my lifetime. My grandpa tells me stories though, about my 5 other aunts and uncles.

They just paid the doctor the money when they needed the doctor.

The real cost of healthcare has risen significantly with time, even in a single generation (dont confuse this with the price, price is what the butchered distorted system pops out - the $8000/p.a. or whatever number gets thrown around).

This is because healthcare has become far more complex and requires more raw materials (doctors/nurses work-hours, doctors/nurses training time, more cost-intensive equipment and more cost-intensive medicine). This is ok because the results are far better, we now live longer healthier lives.

In your Grandads time you could just pay the doctor for your annual cold and occasional spained ankle; however if you tore the miniscus in you knee, sorry bucko, you were given a crutch and declared "lame". Now we dont have to put up with that, we can get surgery and fix that up; however the real cost of the fix isnt cheap, and likely to be beyond the means of 90% of the population (the surgery I had at the beginning of the year would have been in the tens of thousands of dollars order of magnitude) - hell likely even more; not many have a spare couple of thousand to spend on a treatment which in the old days we may have just put up with for the rest of our lives.

Thats where the insurance and socialised models have evolved from. Healthcare isnt cheap; however not everyone needs it. Apart from the elderly not everyone will need a horribly expensive major surgery during their normal year to year life. So insurance is just a form of socialisation under the guise of a "free market" tag - as Doom says, the real free market would be user pays.

Now in reality the true free market option would almost be unanimously rejected by the population. Only the true Libatarian stalwarts like BBS would fight for it;

The moderate libatarians would likely offer some kind of coupon type deal (I think Friedmans' education policy is one such example, though cant remember off the top of my head - not sure if it would work in Healthcare - education is cheap in comparison).

[kentington]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

[AndyDufresne]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

Kentington, you could have always gone to a nice low-cost private surgeon.




--Andy

[DoomYoshi]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

The prices are only so high because of market manipulation.

[Metsfanmax]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

Kentington, you could have always gone to a nice low-cost private surgeon.




--Andy

Who wouldn't trust this guy?

[Night Strike]

Stuff that NS may have missed- the doctor is 67 years old, so well past retirement, I doubt that healthcare reform is why he's shutting down.

But then again, we have the patient addicted to prescription strength cough syrup to think about:

"Oh, I was shocked. I guess it's due to this Obama healthcare deal," says Jean Borgmeyer, a patient of nearly 30 years.

"Unfortunately, it's sad every day, because we get reminded, dealing with the patients," Deckard says.

"Now, I have to find a doctor, and I'll never find another one like him that you can call and get a prescription for cough syrup," says Borgmeyer.

Hmm. This sounds a bit dodgy to me.

Stuff that Symmetry did miss - the primary doctor had a younger colleague who probably could have kept on the private practice and continued serving many of the primary doctor's patients after he retired if the massive regulations hadn't been dictated from above.

[Lootifer]

I don't know what system would work. All I know is that if I had to pay for the treatments of the kidney stone out of pocket, then I would have need to just die instead. It wasn't coming out on its own.

The prices are only so high because of market manipulation.

That's on partly true. And a small part at that.

The major reason removing a kidney stone costs a lot is because you need to pay for (numbers are illustrative only), say, 4 hours of two exceptionally trained individuals, 4 hours usage rental of incredibly specialised equipment, a vertible army of support staff and a cache of medical supplies and drugs that would make hunter s proud.

Yes there is some significant distortion going on in all healthcare systems around the world. But that's only a fraction of the end user costs.

[thegreekdog]

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

A free market healthcare system, for me, is one in which health insurance companies exist sort of like tornado insurance companies - get it if you want, but if you don't, you should be able to pay for the storm damage or risk no storm coming.

All kidding aside, I think I would like to see a situation where medical doctors practice without many restrictions imposed by health insurance companies (e.g. if my head hurts and I want to see a headache specialist, I have to go to three different doctors). I would like to see a situation where charitable hospitals are the norm. Basically, I want to go back to the healthcare economic model of the early 20th century. I go to the doctor, I pay him $100 or whatever I feel like paying him, he checks me out, and sends me on my way. Later that day, he goes to Mary Mother of Mercy Hospital (or Beth Israel if that's your thing) and checks out some people who can't afford to pay him $100.

And the reason that details are not available for this kind of plan is that it will never happen. There are too many people invested in our current system: health insurance companies, for-profit hospitals, non-profit hospitals, doctors, nurses, malpractice insurance, attorneys, etc.

[jj3044]

A free market healthcare system, for me, is one in which health insurance companies exist sort of like tornado insurance companies - get it if you want, but if you don't, you should be able to pay for the storm damage or risk no storm coming.

The problem with this is that the Hippocratic Oath that the doctors pledge won't allow them to just walk-on-by someone who needs help. We would end up worse off because no one would pay, because the doctors would treat the patients simply because they have a conscience.