ObamaCare - "Give up your phone to get it!!!"

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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Sun Feb 10, 2013 1:28 pm

PLAYER57832 wrote:This maybe should go in its own thread, but it is on topic.

At its root, there is something fundamentally, not sure if "immoral" is the correct word, but not quite good about a system in which more money is made when people are sicker.

Set aside the rest of the debate and just think about that for a minute. I am not talking about bad people, though of course such will take advantage of any system. (but ANY system... so sort of irrelevant to this part of the debate). I am talking about very good, very well meaning people.

One study we (more than one person, cannot remember the first poster) found earlier showed that orthopedic costs went up and the results went down when more orthopedists were in the same area. Orthopedics is a good example because while its important, its not life-threatening, and an area where there have been a lot of advances. What the study found was that when there are more doctors in an area, they will tend to treat patients sooner than if there were fewer doctors in the area.

Importantly, none of the doctors seemed to be aware they were doing this. It seemed to happen in a few different ways. One is just that doctors would talk to each other and sort of convince each other to do this or that more. When cases were more borderline, the tendency (unconscious tendency) was for the doctor to convince themselves to do the procedure, because unconsciously they knew that if they did not do it, another doctor might.

Anyway, a real fix will mean changing the way that system works.

It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).

This is an excellent point, and strides are currently being made in this area, as well. In some states, patient-centered medical homes are being created by insurers with pay-for-performance (better outcome) contracts. This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.

Although these arrangements are fairly new, outcomes are starting to look good (at least in my state).
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby WILLIAMS5232 on Sun Feb 10, 2013 2:13 pm

jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.


i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Lootifer on Sun Feb 10, 2013 7:25 pm

WILLIAMS5232 wrote:
jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.


i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.

You can do that in a government controlled situation as well though. Doesnt just have to be free market incentives.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Sun Feb 10, 2013 8:32 pm

WILLIAMS5232 wrote:
jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.


i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.

There will always be people that just don't care about their health and eat/drink themselves to death. It is the doctor's job to make sure that the proper treatment is available, and the proper resources are available to the patient however, and that is what improves with this model. Where before a patient was on their own to find a dietician to help them with nutrition for example, now the nutritionist works for the provider and the patient has access to them for a lower/no cost. We are trying to eliminate barriers for patients in this model as well as incent the doctors to follow up better and not waste resources.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Sun Feb 10, 2013 9:21 pm

PLAYER57832 wrote:
thegreekdog wrote:
PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.


That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered.


80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Mon Feb 11, 2013 9:06 am

jj3044 wrote:
thegreekdog wrote:
jj3044 wrote:hopefully it will turnout better than what we had before.


I honestly hope it will too, but I'm inherently skeptical about all things government. In my opinion, the government does things to benefit itself and its consituents (which are not people like you and me).

jj3044 wrote:1) I am getting my information from the attorney at my company. It's always possible that I am misunderstanding (they do seem to speak gibberish sometimes! ), but I know that the group I referenced in my previous post has an exemption that will expire in 2014, and they are going to be sending the part of their population that would be affected to the exchange.


Okay. That's one company I suppose. I'm not sure that removes my concerns, but perhaps you're not debating here.

jj3044 wrote:2)It doesn't worry me because there will be a good many healthy people who will now be paying for coverage (who didn't previous), so the actual costs will be spread out among a larger population.


Those people did pay for coverage in the past, they just didn't pay for their own coverage.

jj3044 wrote:3) The law you mentioned, "And the law gives States new resources to review and block these premium hikes." is what I was talking about before, about how my state has a healthcare commissioner that reviews rate increases, and approves/modifies/denies them based on information that receive.


Right. Again, not sure that removes my concerns, but perhaps you're not debating.

No, I'm not really debating with you, just letting you know what I have observed thus far working in the industry. I have absolutely no idea if it will pan out great, but I do think that the law is misunderstood, which is warranted based on the ambiguity that the law had when it was passed (as been pointed out since a lot of the congressmen who voted for it didn't read it). I agree that point is messed up, but once the provisions have been explained, I am so far not feeling all that bad about it.

The ACA and healthcare aside, I feel as though our society tends to have a self fulfilling prophecy though... if people think something will fail it typically does.


I think most publicly-aired criticism is misplaced (i.e. criticism by conservative pundits and politicians). The supporters of the law and the detractors of the law do not seem to understand what it does or what it is meant to do.

PLAYER57832 wrote:Most particularly, you have pretty much ignored or underplayed the impact of the previous condition exclusions and lifetime limit provisions. Those alone are responsible for placing thousands, if not millions on the government funded roles instead of private insurance.


The only way I will believe that this is effective is if health care costs go down. There is, as of yet, no incentive associated with a decrease in health care costs.

PLAYER57832 wrote:It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).


Dollars are not the primary driver of medical care (or, at least, they are not supposed to be). The primary driver of medical care is to receive treatment such that you do not need to receive additional medical care. This is precisely why market economics should work in medicine. If I go to Doctor Smith and she doesn't solve my problem, I'm not going to go to Doctor Smith anymore. I'll go to Doctor Jones. Ultimatley, Doctors Smith and Jones are interested in treating and solving my problem, whether because they take their roles as doctors seriously or whether they would like to increase the size of their business.

In any event, the ACA will not solve this problem (if it is a problem) either. Keeping a patient on the books for financial reasons (which, honestly, I don't think doctors do for a variety of reasons) is not going to change if the patient now has better health insurance that will pay for more.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Wed Mar 13, 2013 1:01 am

Congress did not read the yellow book before voting on it. Every single business owner will have to pay someone (actually, multiple people) to read every single page of the red tape stack AND interpret it AND enact it within their companies. And exactly 0 of those pages were ever voted on by our elected representatives or signed into law by the president, yet we will all be punished if we don't follow every single clause. Do people really think there is no harm to all these regulations?

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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 7:05 am

Night Strike wrote:
PLAYER57832 wrote:
thegreekdog wrote:
PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.


That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered.


80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

Your facts are incredibly wrong. How on earth do you interprest that the increases will come from government spending? And how do you justify continually ignoring the real cost savings that are projected in the longer term?

OH... I get it, once again you care more about ideology than truth.

Funny what considering profit above everything else does.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Thu Mar 14, 2013 9:01 am

PLAYER57832 wrote:
Night Strike wrote:
PLAYER57832 wrote:
thegreekdog wrote:
PLAYER57832 wrote:Except, the real question is not if the current law is fantastic, it is whether it is better than what we had.

Those are 2 very, very different questions. I would never say that our current law is great. It has, as you noted a lot of problems. However, it is much better than what we had.


That is the question I'm asking and I'm challenging jj3044's response. I don't think it will be better than what we had.

it already is, even if the cost is more overall.. becuase far more people will be covered.


80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

Your facts are incredibly wrong. How on earth do you interprest that the increases will come from government spending? And how do you justify continually ignoring the real cost savings that are projected in the longer term?

OH... I get it, once again you care more about ideology than truth.

Funny what considering profit above everything else does.


In 2000, 13.1% of the population was uninsured (which means 86.9% were insured).
In 2009, 16.3% of the population was uninsured (which means 83.7% were insured).
In 2011, 15.3% of the population was uninsured (which means 84.3% were insured).

http://money.cnn.com/2011/09/13/news/ec ... /index.htm
http://usatoday30.usatoday.com/news/opi ... 57789682/1

The Affordable Care Act insured approximately 3.6 million more people (raising the percentage from 83.7% to 84.3%).

Now, how much does the Affordable Care Act cost? The cost is constantly changing (I read yesterday that the estimated cost went up... I guess by changing I mean it always goes up). The Congressional Budget Office estimated that the ACA will cost more than $1.7 trillion in federal spending from 2012 to 2022; this cost is set to be offset by penalties and taxes, resulting in net spending of $1.2 trillion.

So, Night Strike's statistics are correct. And, once again, you have no statistics Player. So when you say "once again you care more about ideology than truth" are you talking about yourself? The ACA costs an incredible amount of money and insures 3.6 million more people. Either of those numbers could change, but how can you not be worried?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 9:47 am

thegreekdog wrote:
PLAYER57832 wrote:Most particularly, you have pretty much ignored or underplayed the impact of the previous condition exclusions and lifetime limit provisions. Those alone are responsible for placing thousands, if not millions on the government funded roles instead of private insurance.


The only way I will believe that this is effective is if health care costs go down. There is, as of yet, no incentive associated with a decrease in health care costs.
I see, so more people getting care is just of no consequence to you?

thegreekdog wrote:
PLAYER57832 wrote:It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).


Dollars are not the primary driver of medical care (or, at least, they are not supposed to be). The primary driver of medical care is to receive treatment such that you do not need to receive additional medical care. This is precisely why market economics should work in medicine. If I go to Doctor Smith and she doesn't solve my problem, I'm not going to go to Doctor Smith anymore. I'll go to Doctor Jones. Ultimatley, Doctors Smith and Jones are interested in treating and solving my problem, whether because they take their roles as doctors seriously or whether they would like to increase the size of their business.

No, for several reasons.

First, most people just don't have the option to just "choose another doctor", particularly in critical care, which is where the biggest cost issues are. You may not trust the local "hillbilly" doctor, but if your daughter breaks her leg or has an appendicitis attack or even is in a serious accident (heaven forbid of course) you rarely will be able to just choose whatever doctor you want.

The place where you theoretically can “make the choice” is in basic and preventative care. There, however, there are a few interesting twists.

Take one issue.. use of antibiotics. I hope you are aware that antibiotics are vastly over-used and that, as a result, we will be soon facing a world where there are no longer easy treatments for many diseases. (this IS the real situation, by-the-way…excepting only some magical new discovery akin to the transition from sulpha drugs to antibiotics earlier). So, why is this happening? Two fully market-driven reasons. First, antibiotics give animal producers a slight edge. These antibiotics permeate our world and expose more microbes to antibiotics, killing off many and leaving the more resistant ones behind. That this is happening is no longer even questionable, (unless you are expecting money from the meat industry and willing to thus ignore research) \.

Second, direct use.. doctors prescribe antibiotics to people who don’t need them because, as you say, if that doctor doesn’t give off the antibiotic, then some other doctor will… and the patient will likely not return. Many of these doctors know they are doing something incorrect, but feel they have no choice because they want to make a living. They will try to educate, but some people just won’t listen. [A third issue is not market-driven, per se.. its that people just don’t follow the doctor’s instructions to finish all their medication. As a result, instead of killing off “all” of the bacteria in the body, they leave a lot around.. those left naturally are those better able to resist the drug.. they reproduce and voila, we have more resistant bacterial strains flourishing. All three are significant, but you could even take out this last one and the impact would still be significant.]

A related example was given to you earlier.. that of orthopedics, where the more doctors you have in an area, the more surgeries/procedures and the lower the probability of success. I will refer you back to that discussion rather than reiterating it here, but the basic reason is that well meaning doctors find themselves very slightly making judgement calls more to do something than to not do something when other doctors are around. Partly its like above (not always conscious), that if this doctor doesn’t treat the patient, another doctor might. People are funny in that they too often think a doctor that “does something” is somehow “more willing to listen”, etc than one who just saying “go home and take 2 aspirin”. The other factor is that these doctors talk amongst themselves and wind up convincing each other that doing more work is truly necessary. Again, its not overt and intentional, but the impact is quite real… and dangerous.

I can give you example after example, but the bottom line is that medical care is not a traditional market-driven system. Add in that you have to actually know whether the results the doctor are giving you are or are not better…..and you have a real mess. I mean, there is a HUGE difference between a doctor who studies for years, has years of experience and someone making a few quick (or lengthy) internet searches to find the “better” answer. The internet is good at allowing people to find “answers” that are just plain dead wrong. On this level, this goes well beyond freedom of choice, because people tend to be very vulnerable and willing to listen to anyone who offers hope in many medical situations. It is, in fact, where the “optimism bias” comes seriously into play. The more serious the medical issue, the more vulnerable people can be… but the same thing happens for “lighter” issues as well.

The plain truth is that most people just are not equipped to nay say their doctor and to make truly informed decisions. They can decide they like or dislike the manner of the doctor, but when it comes to outcomes, it mostly involves trust… whether the outcome is good OR bad. Even knowing which happened can be a matter of trust (seriously… think about it. Can you “just tell” if your cancer was really cured… or if other problems were caused by the treatment, etc.?




thegreekdog wrote:
In any event, the ACA will not solve this problem (if it is a problem) either. Keeping a patient on the books for financial reasons (which, honestly, I don't think doctors do for a variety of reasons) is not going to change if the patient now has better health insurance that will pay for more.
Lifetime limits? That IS ALREADY law. I am now able to get care, despite a lapse in insurance, because of the law. Before, my only real option was the PA fair pay plan, but only if I were lucky enough to be one of those enrolled… and that program is apparently on the chopping block.


The REAL solution is to have reasonable, science based limits on healthcare, NOT to leave it up to individual choice. People just don’t have enough information to do that. Insurance companies already do this to boost their profits, but any talk of doing that intentionally, in the open, in a government system subject to challenge gets shot down by conservatives shouting things like “death panels”.. Oh yeah, and your church is very much a part of that problem!

PS Or, to be more brief… The problem is that the first doctor might very well have been the better doctor, medically. It could be that your “problem” was not really a problem, that the risks of any potential solution actually outweigh any benefit (this is often the case with back/orthopedic issues, by-the-way) or that the doctor did have a real solution, but just not one you wanted to hear (maybe you need to lose weight instead of having knee surgery

You could argue that this is part of the system, customer care and all that. and yes, there is a push to train those factors more. Except, well, doctors are human. Doctors tend to get trained in medicine. Attorneys are the ones trained to argue convincingly. ;)
Last edited by PLAYER57832 on Thu Mar 14, 2013 9:55 am, edited 1 time in total.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby AndyDufresne on Thu Mar 14, 2013 9:54 am

Night Strike wrote:Congress did not read the yellow book before voting on it. Every single business owner will have to pay someone (actually, multiple people) to read every single page of the red tape stack AND interpret it AND enact it within their companies. And exactly 0 of those pages were ever voted on by our elected representatives or signed into law by the president, yet we will all be punished if we don't follow every single clause. Do people really think there is no harm to all these regulations?

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Source: Senator Mitch McConnell's staff posted by The Heritage Foundation


McConnell probably has voted nay or obstructed enough votes to make a similar stack, haha.




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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 10:02 am

Night Strike wrote:Congress did not read the yellow book before voting on it. Every single business owner will have to pay someone (actually, multiple people) to read every single page of the red tape stack AND interpret it AND enact it within their companies. And exactly 0 of those pages were ever voted on by our elected representatives or signed into law by the president, yet we will all be punished if we don't follow every single clause. Do people really think there is no harm to all these regulations?

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Source: Senator Mitch McConnell's staff posted by The Heritage Foundation

Actually, they will no more have to do that they for any othe rissue.

Your REAL "point" is that anything to do with government is "just bad". We get that.. now move on to specific examples where and exactly how it is bad.

See, most of also know that while not all regulation is good, not all is bad, either. Adding new regulation is not a universal fix, but neither is dismissing all regulation.

If you want to prove a real point, focus on specifics. Instead of "I hate Obamacare becuase it is Obamacare" (which, to be honest is pretty much your main point right now), how about exactly what you don't like, and what you would put in its place.

But oh.. stick to reality, not the fictions you can find so prevlently on the internet (and this thread)
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Thu Mar 14, 2013 10:19 am

PLAYER57832 wrote:I see, so more people getting care is just of no consequence to you?


It is. I just want to do it efficiently rather than inefficiently. If you look at my post from earlier today, you'll see what I mean.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 10:32 am

warmonger1981 wrote:All I can say is once the foot is in the door it isn't long before most aspects of your health will be in review. Some people are naturally big not by there own doings. Is it fair to make them pay more if it is medically not their fault. Its a very slippery slope.

I agree this is an issue, but you do realize this has little to do with Obamacare? Insurance companies are driving this move already.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 11:16 am

WILLIAMS5232 wrote:
jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.


i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.


do you think the adversisers of these products have any culpability?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 11:24 am

jj3044 wrote:
WILLIAMS5232 wrote:
jj3044 wrote:This means that the provider gets x to treat a patient with diabetes. If the doctor does a bad job helping the patient manage the condition, the patient comes back many times utilizing more of the doctor's resources, which he is not getting paid more for. It is in the best interests for the doctor to provide better care and FOLLOW UP with the patient, which has been lacking previous. Then, if the doctor makes a set of benchmarks as far as outcomes, they get paid a bonus.


i have trouble thinking this will do much. my mother has diabetes because she drank about a gallon of coke a day. ( i'm not a doctor, this is my opinion ) so 5 or so years ago she gets diabetes and the doc tells her she needs to really start managing her sugar intake. but she doesn't do it. no matter who all tells her to she still eats honey buns and pancakes with ms. butterworths syrup. she drinks coke with every meal. a few months ago they had to up her medicine because it's getting worse. similarly i have an aunt ( no blood relation to my mother ) that is in very bad shape due to taking the same course as my mother not managing here sugar consumption. i can not in any way see this as the doctors fault. punishing/rewarding the doctor for this will only create less/worse doctors and a lower standard. just like the school system blames teachers for a students inability to learn creates poorer education.

i think the doctors job is to diagnose, treat and give advice. and at some point people are going to have to accept that their choices determine their consequences.

There will always be people that just don't care about their health and eat/drink themselves to death. It is the doctor's job to make sure that the proper treatment is available, and the proper resources are available to the patient however, and that is what improves with this model. Where before a patient was on their own to find a dietician to help them with nutrition for example, now the nutritionist works for the provider and the patient has access to them for a lower/no cost. We are trying to eliminate barriers for patients in this model as well as incent the doctors to follow up better and not waste resources.

There is nothing wrong with using some market principles, as well as rewards for good outcomes, etc.

However, these workable solutions are very specific and look at very particular situations. Even though they use the ideas of competition and gain, its not really the market-driven scenario being touted. In fact, for these things to work we would need massive amounts of data and some definite directed planning. It requires a planned system, not just a free and open market. The really key point is that just providing patients with the information and allowing their payments to decide the outcome is not going to work.

Your mother is not going to freely choose the doctor who will put her on a diet.. chances are she will quickly run to another doctor who will be “more sympathetic”, even if the directions given are really not as medically sound. BUT… understand the other part. There is a game to play here. Your mother is an adult and moreover has grown up in a world where she is allowed her free choice, has been taught that eating what she wants and enjoying it are “rights”. That sense of entitlement comes very much from the market-driven economy.

Funny, isn’t it.. the problem here is a market and yet, the market is supposed to be the ultimate solution?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby BigBallinStalin on Thu Mar 14, 2013 11:31 am

thegreekdog wrote:
In 2000, 13.1% of the population was uninsured (which means 86.9% were insured).
In 2009, 16.3% of the population was uninsured (which means 83.7% were insured).
In 2011, 15.3% of the population was uninsured (which means 84.3% were insured).

http://money.cnn.com/2011/09/13/news/ec ... /index.htm
http://usatoday30.usatoday.com/news/opi ... 57789682/1

The Affordable Care Act insured approximately 3.6 million more people (raising the percentage from 83.7% to 84.3%).

Now, how much does the Affordable Care Act cost? The cost is constantly changing (I read yesterday that the estimated cost went up... I guess by changing I mean it always goes up). The Congressional Budget Office estimated that the ACA will cost more than $1.7 trillion in federal spending from 2012 to 2022; this cost is set to be offset by penalties and taxes, resulting in net spending of $1.2 trillion.

So, Night Strike's statistics are correct. And, once again, you have no statistics Player. So when you say "once again you care more about ideology than truth" are you talking about yourself? The ACA costs an incredible amount of money and insures 3.6 million more people. Either of those numbers could change, but how can you not be worried?


lol, what a boondoggle!

Those Obamacare-fans are a bunch of useful idiots.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Thu Mar 14, 2013 2:45 pm

PLAYER57832 wrote:Second, direct use.. doctors prescribe antibiotics to people who don’t need them because, as you say, if that doctor doesn’t give off the antibiotic, then some other doctor will… and the patient will likely not return. Many of these doctors know they are doing something incorrect, but feel they have no choice because they want to make a living. They will try to educate, but some people just won’t listen.


I hope you realize that's NOT because of market-driven principles. Health care does NOT run on market principles, which is a major culprit of the exploding costs. Insurance was designed to only cover catastrophic problems, not routine procedures. Today, people use them for routine procedures (including medicines), which allows providers to jack up the costs since the people receiving the treatments don't actually pay for them.

PLAYER57832 wrote:See, most of also know that while not all regulation is good, not all is bad, either. Adding new regulation is not a universal fix, but neither is dismissing all regulation.


How many thousands of pages has Obama's administration added to regulations? We can visually see just how many thousands have so far been added for Obamacare. Do you really think that every single one of these are good, muchless necessary? Shouldn't you first have to prove that regulations are necessary, beneficial, and constitutional in order to enact them? Why do the rest of us have to go back and repeal them? Furthermore, why are unelected members of the administration unilaterally writing laws and enforcing them? I thought these tasks were Constitutionally divided between different branches.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 4:13 pm

Night Strike wrote:
PLAYER57832 wrote:Second, direct use.. doctors prescribe antibiotics to people who don’t need them because, as you say, if that doctor doesn’t give off the antibiotic, then some other doctor will… and the patient will likely not return. Many of these doctors know they are doing something incorrect, but feel they have no choice because they want to make a living. They will try to educate, but some people just won’t listen.


I hope you realize that's NOT because of market-driven principles. Health care does NOT run on market principles, which is a major culprit of the exploding costs. Insurance was designed to only cover catastrophic problems, not routine procedures. Today, people use them for routine procedures (including medicines), which allows providers to jack up the costs since the people receiving the treatments don't actually pay for them.
While you certainly have part of this correct, I am amazed that you can get so much flat wrong.

Health care doesn't run on market principles... true. Nor CAN it. The major culprit in exploding costs is twofold.
1. we now GET so much more healthcare than we ever did, "technology" is expensive.
2. People value their health, value their families' health and, when finally convinced they are sick will pay essentially whatever it takes to get well... even when such expectations are not at all reasonable.
There are other complications, but those are the biggest factors.

You also have right that insurance skews the system, but not as you describe. The coverage provided keeps shrinking-- covering less. Why? Because the customer of insurance is almost always the employer. It USED to be that employers offered insurance because it was a better bargain than offering more pay. They got to offer a nice benefit and got a nice tax benefit. Now, they offer it mostly because they have to… either to meet union demands (more and more rare) or to meet legal demands, and will go with the cheapest policy they can legally, with few exceptions.

Similarly, your idea that providers jack up costs for treatments they are not receiving is not some scheme, it is part of how insurance works. Reducing the coverage offered won’t reduce costs. It will just mean that people have to pay more, in many cases, more than they can afford. In fact, much of the savings to be found are in offering more, basic and preventative coverage.. exactly why insurance companies are doing just that, and exactly what the law you so despise is promoting as well. That part will take time, and will be somewhat offset by the fact that technology keeps increasing.

Conrary to what you seem to think, the real truth is that most people have little control over their health. Of course diet and exercise do a lot, but they are not cure-alls. Furthermore, people are notoriously poor planners and deciders. Just look at how many men refuse to even go to a doctor, as an example.. until they get chest pains, and often even then.. it’s the wives who call. In many cases if they had gone earlier, there would be more to be done. Then again, maybe that is what you consider a cost savings.. someone dying? Insurance companies do!

Night Strike wrote:
PLAYER57832 wrote:See, most of also know that while not all regulation is good, not all is bad, either. Adding new regulation is not a universal fix, but neither is dismissing all regulation.


How many thousands of pages has Obama's administration added to regulations? We can visually see just how many thousands have so far been added for Obamacare. Do you really think that every single one of these are good, muchless necessary? Shouldn't you first have to prove that regulations are necessary, beneficial, and constitutional in order to enact them? Why do the rest of us have to go back and repeal them? Furthermore, why are unelected members of the administration unilaterally writing laws and enforcing them? I thought these tasks were Constitutionally divided between different branches.

Oh please, you really don’t understand or care to understand Obamacare or any other law passed by Democrats. You just get on your high horse and declare “against the constitution”. You know what.. you could spend one tenth of that time reading and understanding and maybe come up with something real to complain about. Your rhetoric is just something you have heard on the grapevine.

None of that “unilateral laws”,e tc, etc, mattered to you when it was policies you like. You bring that up when it is something you think you dislike.. and more often than not cannot even come up with TRUE reasons to dislike it. In this case.. its basically “someone told me its socialism and socialism is bad, so I am against it”. Try harder.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 5:37 pm

thegreekdog wrote:
PLAYER57832 wrote:
Night Strike wrote:
80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

Your facts are incredibly wrong. How on earth do you interprest that the increases will come from government spending? And how do you justify continually ignoring the real cost savings that are projected in the longer term?

OH... I get it, once again you care more about ideology than truth.

Funny what considering profit above everything else does.


In 2000, 13.1% of the population was uninsured (which means 86.9% were insured).
In 2009, 16.3% of the population was uninsured (which means 83.7% were insured).
In 2011, 15.3% of the population was uninsured (which means 84.3% were insured).

http://money.cnn.com/2011/09/13/news/ec ... /index.htm
http://usatoday30.usatoday.com/news/opi ... 57789682/1

The Affordable Care Act insured approximately 3.6 million more people (raising the percentage from 83.7% to 84.3%).

Now, how much does the Affordable Care Act cost? The cost is constantly changing (I read yesterday that the estimated cost went up... I guess by changing I mean it always goes up). The Congressional Budget Office estimated that the ACA will cost more than $1.7 trillion in federal spending from 2012 to 2022; this cost is set to be offset by penalties and taxes, resulting in net spending of $1.2 trillion.

So, Night Strike's statistics are correct. And, once again, you have no statistics Player. So when you say "once again you care more about ideology than truth" are you talking about yourself? The ACA costs an incredible amount of money and insures 3.6 million more people. Either of those numbers could change, but how can you not be worried?
You present statistics, but not any that actually challenge what I have said. Just putting out numbers doesn’t make your data superior. Of course the initial costs will be more, and of course the cost estimates are constantly changing, because more and more of the plan are being implemented and also because the healthcare scene itself keeps changing. The savings are not going to come immediately AND may well be offset by increases in technology. But, per Nightstrikes data, 90-95% of people will be covered instead of 84%. I consider that a success.

Oh, and the reason that went down each year you gave is pretty much a “no brainer”, it was due to the recession and many layoffs.

I still have no idea why you think that refutes what I said or why you think it shows that the costs won’t go down in time.. or that this was the primary goal of the plan anyway. Coverage of more people is itself a worthy goal.

I said much earlier in this thread that the real answer was something like we see in various other countries. (France comes to mind). This was a compromise that Republicans almost seemed to agree to just so they could make sure no better plan went through. Its as though they want a bad plan instead of a good one, because their real goal is something other than seeing more Americans receive medical coverage for the lowest cost possible.

That said, it DID do some important things.. it allows people with p re-existing conditions (read just about anyone who has had ANY gap in insurance) to get coverage and it allows for true lifetime coverage for really sick people.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Thu Mar 14, 2013 6:02 pm

PLAYER57832 wrote:
thegreekdog wrote:
PLAYER57832 wrote:
Night Strike wrote:
80-85% of the population was already covered by insurance at an annual cost of about $2.3 trillion (mostly private money). Because of the (Un)Affordable Care Act, approximately 90-95% of the population will have insurance, with all the increases coming from governmental spending. And how does that make the system better AND sustainable?

Your facts are incredibly wrong. How on earth do you interprest that the increases will come from government spending? And how do you justify continually ignoring the real cost savings that are projected in the longer term?

OH... I get it, once again you care more about ideology than truth.

Funny what considering profit above everything else does.


In 2000, 13.1% of the population was uninsured (which means 86.9% were insured).
In 2009, 16.3% of the population was uninsured (which means 83.7% were insured).
In 2011, 15.3% of the population was uninsured (which means 84.3% were insured).

http://money.cnn.com/2011/09/13/news/ec ... /index.htm
http://usatoday30.usatoday.com/news/opi ... 57789682/1

The Affordable Care Act insured approximately 3.6 million more people (raising the percentage from 83.7% to 84.3%).

Now, how much does the Affordable Care Act cost? The cost is constantly changing (I read yesterday that the estimated cost went up... I guess by changing I mean it always goes up). The Congressional Budget Office estimated that the ACA will cost more than $1.7 trillion in federal spending from 2012 to 2022; this cost is set to be offset by penalties and taxes, resulting in net spending of $1.2 trillion.

So, Night Strike's statistics are correct. And, once again, you have no statistics Player. So when you say "once again you care more about ideology than truth" are you talking about yourself? The ACA costs an incredible amount of money and insures 3.6 million more people. Either of those numbers could change, but how can you not be worried?


You present statistics, but not any that actually challenge what I have said. Just putting out numbers doesn’t make your data superior.[/qoute]

The term "superior" implies that you have data. I hate to break it to you Player, but yet agan...

YOU HAVE NO DATA!
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 6:46 pm

I posted my data earlier, several times, from several sources.

But here is yet another:
http://www.healthcare.gov/blog/2013/03/ ... costs.html
The law includes innovative tools to drive down health care costs. It incentivizes efficient care, supports a robust health information technology infrastructure, and fights fraud and waste. After decades of growing faster than the economy, last year, Medicare costs grew by only four-tenths of a percent per person, continuing the trend of historically low Medicare growth seen in 2011 and 2010.

Major progress in Medicare is sparking smarter care in the private market, and it’s working to bring down costs in the private market. Overall health-care costs grew more slowly than the rest of the economy in 2011 for the first time in more than a decade. And just last week, USA Today reported health care providers and analysts found that “cost-saving measures under the health care law appear to be keeping medical prices flat.”

Even though the health care law is working to bring down costs, critics continue to claim the law is too expensive. In reality, the law is fully paid for, and according to the independent Congressional Budget Office, the law reduces the deficit over the long term. The facts show that employers, patients and our federal budget can’t afford to roll back the law now:

•Fully repealing the Affordable Care Act would increase the deficit by $100 billion over ten years and more than a trillion dollars in the next decade. It would also shorten the life of the Medicare Trust Fund by eight years.
•Health care spending grew by 3.9% in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.
•Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.
•The proportion of requests for double-digit premium increases plummeted from 75% in 2010 to 14% so far in 2013.
•Medicaid spending per beneficiary decreased by 1.9% from 2011 to 2012.
•Medicare spending per beneficiary grew by only 0.4% in fiscal year 2012.
•Slower growth is projected to reduce Medicare and Medicaid expenditures by 15% or $200 billion by 2020 compared to what those programs would have spent without this slowdown, according to CBO.
At the same time the law is driving down cost growth, the Affordable Care Act is strengthening coverage and expanding coverage. Thanks to the law, more than 34 million people with Medicare received a no-cost preventive service. And, over six million Medicare beneficiaries received $5.7 billion in prescription drug discounts.

Some have proposed turning Medicare into a voucher program--undercutting the guaranteed benefits that seniors have earned and forcing them to pay thousands more out of their own pockets. If we turn Medicare into a voucher program, our system doesn’t have any incentives to be more efficient and lower costs. Instead, as costs rise, vouchers will leave seniors to pay more and more out of their own pocket.

The health care law is working to lower costs, increase efficiency, and deliver better patient outcomes – without cutting costs at seniors’ expense. In recent years, we have seen dramatic slowing of the growth of federal health care programs. The best approach to reducing our deficit is to continue implementing common-sense reforms. The health care law is putting us on the right path to make Medicare and Medicaid stronger, more efficient and less costly.


or http://www.americanprogress.org/issues/ ... ers-money/

Issues » Health Care
How Health Reform Saves Consumers and Taxpayers Money
The Affordable Care Act Lowers Costs and Improves Quality
June 29, 2010
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Download this memo (pdf)
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Health reform’s three major goals—insurance reform, affordable coverage, and slower cost growth—are all critical. But controlling costs is key to achieving the other two. Insurance that offers meaningful protection and is affordable to most, if not all, Americans, across the income scale, hinges on getting ever-rising health costs under control.
Fortunately, the Patient Protection and Affordable Care Act links the commitment to coverage with a commitment and a strategy to contain health care costs. The Affordable Care Act has multiple provisions to enhance efficiency and eliminate waste, which saves money for patients and taxpayers and improves the quality of the nation’s health care.
According to the Congressional Budget Office, the Affordable Care Act is fully funded, strengthens the Medicare trust fund, and reduces the federal deficit.
 Spending reductions and new revenues under the Affordable CareAct will fully pay for new benefits to help families afford coverage, and the CBO estimates they will reduce the deficit by $143 billion from 2010-2019 and by between 0.25 percent and 0.5 percent of GDP (about $1.2 trillion) from 2020-2029 (see Figure 1).
 Eliminating excessive payments to private insurers (Medicare Advantage plans) and adjusting prices and other measures to assure efficiency improvements in hospitals, nursing homes, and home health providers save about $400 billion over 10 years.
 CBO estimates that Medicare savings reduce the program’s annual growth rate from 6.8 percent to 5.5 percent—adding 12 years of life to the Medicare trust fund (see Figure 2).
Effective implementation of the Affordable Care Act will reduce administrative costs for small businesses and individuals.
 Thirteen percent of insurance premiums currently go to administrative costs, and people buying on their own in the individual insurance market may pay 30 percent of their premiums to these costs. The Affordable Care Act sets a 20 percent limit on these costs for small firms and individuals.
 The new marketplaces or exchanges for small businesses will lower administrative costs even more. Exchanges streamline marketing and enrollment, and monitor insurer practices to give small businesses and individuals the same administrative efficiencies that only big businesses get today. That lowers administrative costs to 10 percent.
 These efficiencies are estimated to save consumers $211 billion over six years following the introduction of exchanges in 2014 (see Figure 3).
The Affordable Care Act modernizes our health care payment and delivery system (see Appendix).
 Health industry leaders and experts across the political spectrum are in agreement: improving health care quality and lowering costs requires bringing health care into the information age, reforming health insurance markets, learning what works, and rewarding health care providers accordingly. Modernizing the payment and delivery system means moving payments away from fee-for-service every time a patient visits a doctor, checks out of a hospital, or is prescribed a battery of clinical tests.
 The way to get better value is to change the way we pay for care—to shift from a fee-for-service system that rewards more (and more expensive) services without regard to health benefits, to a system that rewards effective care that is provided efficiently.
 The Affordable Care Act’s new authorities create a clear path for payment and delivery reform to lower costs and improve quality. The law penalizes poor performance, rewards good performance, and establishes mechanisms to innovate, evaluate, adapt, and broadly apply effective payment incentives. This path relies primarily on improving Medicare, but its initiatives explicitly extend to the private sector—recognizing that the current excessive spending and inefficiency in the health care system apply to the public and private sectors alike.
Modernizing our health care system with effective implementation of the Affordable Health Care Act will slow cost growth and reduce the deficit even more than expected.
 System modernization—preventing illness, reducing administrative costs with health information technology, and coordinating care—will save $406 billion across the entire health care system and $127 billion in Medicare over and above savings from more accurate prices in the current payment system described above. These actions taken together reduce Medicare’s annual cost growth over the next decade from 6.8 to 4.9 percent, saving a total of $524 billion over 10 years (see Figure 4).
 Greater efficiency across the whole system will lower annual growth in the nation’s health care costs from 6.3 percent to 5.7 percent, even after taking the costs of coverage expansion into account (see Figure 5).
 Even without recognizing potential savings from modernization, CBO found that the Affordable Care Act fully pays for itself and contributes $143 billion to deficit reduction. Taking the full savings potential of modernization into account reduces the federal deficit by an additional $257 billion from 2010 to 2019, for a total of $400 billion in deficit reduction (see Figure 6).
 Achieving these modernization goals means that the health care industry would simply begin to match the performance of the bulk of American businesses as they’ve become increasingly efficient over the last 15 years. Doing the same in the health care industry would achieve the same level of productivity growth improvement that every other U.S. industry has accomplished in recent years.



I can find a few more, if you like…..
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Thu Mar 14, 2013 6:50 pm

BUT let me be clear about one thing... we need further reform, but not a return to what was or even less universal coverage. This bill is benefitting the insurance industry, but I believe that was the Republican plan.

The solution is what other countries have.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Fri Mar 15, 2013 6:45 am

PLAYER57832 wrote:BUT let me be clear about one thing... we need further reform, but not a return to what was or even less universal coverage. This bill is benefitting the insurance industry, but I believe that was the Republican plan.

The solution is what other countries have.


The Affordable Care Act is essentially the Republican plan from the 1990s, yes.

As for your data, it doesn't show the increase in insured or the actual costs or projected costs. It shows the predictions people are making as to how much money the law may save on a going forward basis; those predictions do not include how much money the law will cost in federal spending and if they do, these predictions usually do not take into account costs incurred by the federal government subsequent to 2014 or so.

I'm not calling for cutting the Affordable Care Act and doing nothing (which is what your first link presupposes). Further, your first link makes bold predictions, all of which are positive. The entire first paragraph reads like a campaign speech.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Fri Mar 15, 2013 2:53 pm

thegreekdog wrote:
PLAYER57832 wrote:BUT let me be clear about one thing... we need further reform, but not a return to what was or even less universal coverage. This bill is benefitting the insurance industry, but I believe that was the Republican plan.

The solution is what other countries have.


The Affordable Care Act is essentially the Republican plan from the 1990s, yes.

As for your data, it doesn't show the increase in insured or the actual costs or projected costs. It shows the predictions people are making as to how much money the law may save on a going forward basis; those predictions do not include how much money the law will cost in federal spending and if they do, these predictions usually do not take into account costs incurred by the federal government subsequent to 2014 or so.

They are at least as valid as your projections.


thegreekdog wrote:I'm not calling for cutting the Affordable Care Act and doing nothing (which is what your first link presupposes). Further, your first link makes bold predictions, all of which are positive. The entire first paragraph reads like a campaign speech.


Note that a lot of my condemnation was directed at Nightstrike, who has a far less nuanced opinion. Even so, my basic point is that ensuring that all people are able to get medical care is more important than saving a few dollars.

And that, really is what this is about. Do we ensure that being a citizen of the US means we get healthcare (for which we pay unless truly indigent) and other things people need OR are these just optional niceties that only those who are fortunate enough to be in the top 40-50% of the income earners get to have.

Further, the other question is who is responsible for the debt, and therefore for paying it back. The Republicans, many conservatives want us to believe that the debt is BECAUSE average Americans are greedy and keep demanding more and more from the government without paying more. There is some truth to that. People do want more and do want to pay less. BUT… the idea that it is social security and medical care that is causing our country to be in debt is ridiculous. Social security is a prime example. There was, in the late 70’s and early 80’s a surplus in the social security fund. Was it saved, was it used responsibly to prepare for the future? NO.. Reagan used it to “balance” his budget and then offer tax rebates, particularly to his cronies. Further presidents each decided to keep offering tax bennies, sometimes to everyone and not just the wealthy.

So, the part about people wanting to pay less is correct, but the part that people can do without things like medical care and that we “cannot afford it” is based on the idea that a few people have the right to whatever they want and no responsibility for the consequences of those demands.
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