ObamaCare - exchanges ,report your states options!

[jj3044]

So, to recap the evolving versions of your rebuttal so far: (1) no doctors are against it, (2) okay, doctors are against it but they're just greedy, (3) okay, they're not greedy but the survey is flawed. (4) Next? (This is too tedious - I have to go now anyway. BBS - take over for me.)

Aah, I get it now. You are trying to make a joke or something. That, or you somehow think that me saying a "minority of doctors" = me saying "no doctors". Let me know which it is. If it is the former then congratulations, you got me to respond a few times. If it is the latter, than I suggest you look up the definition of both words/terms.

So again, care to actually critique/respond to my question about quality/outcomes based contracts, or are you just going to ignore my main point entirely?

[Night Strike]

Outcome-based payments presuppose that an illness is completely treated prior to discharge from the health care facility (driving up costs of staying in the hospital longer) while also relying on the patient to keep up on their own with follow-up procedures. That's part of why punishing hospitals for re-admittance within 30 days is an extreme punishment. Those doctors don't have control over the actions of their patients after they leave, yet they're still held liable by the government if those same patients return. That means the patient either stays in the hospital longer or the hospital itself faces large fines if they come back, both of which drive UP costs of health care.

[jj3044]

Outcome-based payments presuppose that an illness is completely treated prior to discharge from the health care facility (driving up costs of staying in the hospital longer) while also relying on the patient to keep up on their own with follow-up procedures. That's part of why punishing hospitals for re-admittance within 30 days is an extreme punishment. Those doctors don't have control over the actions of their patients after they leave, yet they're still held liable by the government if those same patients return. That means the patient either stays in the hospital longer or the hospital itself faces large fines if they come back, both of which drive UP costs of health care.

Actually, your assumptions are not supported by data (at least in RI, where I work), and you don't have a correct understanding of how the process works. Patient Centered Medical Homes have extra support staff (nurse case managers and dieticians, for example), that help coordinate care and follow up with patients. Although these initiatives are fairly new, they are showing that they are lowering cost of care, and improving outcomes (less readmissions and ER visits for example). See the following presentation:
http://www.pcmhri.org/files/uploads/RIB ... -FINAL.pdf

[BigBallinStalin]

I said the (vocal) minority [in New York] is against it

and you were wrong

A poll conducted by the New York State Medical Society [the NY branch of the AMA] finds that 44 percent of MDs [in the State of New York] said they are not participating in the nation’s new health-care plan. Another 33 percent say they’re still not sure whether to become ObamaCare providers.

http://nypost.com/2013/10/29/docs-resisting-obamacare/

Hardly. From your article:

Only 23 percent of the 409 physicians queried said they’re taking patients who signed up through health exchanges.

“This is so poorly designed that a lot of doctors are afraid to participate,” said Dr. Sam Unterricht, president of the 29,000-member organization.

So... 409 doctors responded to the poll out of more than 29,000. That is approximately 1.4% of doctors responding to the survey. Again, the story is misleading. The sample size is horrendously small.

Again, you need to look at all of the facts, what the study was asking, who it was being asked to, and how many responded. Just don't read the words and take it as gospel.

I wouldn't be surprised if we found jj rabidly supporting a source which had similar problems.

That's the problem with the media. You often need to dig deeper yourself to get the true story.

What I wish you guys would do is actually respond to the meat and potatoes of my posts about healthcare, instead of trying to nit-pick apart the semantic points. Such as:

More insurers (and Medicare) are moving towards outcomes-based contracts with providers which provide a set amount to care for a patient's conditions. These contracts have incentives built in so that if the patient outcomes are better, they get paid a bit extra. In this new model, GOOD doctors are rewarded, and poor doctors that either don't have the ability or inclination to provide great care make a little less than they do today in the typical fee-for-service contract.

What are your opinions, in general, of changing from fee-for-service to outcomes & quality based contracting? Do you believe this will help in reducing costs and improving outcomes? Did you even hear of these things happening before I brought them up in this thread?

viewtopic.php?f=8&t=93718&start=5700#p4331293

[Phatscotty]

Liberal entitlement-state dream is crumbling

http://www.cnbc.com/id/101164217

May I ask this question? Why is it that Americans don't have the freedom to choose their own health insurance? I just don't get it. Why must the liberal nanny state make decisions for us? We can make them ourselves, thank you very much. It's like choosing a car, buying a home or investing in a stock. We can handle it.

So why must the government tell me and everyone else what we can and cannot buy?

Charles Krauthammer and the Wall Street Journal's Dan Henninger noted in excellent recent columns that this whole Obamacare business represents the greatest-ever expansion of the liberal entitlement-state dream. But I don't want that dream. And you shouldn't either.

(Read more: When insurers drop policies: Three stories)

Here's what else I don't want: As a 60-something, relatively healthy person, I don't want lactation and maternity services, abortion services, speech therapy, mammograms, fertility treatments or Viagra. I don't want it. So why should I have to tear up my existing health-care plan, and then buy a plan with far more expensive premiums and deductibles, and with services I don't need or want?

Why? Because Team Obama says I have to. And that's not much of a reason. It's not freedom.

Fortunately, NBC News pulled the plug this past week on President Barack Obama's promise that "if you like your own plan, you can keep it." Ditto for keeping your own doctor. The plug was pulled because NBC learned that Team Obama knew—for three years—that stiff new regulations would prevent the grandfathering of existing health-care plans. And not just a few plans. But plans that could affect as many as 15 million individuals.

The day after that bombshell hit, the president tried to blame insurers rather than regulatory overkill for this Obamacare shortfall. Yet both the public and the mainstream media were having none of it. In what may turn out to be a landmark moment, Americans and the media at large have turned against the president and Obamacare.

(Read more: Hillary running ... away from Obama)

Incidentally, equally punitive regulations will hit more than 90 million employer-sponsored health plans next year. It's the same problem as the individual plan. Grandfathering won't work. Moreover, replacing these plans with much more expensive products will constitute a major tax hike on the entire economy. This point shouldn't be lost as Americans worry about being kicked from their plans. Obamacare is not only anti-freedom but anti-growth.

As for the grandfathering lie, Obama's HHS staffers were the saboteurs. They undoubtedly acted with full knowledge of what they were doing, and thus trapped the president in three years of falsehoods that were essential to selling Obamacare.

And I just love it when they tell me that so many of these existing plans are substandard "bad apples." Do the president and his people not know that insurance at the state level is one of the most regulated areas of the economy? They're blaming insurance companies, not their own new regulations. The stupidity of that is hilarious. Do they really think salesmen are out selling these policies off the back of trucks?

(Read more: Obama blames 'bad apple' insurers for dropped coverage)

No, this is federal coercion at its worst. And that's why the public is turning against it. It's not freedom.

Of course, there are other structural problems to Obamacare that are both unfair and unaffordable. Mainly, younger healthy people are not going to subsidize older sicker folks. We should take care of the latter with transparent government subsidies, and not by trying to redistribute resources (again) from the young to the old.

Or then there's the Medicaid entitlement. It's already out of control and close to bankruptcy. But in the early days of Obamacare, Medicaid sign-ups are exploding, all while sign-ups for private plans on the new exchanges are minuscule.

Between the president's broken promises, the millions of policy cancellations, the continued website breakdowns and the unaffordable, unfair con game between the healthy young and the sicker old, this Obamacare monster is well on its way to collapsing of its own weight.

But here's the bigger point: All this is the inevitable result of massive central-planning exercises to control the economy. That's not freedom.

No amount of rescue legislation is going to change this. It's the elections of 2014 and 2016 that will allow citizens to reject this Soviet-style planning. But I'll reference my conservative colleagues in the media once again: Obamacare represents the greatest-ever expansion of the liberal entitlement-state dream. And you know what? That dream is crumbling and dissolving before our very eyes.

And that is freedom.

[mrswdk]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

[Phatscotty]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

are you sure? How do you mean

[Metsfanmax]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

are you sure? How do you mean

Government subsidies are funded by tax revenue, which come from the employed (i.e. the young) and would go to the old (i.e. the unemployed).

[patches70]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

are you sure? How do you mean

Taxing people and giving that tax money to a specific set of people is a way of redistributing wealth, obviously.

The young and old both pay taxes, but then a portion of those taxes are used to subsidize the old, then you have a redistribution with the government as the middle man (who also skims off the top, so that even then it's not very efficient).

[jj3044]

I said the (vocal) minority [in New York] is against it

and you were wrong

A poll conducted by the New York State Medical Society [the NY branch of the AMA] finds that 44 percent of MDs [in the State of New York] said they are not participating in the nation’s new health-care plan. Another 33 percent say they’re still not sure whether to become ObamaCare providers.

http://nypost.com/2013/10/29/docs-resisting-obamacare/

Hardly. From your article:

Only 23 percent of the 409 physicians queried said they’re taking patients who signed up through health exchanges.

“This is so poorly designed that a lot of doctors are afraid to participate,” said Dr. Sam Unterricht, president of the 29,000-member organization.

So... 409 doctors responded to the poll out of more than 29,000. That is approximately 1.4% of doctors responding to the survey. Again, the story is misleading. The sample size is horrendously small.

Again, you need to look at all of the facts, what the study was asking, who it was being asked to, and how many responded. Just don't read the words and take it as gospel.

I wouldn't be surprised if we found jj rabidly supporting a source which had similar problems.

That's the problem with the media. You often need to dig deeper yourself to get the true story.

What I wish you guys would do is actually respond to the meat and potatoes of my posts about healthcare, instead of trying to nit-pick apart the semantic points. Such as:

More insurers (and Medicare) are moving towards outcomes-based contracts with providers which provide a set amount to care for a patient's conditions. These contracts have incentives built in so that if the patient outcomes are better, they get paid a bit extra. In this new model, GOOD doctors are rewarded, and poor doctors that either don't have the ability or inclination to provide great care make a little less than they do today in the typical fee-for-service contract.

What are your opinions, in general, of changing from fee-for-service to outcomes & quality based contracting? Do you believe this will help in reducing costs and improving outcomes? Did you even hear of these things happening before I brought them up in this thread?

viewtopic.php?f=8&t=93718&start=5700#p4331293

The link you provided doesn't answer my question, BBS.

Regarding PS's article:

Liberal entitlement-state dream is crumbling

http://www.cnbc.com/id/101164217

May I ask this question? Why is it that Americans don't have the freedom to choose their own health insurance? I just don't get it. Why must the liberal nanny state make decisions for us? We can make them ourselves, thank you very much. It's like choosing a car, buying a home or investing in a stock. We can handle it.

Because, the current system doesn't work. The young and/or lower income individuals won't pay for coverage...and when they get sick, our taxes pay the bill. We are still subsidizing the poor with our taxes, of course, but this is better to ensure everyone has coverage in my opinion, then paying the full freight of their cost of care.

[BigBallinStalin]

jj3044,

Are your questions relevant to the ACA?

[jj3044]

jj3044,

Are your questions relevant to the ACA?

BBS, I'm honestly shocked by your response... I feel like you would typically research my point before posting this type of a response.

The ACA includes provisions for establishing ACO's (accountable care organizations) that have performance based contracting for Medicare. Because of this requirement, many state insurers are helping to ALSO create Patient Centered Medical Home Practices for the private insurance market that are modeled after the ACO's.

[BigBallinStalin]

jj3044,

Are your questions relevant to the ACA?

BBS, I'm honestly shocked by your response... I feel like you would typically research my point before posting this type of a response.

The ACA includes provisions for establishing ACO's (accountable care organizations) that have performance based contracting for Medicare. Because of this requirement, many state insurers are helping to ALSO create Patient Centered Medical Home Practices for the private insurance market that are modeled after the ACO's.

Ha, well, it's not like I have time to read about everything--especially about something so minor. Regardless, my link is related; mainly it's about costs.

Also, I find no merit in relishing about one small aspect of a large failure. I don't see what's so great about centrally planned 'mutual aid societies'/health centers ("patient-centered", they needed to include that in there to remind the bureaucrats that it's not just about inflating their budgets, right?). We should already know by now the problems and failures of that long-beaten path.

[Phatscotty]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

are you sure? How do you mean

Government subsidies are funded by tax revenue, which come from the employed (i.e. the young) and would go to the old (i.e. the unemployed).

Great, but these aren't taxes. (the author is definitely not the one who is confused)

per Obamacare, they need a bunch of young healthy people paying double premiums (7 million minimum) in order for the program to work, according to HHS. The young people are going to pay more in premiums to help cover the sick and the old.

Premiums are not taxation

[jj3044]

jj3044,

Are your questions relevant to the ACA?

BBS, I'm honestly shocked by your response... I feel like you would typically research my point before posting this type of a response.

The ACA includes provisions for establishing ACO's (accountable care organizations) that have performance based contracting for Medicare. Because of this requirement, many state insurers are helping to ALSO create Patient Centered Medical Home Practices for the private insurance market that are modeled after the ACO's.

Ha, well, it's not like I have time to read about everything--especially about something so minor. Regardless, my link is related; mainly it's about costs.

Also, I find no merit in relishing about one small aspect of a large failure. I don't see what's so great about centrally planned 'mutual aid societies'/health centers ("patient-centered", they needed to include that in there to remind the bureaucrats that it's not just about inflating their budgets, right?). We should already know by now the problems and failures of that long-beaten path.

Minor?

One of the main goals of the ACA is to change the way we deliver healthcare to reduce costs in the long term. ACO's are part of that main initiative, and is demonstrating that (so far) there is an ROI on this type of model.

So what is considered "major"? The death panels that are created from the law?

[BigBallinStalin]

jj3044,

Are your questions relevant to the ACA?

BBS, I'm honestly shocked by your response... I feel like you would typically research my point before posting this type of a response.

The ACA includes provisions for establishing ACO's (accountable care organizations) that have performance based contracting for Medicare. Because of this requirement, many state insurers are helping to ALSO create Patient Centered Medical Home Practices for the private insurance market that are modeled after the ACO's.

Ha, well, it's not like I have time to read about everything--especially about something so minor. Regardless, my link is related; mainly it's about costs.

Also, I find no merit in relishing about one small aspect of a large failure. I don't see what's so great about centrally planned 'mutual aid societies'/health centers ("patient-centered", they needed to include that in there to remind the bureaucrats that it's not just about inflating their budgets, right?). We should already know by now the problems and failures of that long-beaten path.

Minor?

One of the main goals of the ACA is to change the way we deliver healthcare to reduce costs in the long term. ACO's are part of that main initiative, and is demonstrating that (so far) there is an ROI on this type of model.

So what is considered "major"?

The costs. I'm just tired of people speculating about imagined benefits--in the face of constant failures of the ACA--while also ignoring the obvious, increasing costs.

[Phatscotty]

btw, if you voted for Obama in support of Obamacare and are young and healthy, I DEMAND YOU TO SIGN UP FOR OBAMACARE RIGHT F'ING NOW!

No way in thee blue hell you are gonna put Obamacare on everyone else but when it comes to putting your own skin in the game, you go for the cheapest option?? NO WAY!!!

PUT YOUR MONEY WHERE YOUR MOUTH AND YOUR VOTE IS. Obamacare needs at least 7 million young and healthy people to pay an extra 2,500$ every year for a bunch of crap they don't need, to help with the cost for all the poor and old and sick people. THIS IS YOUR FAIR SHARE!

[Phatscotty]

Regarding PS's article:

Liberal entitlement-state dream is crumbling

http://www.cnbc.com/id/101164217

May I ask this question? Why is it that Americans don't have the freedom to choose their own health insurance? I just don't get it. Why must the liberal nanny state make decisions for us? We can make them ourselves, thank you very much. It's like choosing a car, buying a home or investing in a stock. We can handle it.

Because, the current system doesn't work. The young and/or lower income individuals won't pay for coverage...and when they get sick, our taxes pay the bill. We are still subsidizing the poor with our taxes, of course, but this is better to ensure everyone has coverage in my opinion, then paying the full freight of their cost of care.

How does Obamacare change any of that??? Everyone will have coverage???

Our system would work if government was not driving up prices with trillions of government dollars flowing into the healthcare system every year. It's the same as when government got involved with housing, and the same with tuition.

The more the government tries to help, the more unaffordable those things become, then there is no choice but for the government to take over....it's almost like a Socialism strategy eh? Sure the government can subsidize it, but it drives up the price for everyone else, until it reaches a breaking point. That's why 40 years ago it was the norm for college students to pay their tuition with cash on the spot with just a couple part time jobs over the summer and graduate with little to no debt and get a real education in the process. Yet, the government gave very little 'help' back then, because help wasn't needed, because there weren't billions of federal dollars being injected into every school year after year

[Metsfanmax]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

are you sure? How do you mean

Government subsidies are funded by tax revenue, which come from the employed (i.e. the young) and would go to the old (i.e. the unemployed).

Great, but these aren't taxes. (the author is definitely not the one who is confused)

per Obamacare, they need a bunch of young healthy people paying double premiums (7 million minimum) in order for the program to work, according to HHS. The young people are going to pay more in premiums to help cover the sick and the old.

Premiums are not taxation

What you said here is completely unrelated to mrswdk's point. The point is that government subsidies are resource redistribution, no matter which way you slice it, so the statement "we should be doing government subsidy instead of resource redistribution" is quite possibly devoid of all meaning.

[patches70]

[Phatscotty]

From your last article:

We should take care of [old people] with government subsidies, and not by trying to redistribute resources from the young to the old.

Your author seems a bit confused.

are you sure? How do you mean

Government subsidies are funded by tax revenue, which come from the employed (i.e. the young) and would go to the old (i.e. the unemployed).

Great, but these aren't taxes. (the author is definitely not the one who is confused)

per Obamacare, they need a bunch of young healthy people paying double premiums (7 million minimum) in order for the program to work, according to HHS. The young people are going to pay more in premiums to help cover the sick and the old.

Premiums are not taxation

What you said here is completely unrelated to mrswdk's point. The point is that government subsidies are resource redistribution, no matter which way you slice it, so the statement "we should be doing government subsidy instead of resource redistribution" is quite possibly devoid of all meaning.

I don't know if I should keep reading your posts. I think you do this on purpose....

Anyways, what I said there was CORRECTING mrs's mispoint. The author was talking about the premiums being an add-on to wealth and resource redistribution from young to old, but now I am just repeating myself, again...

[Metsfanmax]

What you said here is completely unrelated to mrswdk's point. The point is that government subsidies are resource redistribution, no matter which way you slice it, so the statement "we should be doing government subsidy instead of resource redistribution" is quite possibly devoid of all meaning.

I don't know if I should keep reading your posts. I think you do this on purpose....

Anyways, what I said there was CORRECTING mrs's mispoint. The author was talking about the premiums being an add-on to wealth and resource redistribution from young to old, but now I am just repeating myself, again...

Whether it's taxation or insurance premiums, either one is a redistribution of resources. This makes the sentence, as read, meaningless. If the author was making a point about direct redistribution through government subsidy being better than indirect redistribution through premiums, then that's one thing. But I don't think so -- it looks to me like the statement just completely missed that government subsidies are, in effect, a resource distribution from the young to the old (just using a different mechanism).

[BigBallinStalin]

Honestly, guise, I think the author mixed up the subject and object.

[Phatscotty]