2 of 5
2
ACA
Posted: 26 October 2013 09:47 PM   [ Ignore ]   [ # 16 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2602
Joined  2012-10-27
macgyver - 24 October 2013 01:24 PM

I agree Lois. They are also the ones complaining the most about its other flaws but most of the short comings of the ACA are due to compromises that had to be made to get the necessary republican votes.

A perfect Catch 22, isn’t it?

Lois

Profile
 
 
Posted: 26 October 2013 09:49 PM   [ Ignore ]   [ # 17 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2602
Joined  2012-10-27
CuthbertJ - 25 October 2013 10:22 AM

The real “tell” in all this is that the major parts of the ACA are Republican ideas. They hate ACA because they’re racists plain and simple. And lefties hate it because, well, it’s Republican legislation.

Please explain how it’s Republican legislation.

Profile
 
 
Posted: 26 October 2013 10:01 PM   [ Ignore ]   [ # 18 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2602
Joined  2012-10-27
macgyver - 26 October 2013 10:45 AM
Bryan - 26 October 2013 01:28 AM
CuthbertJ - 25 October 2013 10:22 AM

The real “tell” in all this is that the major parts of the ACA are Republican ideas. They hate ACA because they’re racists plain and simple. And lefties hate it because, well, it’s Republican legislation.

A conservative think-tank comes up with a insurance marketplace plan combined with an individual mandate and PRESTO:  It’s all Republican idea.  That plan never had strong support among Republicans. The plan we’ve got is crony capitalism at its worst and a thinly-disguised effort to embed welfare-state dynamics in the insurance industry nationally.  It’s a very liberal bill—as liberal as the Democrats who pushed it through Congress (to the point of passing it via reconciliation) could make it.

Here’s a history refresher.

http://healthcarereform.procon.org/view.resource.php?resourceID=003712

The main problem I have with that version is that it neglects to mention that the CBO projects deficit reductions based on a boatload of taxes and unrealistic projections about cuts to Medicare spending (pretending the doc fix doesn’t happen more-or-less annually).  It’s a built-in disadvantage of the CBO’s use of current law as a baseline.  And the Democrats took full advantage of it to peddle the idea that the law is a deficit-cutter.

But the vote history is spot-on.

Bryan, quite frankly the private insurance industry really has no business in health care except as a conduit for a national program. The days of private insurance companies providing a hap hazard patchwork of options available to only those who are employed by a generous employer, and the government filling in for the old, poor, or disabled need to come to an end. This patchwork approach has resulted in fragmented, ill apportioned, misused, over used, and under used care with large segments of the population getting no care at all.

The only way to fix this is with some sort of central oversight and private industry can not provide that.

Unfortunately, the government can’t either because Republicans won’t allow it. They will never allow it.  Their intention is to trash any system that would provide care to everyone.  Such an idea is anathema to them. It’s socialism, they’d say. They would rather that the public continue paying for whatever passes for care for the uninsured through increased costs for all medical services and through overly stressed emergency rooms and hospitals and generally barely adequate care for everyone but the wealthy.  They don’t mind paying for it in this destructive but more hidden way as long as it’s never called a tax.


Lois

Profile
 
 
Posted: 26 October 2013 10:37 PM   [ Ignore ]   [ # 19 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  3349
Joined  2007-11-21
macgyver - 26 October 2013 02:20 PM

Bryan you are making a common mistake that I hear economists make frequently. You are treating medical care like any other commodity or service. There are some important differences though.

The laws of supply and demand will apply regardless of the differences you cite.

1) We need to start with the premise that everyone has the right to basic health care. Unlike a car , or a computer, or a haircut, everyone in this country has a basic right to healthcare. We as a society have already made this decision so its not really up for debate. we have medicaid and medicare already in place which are supposed to fill the gaps in private insurance. We have laws forbidding ER’s from turning away the uninsured. We have as a society decided that no one should be denied care we just have a lousy system for ensuring that.

Why do we need to start with the premise that everyone has the right to “basic health care”?  And who defines “basic”?

2) Unlike dishwashers and TV’s patients don’t have and never will have a very accurate way of evaluating the quality of the service they get. For this reason a system that falls back on free market forces of supply and demand will result in services being sold at discount prices that can’t support high quality care. It will be a race to the bottom. Providers know that patients are very poor judges of good quality medical care so they will cut corners and provide the cheapest service because thats what will attract the greatest volume of patients. Currently the government and insurers do at least some degree of vetting of credentials. Without that minimal safety net patients will be left to the wolves.

Yours gives every impression that it is a slippery slope argument of the fallacious kind.  How can people receive lousy healthcare and not realize it based on word of mouth or the success record of doctors?  Or even based on lawsuits?

Ideally if you want to put the patient back in the decision making loop I would set up MSA’s for everyone. They have catastrophic coverage after the first $5,000 in costs and the MSA is there to pay for most of the first $5,000.

I’ve encountered a reasonable person!  wink
Thank you.

Usually the first $5,000 is contributed to by the patient and the employer or the government with any unused funds remaining at the patients disposal for future medical costs or as an auxiliary retirement fund. This way the patient has some skin in the game for minor medical issues and they have the choice of going where ever they want, but they are covered for the big ones and have to stick to a program within their plan that has been vetted properly.

Also reasonable.  I don’t necessarily agree with the proposal, but it’s a long way off from silliness.

3) Rationing - Typically supply and demand creates a price structure that rations services to those who can afford it. Not a very effective method of rationing medical care in a fair and effective way though. The wealthy get everything they want including a lot of useless and sometimes harmful care and the poor miss out on crucial care. Removing that mechanism would I agree result in rampant overuse. So what’s the solution? Partly what I mentioned above but, the best solution is to also have a panel of experts using evidence based guidelines to decide what services are effective and which ones are not and then create a system where all effective services are covered when its justified and ineffective or unnecessary services are not covered at all. This eliminates over use of services by everyone. But his needs to be done centrally and nationally. Right now its done by individual insurance companies creating a patchwork of policies that dont make sense allowing some people to get coverage for silly things that dont work while others are denied basic services.

“Rationing” is typically defined as government-mandated, and that’s how most people understand it.  It’s true that “price rationing” serves to slot consumers toward certain types of and quality of services, not taking charity into account.  Charity medical care has a strong history in the United States. 

The individuals on the panel that makes these decisions should be appointed like a supreme court judge is so that they would be free from public and political pressure and special interest groups.

Exactly.  They need to be unaccountable for their decisions.  Or something.

See, that’s the great thing about price rationing.  It keeps accountability at the local level.

Profile
 
 
Posted: 27 October 2013 09:31 AM   [ Ignore ]   [ # 20 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  4416
Joined  2008-08-14
Bryan - 26 October 2013 10:37 PM

McGeyver-Ideally if you want to put the patient back in the decision making loop I would set up MSA’s for everyone. They have catastrophic coverage after the first $5,000 in costs and the MSA is there to pay for most of the first $5,000.

I’ve encountered a reasonable person!  wink
Thank you.

Yes, you’re a reasonable person to Bryan because you share the same opinion of his.
But of course “A Rose by any other name…”
Yes those MSAs will be filled by employers or the Govt. So let’s just stick with Tax and spend in the first place.
After all, nobody is going to force me to save my money in a savings account I don’t want!
That’s Socialism!

 Signature 

Row row row your boat gently down the stream.  Merrily Merrily merrily merrily life is but a dream!

Profile
 
 
Posted: 27 October 2013 10:26 AM   [ Ignore ]   [ # 21 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2134
Joined  2007-04-26

Bryan, when it comes to health care you are a consumer so I wouldnt expect you to know this but the idea that a patient can actually distinguish good care form bad care is naive and foolish. It implies that the patient has not only enough knowledge but more knowledge than the provider thereby allowing him/her to know better than the doctor when appropriate care is being provided. It makes no sense at all.

Its been my experience after a quarter century in practice that consumers use several criteria to decide if the care they are getting is good.

1) Is the office pretty?
2) Are they greeted courteously?
3) Is the doctor empathetic?
4) Do you have to wait long in the waiting room?
5) Does the doctor give them what they think they need?
6) When it comes to treatments and tests, more is better and less is worse.

While I would be the first to agree that some of these things should be present in any office visit some of them are meaningless, some are important, and some of the things patients like are actually markers for particularly bad care ( ie. doctors giving patients what they want and doing more rather than less).

In addition, lawsuits are a useless measure of a doctors ability. Doctors rarey get sued for incompetence. They get sued only if three criteria are met.

1) There is a poor outcome whether the doctor did something wrong or not.
2) There is the possibility of a large settlement
3) The lawyer thinks they can convince a group of medically ignorant jurists that the doctor deviated from standard of care. Since the correct course of care in medicine frequently flies in the face of common sense this is not hard to do.

As a result if you are an Og/Gyn where the life of a newborn is in your hands and the decisions are based on conditions that are never black and white you will get sued regularly whether you are a great doctor or not. If you are a geriatrician taking care of old people you will almost never get sued. For all sorts of reasons many of the best doctors get sued frequently and some of the worst never get sued at all. Law suits have nothing to do with quality of care.

Insurance companies and Medicare are in the process of trying to come up with “quality measures” that are meant to measure outcomes which is an attempt at least to approach this issue in a rational manner. The current system is flawed because of the patchwork approach, the lack of practicing physicians on the boards that design the measures, the ability of providers to game the system by focusing on things the system measures and ignoring the rest.  But at least its an attempt to work towards a more uniform and sensible way of evaluating care. This is where a universal health care system can actually improve things by creating a uniform set of measures that are agreed upon by practicing physicians and applying them nationally. Patients can then see who is best meeting those goals and doctors can have a uniform set of goals which will help them do their job better. It may also improve the malpractice situation some because the correct course in many cases will be harder to question. It will be tougher for lawyers to find doctors who are willing to perjure themselves for a price.

When you buy a TV or a dishwasher and get it home you know pretty quickly whether you made a good choice or not. You have the tools you need to make that judgement. When you get home after a doctors visit you have no idea if you got good advice or bad. Unless you have a medical degree and additional training in the specific field that covers your problem you are not equipped to determine if the care you got was correct. Common wisdom aside, Google does not fulfill that role well at all. Without guidance from outside patients would be woefully unable to know when they are getting good care or bad and I suspect they will end up with providers who give them inexpensive care that looks good on the surface but is actually very bad.

 Signature 

For every complex problem there is a solution that is simple, obvious,.... and just plain wrong

Profile
 
 
Posted: 27 October 2013 01:59 PM   [ Ignore ]   [ # 22 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  3349
Joined  2007-11-21
macgyver - 27 October 2013 10:26 AM

Bryan, when it comes to health care you are a consumer

I’ve logged over 10 years in the medical field.  You’re right about the average consumer, but that’s primarily because third-party payment discourages patients from having concerns about cost.

Consumers would treat health care kind of like auto repairs if the payment system was more direct.

In addition, lawsuits are a useless measure of a doctors ability.

http://patients.about.com/od/doctorinformationwebsites/a/malpracticeinfo.htm

Profile
 
 
Posted: 27 October 2013 03:18 PM   [ Ignore ]   [ # 23 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2134
Joined  2007-04-26
Bryan - 27 October 2013 01:59 PM

In addition, lawsuits are a useless measure of a doctors ability.

http://patients.about.com/od/doctorinformationwebsites/a/malpracticeinfo.htm

Bryan that site does not offer anything to counter what I said. Yes you can get malpractice information on doctors and yes you can come up with anecdotal reports of cases where a doctor committed malpractice and was later found to have along record but I can tell you for a fact that some of the best doctors in our area, people I would trust my life to, have quite a few law suits and some of the absolute worst doctors have never been sued. On the whole, lawsuits have little to do with competence. They are a misleading data point for patients and are unfair to the doctors who get maligned by this info.

I’ve been privy to the facts of dozens of lawsuits from the doctors point of view, the patients side and as a consultant to a lawyer where I have reviewed charts.

I am speaking as someone who has never been sued so this is not a defensive posture at all when I say law suits prove absolutely nothing.

 Signature 

For every complex problem there is a solution that is simple, obvious,.... and just plain wrong

Profile
 
 
Posted: 27 October 2013 06:50 PM   [ Ignore ]   [ # 24 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  3349
Joined  2007-11-21
macgyver - 27 October 2013 03:18 PM

I am speaking as someone who has never been sued so this is not a defensive posture at all when I say law suits prove absolutely nothing.

Your point about lawsuits providing potentially misleading information is well taken.  However, it is possible in principle for uncontested facts in evidence to provide a clear indicator that a person would wish to pass over the services of a given physician.  In short, lawsuits may prove more than nothing, and the main point is that means exist to helpfully evaluate doctors (apart from those you listed).

Profile
 
 
Posted: 28 October 2013 04:54 PM   [ Ignore ]   [ # 25 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  685
Joined  2012-04-25
Bryan - 26 October 2013 01:28 AM
CuthbertJ - 25 October 2013 10:22 AM

The real “tell” in all this is that the major parts of the ACA are Republican ideas. They hate ACA because they’re racists plain and simple. And lefties hate it because, well, it’s Republican legislation.

A conservative think-tank comes up with a insurance marketplace plan combined with an individual mandate and PRESTO:  It’s all Republican idea.  That plan never had strong support among Republicans. The plan we’ve got is crony capitalism at its worst and a thinly-disguised effort to embed welfare-state dynamics in the insurance industry nationally.  It’s a very liberal bill—as liberal as the Democrats who pushed it through Congress (to the point of passing it via reconciliation) could make it.

Here’s a history refresher.

http://healthcarereform.procon.org/view.resource.php?resourceID=003712

The main problem I have with that version is that it neglects to mention that the CBO projects deficit reductions based on a boatload of taxes and unrealistic projections about cuts to Medicare spending (pretending the doc fix doesn’t happen more-or-less annually).  It’s a built-in disadvantage of the CBO’s use of current law as a baseline.  And the Democrats took full advantage of it to peddle the idea that the law is a deficit-cutter.

But the vote history is spot-on.

Revisionist history at its best. Nice. And a liberal bill? You evidently think Democrats are all liberal.  There are very few liberal Democrats, maybe Bernie Sanders (independent actually) Alan Grayson, maybe Russ Feingold.  You need to stop watching Fox.

Profile
 
 
Posted: 28 October 2013 07:23 PM   [ Ignore ]   [ # 26 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2602
Joined  2012-10-27
VYAZMA - 26 October 2013 12:41 PM
Bryan - 26 October 2013 12:22 PM

Who pays for it?

The fundamental problem here is an economic one.  Third-party payment (insurance or gov’t single-payer) strongly encourages increased demand for services.  Turning the system into single-payer does not solve the fundamental problem unless you set limits on payment (yes, that’s called rationing).

And the system that we used to have was by largely Laissez-faire capitalism.  That had fundamental problems too.
Millions and millions of people were uninsured because they couldn’t meet the demand for payment.
Yes, that’s called rationing!!!
At least under this system everyone get’s insurance.  We’ll see what if any rationing takes place.
Under the old system, rationing did take place.  Millions and millions of people didn’t get insurance period. That’s rationing out the supply
so that only those who can afford insurance get insurance.

Is this going to be a segue into “Death Panels” for you Bryan?
I’d love to hear you bloviate about Death Panels.  That would be entertaining!

Death panels are perfectly ok as long as they are being used by profit making private businesses. No Republican ever complained about them when they were being used by private insurers.

 

Lois

Profile
 
 
Posted: 29 October 2013 09:55 AM   [ Ignore ]   [ # 27 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  685
Joined  2012-04-25
Lois - 26 October 2013 09:49 PM
CuthbertJ - 25 October 2013 10:22 AM

The real “tell” in all this is that the major parts of the ACA are Republican ideas. They hate ACA because they’re racists plain and simple. And lefties hate it because, well, it’s Republican legislation.

Please explain how it’s Republican legislation.

The individual mandate and the idea of exchanges both started as Republican ideas.  I got my information straight for the horses mouth…it was Obama himself who when the thing was still going through congress literally said at a news conference words to the effect: I don’t understand why this is so hard to get through, these are Republican ideas, I got from Republicans when I was in Congress.

Profile
 
 
Posted: 29 October 2013 09:57 AM   [ Ignore ]   [ # 28 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2134
Joined  2007-04-26
Lois - 28 October 2013 07:23 PM

Death panels are perfectly ok as long as they are being used by profit making private businesses. No Republican ever complained about them when they were being used by private insurers.

Lois

There are no death panels and never have been. This was a scare tactic and a total distortion of reality. Medicare simply decided to allow physicians to be reimbursed for the time required to counsel patients on end of life decisions so that these conversations could occur proactively. Its something everyone should be doing and if possible, with the counsel of their family doctor. The fact that that effort was somehow distorted into “death panels” by Sarah Palin and the republican party is a sign of whats wrong with our political system. It makes it impossible to have an intelligent discussion with them on anything.

Sorry. didn’t mean to use the words Intelligent and Sarah Palin in the same paragraph. my bad

 Signature 

For every complex problem there is a solution that is simple, obvious,.... and just plain wrong

Profile
 
 
Posted: 29 October 2013 10:34 AM   [ Ignore ]   [ # 29 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  3349
Joined  2007-11-21
macgyver - 29 October 2013 09:57 AM
Lois - 28 October 2013 07:23 PM

Death panels are perfectly ok as long as they are being used by profit making private businesses. No Republican ever complained about them when they were being used by private insurers.

Lois

There are no death panels and never have been.

Sure there are.  You’ve been misled by the mainstream media, which put on a concerted effort to distort the issue.  To their credit, the distortion was extraordinarily successful.

Palin’s original “death panel” comment was an expression of economist Thomas Sowell’s observation that putting the government in charge of healthcare inevitably puts the government in charge of who gets treatment, who doesn’t, and what kind of treatment they receive.  The media conveniently dropped the context and used the latter part of Palin’s statement, a dramatic and personalized objection to government control to make it look like Palin was saying the law had a provision for a body that would explicitly made individual decisions for people about their health care.  That was never Palin’s point.

This was a scare tactic and a total distortion of reality.

Incorrect.  Economists (and Democrats) Robert Reich and Paul Krugman have affirmed that the IPAB figures to save the government a great deal of money by eliminating wasteful and expensive medical treatment for older people near the end of life.  So scare tactic, yes, based on a rational fear of giving the government too much control people’s personal lives.  But certainly not a distortion of reality once the media spin is neutralized.

Medicare simply decided to allow physicians to be reimbursed for the time required to counsel patients on end of life decisions so that these conversations could occur proactively.

That’s part of the media spin, based on President Obama’s response to Palin’s original comment.  You bought it.

Sorry. didn’t mean to use the words Intelligent and Sarah Palin in the same paragraph. my bad

A little ridicule of Palin makes the media lies go down even more smoothly.

Profile
 
 
Posted: 29 October 2013 10:53 AM   [ Ignore ]   [ # 30 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  3349
Joined  2007-11-21
CuthbertJ - 28 October 2013 04:54 PM
Bryan - 26 October 2013 01:28 AM
CuthbertJ - 25 October 2013 10:22 AM

The real “tell” in all this is that the major parts of the ACA are Republican ideas. They hate ACA because they’re racists plain and simple. And lefties hate it because, well, it’s Republican legislation.

A conservative think-tank comes up with a insurance marketplace plan combined with an individual mandate and PRESTO:  It’s all Republican idea.  That plan never had strong support among Republicans. The plan we’ve got is crony capitalism at its worst and a thinly-disguised effort to embed welfare-state dynamics in the insurance industry nationally.  It’s a very liberal bill—as liberal as the Democrats who pushed it through Congress (to the point of passing it via reconciliation) could make it.

Here’s a history refresher.

http://healthcarereform.procon.org/view.resource.php?resourceID=003712

The main problem I have with that version is that it neglects to mention that the CBO projects deficit reductions based on a boatload of taxes and unrealistic projections about cuts to Medicare spending (pretending the doc fix doesn’t happen more-or-less annually).  It’s a built-in disadvantage of the CBO’s use of current law as a baseline.  And the Democrats took full advantage of it to peddle the idea that the law is a deficit-cutter.

But the vote history is spot-on.

Revisionist history at its best. Nice.

Got specifics?  The vote history, as I wrote, is spot-on.  And that tells the story.

And a liberal bill? You evidently think Democrats are all liberal.

I think every Democrat is more liberal than every Republican, with at most one or two exceptions.  That leads to the conclusion that the majority-passed bill is as liberal as the majority could make it.  The math is on my side.

There are very few liberal Democrats, maybe Bernie Sanders (independent actually)

And self-described socialist.

Alan Grayson, maybe Russ Feingold.  You need to stop watching Fox.

I don’t watch television news at all except when I’m doing research (usually just checking transcripts for things people said).

You need stop using the invocation of Fox News as an excuse for a coherent argument.  Encapsulated, your argument boils down to saying that since Democrats in Congress aren’t really so liberal on some relative scale or other therefore the legislation isn’t liberal.  You’re skipping over the simple fact that the relevant population for relative comparisons is Congress itself.  The most liberal part of Congress passed the most liberal bill it could possibly pass.

Oh! Oh! Oh!  Fox News!
lol
Save it.

Profile
 
 
   
2 of 5
2