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ACA Running Thread

No one is disputing the rollout should have been better, but the reality is only fools would have thought it would be perfect. At this point over 4M people have signed up through the national and state websites. The projections are that 5.5.-6M will have signed up by the end of March. It'll be short of the 7M projected, but considering all the problems and the tens of millions to get people not to sign up, that's not bad.

There's still a lot to be done.
 
Unless you die suddenly without entering a hospital or suffer from a long term chronic illness, most of your medical bills will come in the last days/months of your life. That applies to all ages, not just seniors.
 
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The ACA rollout wasn't just imperfect, it has been a total clusterfuck. Have any of the administration's projections thus far have been even close to accurate?
 
Wrangor said:
We should have a different narrative at the end of life. I know that i plan to differ from the norm. I think this has been posted before but an interesting op ed on the subject.

http://www.theguardian.com/society/2012/feb/08/how-doctors-choose-die
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I agree. I have spoken with hundreds of family members of nursing home residents who cannot accept the pending death of their loved one. They often goad the unfortunate resident and physician into efforts that will only prolong agony. They also tend to take their guilt out on the nursing staff. I should add that I've also spoken to hundreds of family members who understand and accept what is certain to occur. The worst situations are when there is a family member on each side - that makes it hell for all concerned.
 
RJKarl said:
No one is disputing the rollout should have been better, but the reality is only fools would have thought it would be perfect. At this point over 4M people have signed up through the national and state websites. The projections are that 5.5.-6M will have signed up by the end of March. It'll be short of the 7M projected, but considering all the problems and the tens of millions to get people not to sign up, that's not bad.

There's still a lot to be done.
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Ok, now subtract the people who had their old insurance cancelled that signed up to get their new insurance through one of the websites as they are not newly insured.

Now subtract the people who have signed up but haven't paid their premiums and therefore don't have insurance.

Finally subtract those that would have gotten insurance for the first time without the law but happened to use the ACA sites to buy.

There's your net impact. It will be considerably below the numbers reported.
 
WFU71 said:
I agree. I have spoken with hundreds of family members of nursing home residents who cannot accept the pending death of their loved one. They often goad the unfortunate resident and physician into efforts that will only prolong agony. They also tend to take their guilt out on the nursing staff. I should add that I've also spoken to hundreds of family members who understand and accept what is certain to occur. The worst situations are when there is a family member on each side - that makes it hell for all concerned.
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Im a huge believer in better managing end of life decisions. But can you imagine the outcry if we had real discussions on this at the national level. Yet another reason we have 0% chance of implementing single payer.
 
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CHDeac said:
Im a huge believer in better managing end of life decisions. But can you imagine the outcry if we had real discussions on this at the national level. Yet another resin we have 0 chance of implementing single payer.
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Megyn Kelly's head would explode on camera.
 
I very much agree about end-of-life care. We disproportionately spend our resources at the "margins" of life. This isn't germane to the thread, but for those interested, make sure that you make it abundantly clear to your next of kin what your desires are. And be specific. Would you want CPR? A breathing tube? A ventilator? IV antibiotics? A feeding tube? A living will is often insufficient, because 1) physicians are unwilling to follow it if it is contrary to the next of kin's wishes and 2) it's often so vague as to be useless in guiding medical management.
 
DeacinBama said:
I very much agree about end-of-life care. We disproportionately spend our resources at the "margins" of life. This isn't germane to the thread, but for those interested, make sure that you make it abundantly clear to your next of kin what your desires are. And be specific. Would you want CPR? A breathing tube? A ventilator? IV antibiotics? A feeding tube? A living will is often insufficient, because 1) physicians are unwilling to follow it if it is contrary to the next of kin's wishes and 2) it's often so vague as to be useless in guiding medical management.
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This x1000.

I also find it ironic how much we spend on meaningless stuff in medicine. Defensive medicine aside, we as consumer make horrible cost decisions when it comes to, largely because we are so insulated from the actual costs.

We waste money on the stupid stuff and we wasted money at the end of life. Meanwhile, we need to spending $ on disease / health management which are cost killers.
 
CHDeac said:
[/B]

Serious question that no one really seems to address. How would we ever switch to this in our "have it your way society"? Hell, most americans insurance isn't directly impacted by the ACA and they still hate it. Imagine if it did impact them!

Why is Medicare (a form of single payer after all) still so much more expensive than what other countries pay for their Sr. populations? I dont have the stat handy but Matt Miller (politico and current candidate to fill Waxman's seat) consistently quotes something like we spend x% more on Sr. care than any other county even thought its single payer AND subsidized by private pay.

I just don't buy the argument that single payer would work in our society.
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The simple fact is that in order for US health expenditures to come down to levels commensurate with those in comparable countries, almost every participant in the health marketplace is going to have to make less money. That includes big pharma, medical device makers, physicians, hospital executives, everyone. Other countries with heavily single-payer systems, even where there is also private insurance in the mix, have been able to hold these participants' profits down by government fiat or market power. They simply pay far less for drugs, hospital stays, physician services, everything. They balance this out, in part, by other spending such as making sure their doctors are trained at the expense of the state instead of required to take out hundreds of thousands in loans that must be paid back out of exorbitant doctor salaries.

The US consumer and US taxpayer is in a very real way subsidizing the rest of the world by paying stupid prices for medical devices and pharmaceuticals so that Big Pharma and Big Device can accept lower profits in the rest of the world.

that is why it is almost inconceivable that we'll ever have single payer or really put a dent in health spending in the foreseeable future. the people whose oxes must be gored to make it happen have mucho political power. Only when health spending becomes truly and completely unaffordable (i.e., mothball the carrier fleet and cancel the Marines) will our politicians be able to overcome the weight of that lobby and make real changes.

You can blame obesity and med mal and defensive medicine and end of life all you want, but the fact is all that could be overcome if we weren't paying $30 for a !&*$ing aspirin.
 
The fact is that 50% of healthcare spending is spent on care for 5% of the population - "high risk" patients with complex diseases or comorbidities. The focus should shift to the "rising risk" patients (~15%-35% of the popualation) who may have some chronic conditions that are not under control...the system needs to help prevent these patients from moving to "high risk" patients to help elminiate the higher acuity, high cost spending. This is the goal of accountable care organizations but so far studies are not showing the successess that ACOs expected.
 
Deacon923 said:
The simple fact is that in order for US health expenditures to come down to levels commensurate with those in comparable countries, almost every participant in the health marketplace is going to have to make less money. That includes big pharma, medical device makers, physicians, hospital executives, everyone. Other countries with heavily single-payer systems, even where there is also private insurance in the mix, have been able to hold these participants' profits down by government fiat or market power. They simply pay far less for drugs, hospital stays, physician services, everything. They balance this out, in part, by other spending such as making sure their doctors are trained at the expense of the state instead of required to take out hundreds of thousands in loans that must be paid back out of exorbitant doctor salaries.
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We have a shortage of Drs in this country and it's projected to worsen as the population ages. "Importing" Drs from other countries is one solution. As you said Drs can make more here so this approach is a realistic option. We could also loosen our standards making it easier to become a physician domestically. If we don't do either of those things we will exacerbate the shortage by reducing net compensation to Drs. We have raised their taxes substantially in the last few years. I don't want to see the result of a major pay reduction on top of that increase.
 
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Deacon923 said:
You can blame obesity and med mal and defensive medicine and end of life all you want, but the fact is all that could be overcome if we weren't paying $30 for a !&*$ing aspirin.
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Before Medicare, we weren't paying $30 for a !&*$ing aspirin. In an amazing coincidence, just about any time you force one person to pay another person's bills, that second person's bills go way, way up. Government "studies" just can't seem to figure out why.
 
Deacon923 said:
You appear to be ignorant on this subject. You can begin to educate yourself here: http://theincidentaleconomist.com/wordpress/private-vs-public-health-care-cost-control-faq/
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So you think that when one person is forced to pay a second person's bills that the second person use less of that good or service? You appear to be quite ignorant on this subject. You can begin to educate yourself here:

http://www.cato.org/publications/policy-analysis/why-health-care-costs-too-much
 
DreamOnDemOn said:
So you think that when one person is forced to pay a second person's bills that the second person use less of that good or service? You appear to be quite ignorant on this subject. You can begin to educate yourself here:

http://www.cato.org/publications/policy-analysis/why-health-care-costs-too-much
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I read Cato as much as you do, I suspect, and I have read that policy analysis. Cato places the blame on ALL third party payors, public and private, for removing the purchasing decision from the consumer. It is quite indisputable that private third party payors pay more for health care than public payors. In fact, that was the express reason the healthcare industry got so upset over Hillarycare in the 90s and fought any "public option" in Obamacare in 2009 - they knew that single payer would pay them less, and there was a great hue and cry over how that would dampen innovation and patient care etc. etc.

If you are going to argue over this, you need to learn some facts, not just opinions, and the fact is that Medicare holds costs down better than any private insurer.

Now, if you are trying to argue that we ought to abolish insurance entirely, the Cato paper is relevant. But you started this out by expressly blaming Medicare and "force" for rising costs, when in fact the private un-"forced" sector pays far more for care. What argument are you trying to make?
 
Deacon923 said:
I read Cato as much as you do, I suspect, and I have read that policy analysis. Cato places the blame on ALL third party payors, public and private, for removing the purchasing decision from the consumer. It is quite indisputable that private third party payors pay more for health care than public payors. In fact, that was the express reason the healthcare industry got so upset over Hillarycare in the 90s and fought any "public option" in Obamacare in 2009 - they knew that single payer would pay them less, and there was a great hue and cry over how that would dampen innovation and patient care etc. etc.

If you are going to argue over this, you need to learn some facts, not just opinions, and the fact is that Medicare holds costs down better than any private insurer.

Now, if you are trying to argue that we ought to abolish insurance entirely, the Cato paper is relevant. But you started this out by expressly blaming Medicare and "force" for rising costs, when in fact the private un-"forced" sector pays far more for care. What argument are you trying to make?
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Medicare does pay providers less. In fact, it pays so little that physicians are starting not to accept it and oldsters are going to have trouble finding a physician even though they have "insurance". But it most certainly does not hold down health care costs for the simple reason that CATO points out. Costs for Medicare and Medicaid have increased a lot--and a great deal of Medicare is used in the last few months of life where it often does no one except the hospital any good. Medicare tries to stiff the hospital and the hospital figures out ways around the roadblocks and gets themselves a good chunk of the tax booty anyway. This is why you pay $30 for a !&*$ing aspirin. Look at the way they string physicians along every year with threats of decreasing their pay again.

A much better system is what we had before large scale government involvement with tax incentives for business provided insurance and then out and out forcing one person to pay for another person's helath care: people insured themselves as they saw fit based on what their needs were. Insurance was very cheap. Insurance paid the provider a decent amount and the provider charged a decent amount. That is now completely screwed up as $30 !&*$ing aspirins demonstrate.
 
Oh OK. So the reason that health costs are high is that medicare pays too little. I see. That makes total sense. Does your grand theory also explain why ever other country with more public /single payer options spends far less on health care, with similar and often better outcomes, than the the us?

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