FED says Obamacare slowing hiring, sales.

[gator421]

Originally Posted by CHFG8R

It would be the common sense approach, IMO. Either do it or don't, but don't waste everyone's time (and money) on colendar legislation like this. I mean, couldn't you just expand Medicare, in essense, to cover everyone? No more need for medicaid and insurance companies could sell supplimental packages.

I've even talked to employers and one of the major issues they (and many for that matter) have with ACA is the uncertaintly of exactly how it's going to affect cost. Nobody knows because it's such a complete cluster. . . .

With single payer, at least you know what your cost is going to be, what percentage of your revenue you will contribute and your costs are, more or less, fixed.

Again, I'm not saying I fully support single payer, but it makes exponentially more sense than this patchwork, nonsensical attempt to cover everyone while still throwing bones to the insurance companies.

This bill was passes because, well, they wanted to pass it (victory over the opposition). By they time they voted on it, it was a joke and everyone knew it.

I'm not disagreeing with you. I think medicare is an excellent template for national healthcare.

[CHFG8R]

Originally Posted by 108

health care reform will never be worth it to conservatives unless their man in charge passes it, and therefore any potential consequences in implementing will not be worth it

Exactly. Same game plan that "your team" engaged in when they rammed ACA down the country's throat.

Political spoils once again trumping objective decisionmaking.

[108]

Originally Posted by mastoidbone

while we needed reform----this bill was terrible legislation.
It WILL increase coverage which is good---but cost control measures are 100% unproven.
ACO models tried in past have FAILED.

So i think ANY cost estimate is a total guess--nothing else. Might be correct---or could be wrong by usual amount when it comes to govt cost forcasts on health spending---30-50%.

It is just like guns---the desire to be seen doing something---regardless of how it does or does not help the problem--means doing something....even if it is bad legislation.

And the ACA is bad legislation with VERY weak cost controls.

i agree with most of what you said, so the question is, why aren't are elected leaders trying to improve its cost controls?

rhetorical que$tion

[CHFG8R]

Originally Posted by 108

i agree with most of what you said, so the question is, why aren't are elected leaders trying to improve its cost controls?

rhetorical que$tion

For the same reason your side caved to insurance companies, that's why. Money. Lobbying. The need for victory over the opposition.

[Row6]

Originally Posted by CHFG8R

Row, let's get down to brass tax, okay? You and I both know that the insurance companies are the problem here from the (D) point of view and that the goal is to essentially cut them (more important, their ability to make decisions that affect our health) out of the process. But your team feared the lobbying onslaught they would engage in if you did cut them out, so you threw them a bone (after consulting with them no less). Now, that said, still worth it? Did it still accomplish the goals?

You saying that you trust them now? Because I don't. My deductible went up $1000 this year and I had a $250 prescription deductable added all while taking more out of my check. Sorry, Dude, just not seeing any benefits at this point.

But, hey, your team did make the (R)s eat crap on this. So, I guess you have that.

Putting aside who's team is who - this bill was essentially Bob Dole's plan - I don't trust insurance companies or anyone without oversight. My understanding of insurance exchanges however will be open competition based on set minimum standards that individuals will be able to buy from irregardless of their being part of a larger group as is now the case. This seems to employ competition - not trust - as the determiner of charges.

In the bigger picture, up until the recent ascent of the tea party both parties agreed - since Nixon - on the necessity of a national health care plan. The explosion of costs - especially when compared with the rest of the world - has made that wish an imperative. Yet for over 40 years none was passed. We have now a law in place which is the camel's nose in the tent and which can be modified - and hopefully for the better - by whichever party is in power, or hopefully by the agreement of both. That is no small achievement and one to celebrate and build on.

[Row6]

Originally Posted by CHFG8R

For the same reason your side caved to insurance companies, that's why. Money. Lobbying. The need for victory over the opposition.

I think you have the sides confused here. Republicans opposed stronger cost controls and continue to decry the ones it contains as death panels. If some Republicans had joined in compromise they might have gotten some demands in the bill - like tort reform - and Democrats wouldn't have been so beholden to people like the Senator from Hartford - Lieberman.

[CHFG8R]

Fair points Row. I guess the whole system is what frustrates me. Instead of just doing what's right, we have the nose-in-tent approach. Which in short, as I see it, means this will fail miserably and will eventually have to be bailed out by a single-payer system.

Sad that we can't just get things right the first time around and have to play all these f-ing games.

[Row6]

Originally Posted by CHFG8R

Fair points Row. I guess the whole system is what frustrates me. Instead of just doing what's right, we have the nose-in-tent approach. Which in short, as I see it, means this will fail miserably and will eventually have to be bailed out by a single-payer system.

Sad that we can't just get things right the first time around and have to play all these f-ing games.

I agree, but that's how compromise works in a democracy. It's messy. I recommend the movie "Lincoln" as a graphic example of the process.

[mastoidbone]

Medicare has its own problems.
Does not decrease utilization for one.
Makes massive mistakes--like anesthesia payments.

Medicare usually pays 80% of commercial.
It pays anesthesia 25%.

Meaning they expect anesthesia providers to work for $20-30 an hour. Thus happened in 1993--causing 90% decrease in applicants for residency. The markets made up for it---but now 20 years later govt STILL has not fixed the problem despite govt investigations finding the error.

Without markets--there would be little anesthesia services available.
So mistake by Medicare as a single option can wipe out health care access.

[Row6]

Originally Posted by mastoidbone

Medicare has its own problems.
Does not decrease utilization for one.
Makes massive mistakes--like anesthesia payments.

Medicare usually pays 80% of commercial.
It pays anesthesia 25%.

Meaning they expect anesthesia providers to work for $20-30 an hour. Thus happened in 1993--causing 90% decrease in applicants for residency. The markets made up for it---but now 20 years later govt STILL has not fixed the problem despite govt investigations finding the error.

Without markets--there would be little anesthesia services available.
So mistake by Medicare as a single option can wipe out health care access.

Solutions? - that is other than tort reform. That is not the cure all you and other docs claim.

[mastoidbone]

Medicare making all rules can have devastating effects. That simple decision chased thousands of cases to be cancelled due to lack of providers. Hospitals simply could not get people to work and residency programs had to import med school grads from china to fill ORs at shands for example--which caused many problems and one death I am aware off.

Single payer can work---but if you make a payment mistake and don't listen to docs (like Obama) you can wipe out an entire specialty most people desire!

Why does Medicare seem to think Anesth should be paid less then factory workers with a HS degree?
How much confidence should we have if in 20 years they still have been unable to fix Anesth payments?
Is 20 years to short a time for govt workers to fix a problem?

[mastoidbone]

Tort reform is a solution to reducing defense medicine---200 billion a year Obama is choosing not to save to provide favors for a giant donor of his--trial lawyers--who donate 90% to dem party--shocking dems are against tort reform--shocking.

But tort won't do much for access to care.
But tort plus end of fee for service might save 200 billion a year and fix our budget in 5 years--but would hurt trial lawyers--so Obama is against meaningful refor
.
He gives lip service to subject--but is on record being against caps--which are bedrock of true reform.

[108]

Originally Posted by CHFG8R

For the same reason your side caved to insurance companies, that's why. Money. Lobbying. The need for victory over the opposition.

Exactly

When they have so much power to influence campaigns, our elected leaders bow to them

[108]

Originally Posted by mastoidbone

Tort reform is a solution to reducing defense medicine---200 billion a year Obama is choosing not to save to provide favors for a giant donor of his--trial lawyers--who donate 90% to dem party--shocking dems are against tort reform--shocking.

But tort won't do much for access to care.
But tort plus end of fee for service might save 200 billion a year and fix our budget in 5 years--but would hurt trial lawyers--so Obama is against meaningful refor
.
He gives lip service to subject--but is on record being against caps--which are bedrock of true reform.

Can you provide a link to that $200 billion a year number?

[mastoidbone]

There are some studies--i will link when home.
To do a gut check--ask a doc you know what percent of health care, tests, imaging, etc are defensive---number my colleagues banter about is 20-30%.

health care spending is 2.5 trillion. Let's Assume docs are wrong and it is 10%---that is still 250 billion a year.
And it is MORE then 10%---ask any medical professional you know.

[Gatorrick22]

Originally Posted by Row6

Gee, if this is true that's too bad, especially given how efficient and inexpensive US health care had been before the law, and how eager employers had been to cover everyone.

It's just an outrage that every single effect of a complex law which will impact tens of millions of Americans is not 100% positive. How could this be?

A great alternative to the ACA would have been lowering the cost of healthcare in the first place. The Pubs put several ideas that would have done just that, but BO poo-pooed that in favor of complete government control.

[Row6]

Originally Posted by mastoidbone

Tort reform is a solution to reducing defense medicine---200 billion a year Obama is choosing not to save to provide favors for a giant donor of his--trial lawyers--who donate 90% to dem party--shocking dems are against tort reform--shocking.

But tort won't do much for access to care.
But tort plus end of fee for service might save 200 billion a year and fix our budget in 5 years--but would hurt trial lawyers--so Obama is against meaningful refor
.
He gives lip service to subject--but is on record being against caps--which are bedrock of true reform.

To repeat, solutions? Cut the tort reform crap. Whatever it's benefits - and there may be some - multiple studies and the cost of health care in states where it's been enacted show it's not a game changer. tell us what else you've got.

[mastoidbone]

links on costs
up to 600-800 billion a year-----too bad obama is owned by trial lawyers...
http://www.jacksonhealthcare.com/med...book_final.pdf

Physicians estimate the cost of defensive medicine to be in the $650-$850 billion range, or between
26 and 34 percent of annual healthcare costs in the U.S.
Ì Physician compensation accounts for only about eight percent of total U.S. healthcare costs
Ì About six percent of physicians’ total compensation comes from medical orders such as prescriptions,
imaging, lab tests, admissions and surgery fees
Ì Many physicians reported practicing “rule-out medicine” rather than “diagnostic medicine” out of fear that
they will miss a diagnosis and be sued
Ì 76 percent of physicians reported that defensive medicine decreases patients’ access to healthcare
Ì 53 percent reported delaying adoption of new medical techniques, procedures and treatments due to fear
of lawsuits
Ì 75 percent of physicians believe defensive medicine will adversely impact the physician shortage

http://www.stanford.edu/~jay/health_...e_medicine.pdf

http://www.aaos.org/news/aaosnow/dec10/advocacy2.asp

If the Kessler and McClellan estimates were applied to total U.S. healthcare spending in 2005, the defensive medicine costs would total between $100 billion and $178 billion per year. Add to this the cost of defending malpractice cases, paying compensation, and covering additional administrative costs (a total of $29.4 billion). Thus, the average American family pays an additional $1,700 to $2,000 per year in healthcare costs simply to cover the costs of defensive medicine.

http://www.amjorthopedics.com/PDF/041020069.pdf

http://www.massmed.org/AM/Template.c...ONTENTID=27797

[mastoidbone]

not a game changer?
i guess 100-200 billion a YEAR is not a game changer----and i get it----you think 1 trillion deficits are no big deal---just steal it from the kids----i get it.

To most of us---saving 100-200 billion a year at cost of offending trial lawyers is a game changer.

[mastoidbone]

to be complete----other way to save HUNDREDS of billions is end fee for service and ration care...2 pretty simple ideas that face tremendous obstacles.

rationing is easy---develop ( already available) criteria upon admission of certain patients on what is there probability of benefiting from intensive care---if low---admit to hospice instead of icu.--this IS a death panel based on scientific criteria and probability. IF family wants to pay out of pocket---go ahead---but not medicare dollars.

fee for service is more complicated. We work FAR more hours then most other professionals including 24 hour shifts, entire weekends, etc. If we are to be salaried we WILL work less---so costs for physician services may actually need to go up while this creates OVERALL reduced utilization and savings.