How can you add 30,000,000 million people to a program and reduce costs?

Discussion in 'Too Hot for Swamp Gas' started by dadx4, Aug 2, 2013.

  1. dirigo
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    dirigo Member

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    Sorry to rain on your parades, QGa and olph, but your pal asked the board a question and I gave what I believe to be viable answer. Why don't you two give it a shot. Check your anger at the President at the door and contribute something to the discussion.
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  2. gatordowneast
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    gatordowneast Well-Known Member

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    Dirigo, you gave a detailed and thoughtful response. My answer would be within your answer...there is likely far better ways to approach the end result we all want which is access and holding down or reducing costs for all. So rather than cram a monstrosity down the throats of a very diverse nation with a mix of rural, urban, suburban, ethnic, racial issues, why not allow the states to serve as our "laboratories or incubators" and come up with best practices at the 5-10-15-20 year marks?

    For example in Maine (I'm assuming you are here or from there) the Exchange costs for rural residents in Aroostook Co and other locations will be far higher than in Southern Maine. Yet incomes in those counties are far less. I think we can do better.
  3. Swamp_of_Gators
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    Swamp_of_Gators Well-Known Member

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    30,000,000,000,000 is a lot of people...
  4. surfn1080
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    surfn1080 Well-Known Member

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    Do you really believe the ACA is going to reduce cost? Do you really believe insurance premiums are going to go down? I don't want to be a patient on a list that has to wait 2-3 months to see a doctor for a cancer or something serious.

    The ACA didn't fix any of the problems in our current system. It actually jacking up prices and now our shortage of doctors have to treat 30m more people. You throw crap at crap and you get crap.

    By the way how are most the euro countries doing financially?
  5. ncbullgator
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    ncbullgator Well-Known Member

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    So let me get this straight.

    Dirigo agrees that many of his hard working, privately employed neighbors will have to pay siginifcantly more to fund the insurance costs of the 30M slackers who pay nothing and want to keep it that way.

    But that's ok because it would help his "business" competes with European companies.
  6. QGator2414
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    QGator2414 VIP Member

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    You say you favor the obamacare and imply that it is because you have to compete with other countries based on healthcare premiums. I am assuming you provide insurance for your employees based on that and it would make you the first company I know that is benefitting from lower premiums now (Fred on too hot says their rates when down recently but switching plans and refusing to disclose the difference in coverage (copays and deductibles) leaves some questions.

    We pay 100% of our employees premiums and I am really concerned about that changing at the end of the year. Another increase like this past year and we probably have to ask the employees to contribute something. Thanks to the wonderful aca if we ask them to contribute 10% we cannot keep the current plan.

    This law is a flipping disaster and I would challenge you to call 10 doctors, 10 accountants and 10 business owners that provide insurance for their employees to get a good idea about this mess.
  7. gatordowneast
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    gatordowneast Well-Known Member

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    Q, those in love with Obamacare likely think they are getting it for free. Or, they have been exempted and someone else is paying their tab. So again, typical libbie lefty bullshit...ok for thee but not for me.
  8. dirigo
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    dirigo Member

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    I'm not sure where to begin. First, I am far from a liberal. I was a registered Republican (as were my parents, grandparents, great-grandparents; if you know anything of the history of the State of Maine you'll know what i'm writing about) until a few years ago (Reagan and Bush 41 both times and 43 the first time) but why is that even relevant to a discussion among college educated individuals focused on perhaps the most significant social issue of our time. The, "yeah, but your mother wears army boots" has dragged this site down to the point that its value as a forum to exchange reasoned arguments is in doubt to most who visit.

    To reiterate the core of my argument, I believe that what we're seeing with the ACA is the first step of a generational sea change in the financing of our healthcare, certainly in the healthcare of the working poor and those that the free market has (probably rightfully) excluded. It will certainly impact traditional delivery but in the end its much more about the money. Beyond that there will be the ever-present unintended consequences. Some, maybe most, will be bad (eg., 30M+ new users seeking the sort of access those of us who visit this board take for granted without a commensurate increase in the capacity of the provider networks) but believe it or not some will be good. It will be years before it will have any significant positive impact on the competitiveness of US business, but I believe it will come. Its already bring us volumes of new information on the pricing of most treatments and surgeries. That was unheard of even 5 years ago. And yes, there will be Congressional action to improve what everyone has known was a flawed bill - remember how the election of Scott Brown in Mass. required the then Dem controlled House to accept the Senate bill whole-hog to prevent any compromise from the Conference going back to the Senate to then be filibustered to death.

    From a macro view the basic system of delivery of healthcare has not been changed in any dramatic way. Sure, there will now be an additional 30M+ competing with "us" for doctor appointments and OR time but the same providers who will treat/heal us will continue to be privately owned and they, big pharma, and the DME industry will continue to receive almost all of their revenue from the same trinity of payers (insurance companies, Medicare and Medicaid) that have been paying them for years.

    Not to be cute but one could make a straight-faced argument that in 2009/10 Obama and the then Dem controlled Congress basically said something like this to the Republicans and Libertarians:
    "We all agree that our current healthcare system is a disaster (out-of-control costs; the single largest generator of personal bankruptcies; etc). We just disagree on how to fix it. The libs want Medicare for everyone or worse yet a state run system. The cons don't want much of anything to change, save the ability to sell across state lines and the dramatic cut back in the public to pursue alleged medical malpractices). So we'll just "punt". We'll keep all the structural components of the existing system that you like so much but you will directly shoulder (through insurance premiums) a much larger share of the cost of the very poor, the working poor, and perhaps the most expensive sector of the users/patients - the uninsurable. We did that for decades with your taxes but we all realize that's been an abysmal failure so we'll reduce the role of government as the middleman (calm down, I wrote "middleman", the overall role of government won't change much at all). We'll also give you lots of information that you've never had before so roll up your sleeves and use this information and your free market instincts and together we can slowly but surely bring about significant improvements."

    Downeast, I'm very familiar with what's going on in the Pine Tree state. Their problems, as you've described (and there are more) were not unpredicted or unable of solution when both sides of the aisle finally decide its time to act. Your solution - let the states act as test sites - is a good idea but suffers from a few significant flaws. There is an extremely wide disparity in the resources available to the separate states to bring to bear on solving their state's problem. Think Maine v Connecticut or Mississippi v Texas, not to mention at least as wide a disparity in how each state perceives the importance of this problem. Think Massachusetts and Romeycare v Texas with an uninsured rate that is 1.5 to 2 times the national average. Beyond that you have to admit that we already have lots of data from 2 such test sites. First, the residents of Massachusetts overwhelmingly support Romneycare. On the other hand the experiment undertaken by Washington state (and I believe another half dozen or so) in the 90s (universal coverage/no exclusion for pre-existing condition) without an individual mandate was an abject failure - spiraling premiums quickly followed by the mass exodus of health insurers from that market. Finally, this is truly a national problem that demands a nationwide comprehensive solution.

    I hope that those who read this see it for what it is - one old man's analysis of how we got to where we are and my hope as to how we may be able to make it better. At my age I probably hate change more than most on this board and believe me from a selfish point of view I'd be more than happy to just maintain the old system. However down deep I know it's unsustainable and I suspect most of you agree with that limited thought.

    Now lets debate it. I look forward to learning what I've missed as well as the new ideas from your reasoned arguments but to those who only think in terms of ad hominem abuse, don't waste our time. .
  9. Row6
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    Row6 New Member

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    Easy in principle:

    1 Spread risk through more insured
    2 Provide more efficient service, including no more ER room as a GP visit.
    3 Study effective care and promote their use
    4 Move care to results based instead of procedure based
    5 Anyone for tort reform? If republicans had a lick of sense they'd be negotiating to get it in reform package which Obama indicated 2 years ago in the SOTU speech he welcomed. They seem to prefer j..k off votes on repeal which serves no other function than as porn for the right.
  10. HallGator
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    Well said.
  11. jimgata
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    jimgata Premium Member

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    Are we really mandating everyone to have insurance? The fines for not having insurance are low. When those that do not buy insurance and wait until an illness to buy insurance, will put an additional burden on health costs. The CBO even projects that after a decade of Obamacare, 30,000,000 will still be without insurance.
    It appears that a lot of changes are being made that will only result in more expense and probably less care.
  12. vangator1
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    vangator1 Well-Known Member

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    This is "liberalland". Anything is possible.
  13. Row6
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    Row6 New Member

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    Quite well on health care compared to us. They spend on average 60% of what we do with roughly equal health stats and patient satisfaction measures.
  14. gatordowneast
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    gatordowneast Well-Known Member

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    Dirigo, I do think most would not disagree that the current system of health care delivery and financing is broken for some. But when we survey those with insurance whether provided for by their employer or purchased on their own, they are fairly satisfied with their health care when they need it. Those on medicare and supplemental plans, are likewise, fairly satisfied. All who are paying the tab will also likely agree that prices have risen at an unsustainable rate.

    So, how do we slow down the costs while providing options for the 30-50 M without insurance? I just don't see how turning our current system upside down with the ACA will accomplish either. We are about to piss off the majority who are fairly happy to hopefully accommodate those without coverage.

    Perhaps we should have just addressed those without coverage without screwing with those who do?
  15. QGator2414
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    QGator2414 VIP Member

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    Let's get rid of the middleman. The problem is that means removing power from government and in our current quasi fascist system that will not happen sadly.

    No more mandated coverages.

    Allow small businesses to group with their trade associations.

    Allow people to shop across state lines for insurance.

    Push HSA's (what insurance really is...coverage against catastrophic loss).

    Allow NP's and PA's to own their own practices.

    Etc etc etc...

    Simple less intrusion by the government. Instead we got 2700 pages that did not address costs that we had to pass so we could find out what's in it. That is a disaster!
  16. asuragator
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    asuragator Well-Known Member

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    You are right in that those with insurance tend to be satisfied with it. That is clear. As are those with medicare and supplemental coverage. And I think you raise good questions about the unsustainability of the costs and that we need to address them.

    I'll try to keep it as less partisan as possible b/c I think there's a good discussion to be had, but let me at least say that this has been a problem for twenty years. We've had increasing costs, millions of uninsured (many of whom use emergency medicine for routine care), and families who have done everything right but lose everything to catastrophic illnesses and death. These are real problems affecting real Americans, all of us. And it's hard to listen at times to the pubs who did absolutely nothing for twelve years about these costs while they had control of congress and who still don't have a viable way to address it besides nonsense votes to repeal. That said, I don't think the ACA will be sustainable as it is. It will need tweaks and the dems have a hand in actually coming up with a better way of doing things that isn't just anti-republican.
  17. asuragator
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    asuragator Well-Known Member

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    On a related point downeast, I don't agree with you that we are about to piss off people as much as you think, and some of those that will get pissed are actually just primed to anyway. But even though some will be pissed and anything major like this takes adjustment(s), it is a start toward addressing this problem. I mean, as much as some like to taut our capitalist society; other countries that we compare ourselves too cover everyone in some way and they show just as much if not more satisfaction (recognizing that no system is perfect and people in all systems have legit complaints), and they also do it at less of a percentage of our GDP.

    Also, there is a divide in public perception and individual components of the ACA versus the whole thing. Majorities have been shown to like many facets of it individually even if they seem not to like entire kaboodle. That might speak to a bit of discordance in understanding as much as anything else.

    Personally, I don't know the answers to a fix but I do know that
  18. gatordowneast
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    gatordowneast Well-Known Member

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    On people getting upset, it is with rates. My sister in law has her new rates... up 24% for exact same coverage with BCBS. She is on a fixed income due to her husband's death. She has 3 kids under age 16 and the family coverage went from 950 to 1200/monthly. Fairly significant. Several of our clients (F500) coverage is changing pretty dramatically with employees shouldering larger costs, copays and larger deductable. I would assume that is due to rates going up substantially for the company.

    I would guess we will all be paying more for less. In some cases our costs will be dramatically higher so people will choose a lessor level of coverage.
  19. QGator2414
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    QGator2414 VIP Member

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    Did they have a supermajority like the dems at any point like the dems recently did?

    Just had to be a little partisan... ;)

    That said I agree the pubs failed just like the dems...

    The root of the problem is Medicare which is well liked by those who have been receiving more than they paid for. But Medicare began the massive intrusion by government into healthcare. That along with the inability to represent and now we have a quasi fascist system that is getting worse by the day. Obamacare expedited this shift unfortunately.
  20. asuragator
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    asuragator Well-Known Member

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    I am no health care expert so I can't speak to the increase in your sis-in-law's rates. However, there is probably more to it than just the ACA. In many places, the rates would have gone up anyway. But also, we have yet to have the all those uninsured enter the market, which with the subsidies is as has been reported expected (or maybe hoped, depending on ones level of cynicism) to offset the increases and actually reduce costs.

    The reason I question how much it has to do with ACA is that one of the provisions is that there is expanded coverage for everyone that is required by law (which is one of the items that increases rates) so it seems odd that it went up and then she only gets the same coverage.

    In any case, I prefer a single payer or universal coverage. I tend to think that if other countries we compare ourselves to that can do it and do it pretty well for less with similar or better customer satisfaction while getting all folks covered, why can't we?

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