The very real impact of Obamacare opposition, in one map

[Helix]

*Snipity On* People die in the streets of all countries (that have streets). The difference is that in first world countries, they typically don't die of starvation; they die in a car crash. I'm not sure what you mean by this. *Snipity Off*

i was using hyperbolic language, which i shouldn't have done. however, the "sink or swim" thing when it comes to health care and the ability to pay really annoys me. first world nations don't do that.

In terms of care. I think government should get out of the healthcare as much as possible besides maybe regulating for safety (driven primarily by the appropriate private professional medical associations) and funding research. I think healthcare should be based on personal choice, responsibilty, and charity; it shouldn't be based on coercive taxation, beurocracy, and government subsidization.

i just don't agree at all. health care is an essential service with inelastic demand, and on top of that, geographical location is a critical factor. i don't see an unregulated market working well in that scenario.

 

[Renae]

Hmmm if the source is so bad.. then it should be easy for you to refute it.. ..

Or you can run away.

The sources, he was using to refute my original information, which still stands. Try reading instead of looking for spots to be witty, you MIGHT have some more success there.

 

[CycloneWanderer]

i was using hyperbolic language, which i shouldn't have done. however, the "sink or swim" thing when it comes to health care and the ability to pay really annoys me. first world nations don't do that.



i just don't agree at all. health care is an essential service with inelastic demand, and on top of that, geographical location is a critical factor. i don't see an unregulated market working well in that scenario.

What? In a world where doctors voluntarily fly around the world, literally risking life and limb, you believe that we just don't have the people or the technology to care for each other?

In essense, you just don't think certain people have the capability to "swim" when adequately motivated by their own personal well-being? I implore you, what certain groups of people do you believe have not the potential (read: capability) to care for themselves directly or through voluntary collaborative endeavors?

 

[jaeger19]

lots of ways to pay for it. a couple ideas :

no more pro bono global military actions. if the rest of the world wants an army, it can build and fund one. the US does a lot in the Middle East that Saudi Arabia, as regional hegemon, should be doing.

Like it

all income taxed as income above a cap.

Like it

legalized pot; excise tax

Yep.. need to regulate for safety though.. and consistency in dosing for medical reasons.

Also should come up with a safer alternative drug that's an "upper" and make it legal. I think if we cover both sides of the spectrum with better controls.. the need for an unsafe market will decline.

return to 1990s income tax levels for all brackets
and if that still doesn't fill the gap (which these combined measures certainly would,) we can look at a low percentage national sales tax.

Two very bad ideas. First.. its the effective tax you pay.. not the "tax bracket"... raising brackets has now effect if you have so many special deductions that segments of the population can avoid taxes, particularly the most connected that can afford a tax increase. the reality is that if we returned to a 1990's tax bracket it would likely hit the poor and middle class the most and hit them hard and hurt our economy.

A national sales tax is a terrible idea, Besides being regressive and hurting business in this manner... because the tax would effect higher priced goods.. which encompass most American made goods.. it would make goods from countries like china even more competitive.

addressed above

. Not really as pointed out above.

Medicaid is pretty decent, but you have to be very poor to fully reap the benefits. i had several friends on it when i was younger, and it paid for everything. of course, it's different these days in my state, as we've elected a Republican supermajority, and they do not like Medicaid.

Medicaid for adults pretty much sucks.. its better than nothing but as a health coverage it sucks.. Medicaid for long term care is a great deal. And that's having businesses in liberal states as well as red states. In fact an irony... I would MUCH rather deal with Medicaid in a Red very conservative state than the monumental FUBAR that is in one of the liberal states I own facilities. In fact.. we do not accept Medicaid in this state.. (only for long term care facilities.. and then only for assisted living).

has to be done. the current costs aren't realistic. surgeons are going to have to get paid less, we need more doctors, and malpractice suits are going to have to be seriously addressed.

Surgeons paid less.. GP's get paid less and you get fewer doctors. Pretty simple.. already seen it to a degree. Its going to be worse in a few years. I've watched my competition decrease in the area except for large hospital systems (larger than ours) People have fewer surgeons in the area.

Malpractice has to be addressed as does the other costs of being a provider.. not just tort reform.. but education, documentation costs, compliance costs etc. Those costs continue to climb while reimbursement has gone down. I am reimbursed less per patient NOW than I was 10 years ago.. my operating costs have not gone down. The reason that I have been able to continue to make it is on expansion of new business, and because I managed to have no debt that had to be serviced. Thats why I don't get new competition in the area except for extremely large chains.

The "doctors make too much" is simply a lame explanation for whats happening in the market. Its amazing to me how some folks will cry "teachers make too much",,. then get amazed that the teachers that they recruit suck or if they are good and smart.. end up going into other careers. but then the cry is "doctors make too much" but there is no thought that their could be any negative consequences of that.

they are going to have to negotiate a lower price, and providers are just going to have to make salaries more comparable to Europe. cost is the biggest issue, and we need to have a serious discussion about bringing costs down. what i support is one idea, and there are others, as well. but we really need to look at this problem and get serious about fixing it.

Again.. I don't think you are going to be able to get lower prices without serious consequences. Salaries more comparable to Europe would especially have serious consequences and would mean decreased care, decreased availability of physicians in this country. There are other ways to lower costs without having to lower prices. One of the biggest issues is not on how much an individual procedure costs.. but in what is ordered and the amount its ordered. For example.. I see a patient, they have an obvious problem that needs a test ordered. They get the test... yep.. I'm right.. and they need a referral to surgery. The surgeon orders the same dang test AGAIN. Why? They will say its because of insurance.. but that's bull puckey. Its because they are in a hospital system that encourages them to order as many tests as possible as its a great money maker. The truth is.. you lower reimbursements further? My facilities would have to do that.

You can say.. lower salaries.. sure.. you lowering my insurance? Lowering the cost of education? Lowering the cost of square footage? Lowering marketing costs? so on and so forth?

 

[jaeger19]

The sources, he was using to refute my original information, which still stands. Try reading instead of looking for spots to be witty, you MIGHT have some more success there.

The information from his sources is still correct and so far you have not presented anything that takes from that. Or do you have evidence that said sources data is faulty.? You might try reading a little more.. and then you might have more success here.

 

[Renae]

The information from his sources is still correct and so far you have not presented anything that takes from that. Or do you have evidence that said sources data is faulty.? You might try reading a little more.. and then you might have more success here.

I already debunked his posts, before he posted them.

 

[jaeger19]

they certainly aren't. we have social safety nets, and we have universal health care already. i just want to fix it to make it better.

Agreed and I want to do better to.

i would actually really like it if there were more moderate Republican candidates

Actually you want REALLY conservative republican candidates.. not this perversion that's been come to be called conservative...

"we believe in smaller government.... and that woman has to have a vaginal ultrasound if she wants an abortion"

We believe in smaller government except we get to tell you who you can marry"...

Please.

 

[jaeger19]

I already debunked his posts, before he posted them.

Nope.

 

[Renae]

Nope.

Okay, we'll then we'll agree to disagree. He already admitted he didn't believe that longer wait times kill people, why should I waste time with more "proof" after that?

 

[Helix]

What? In a world where doctors voluntarily fly around the world, literally risking life and limb, you believe that we just don't have the people or the technology to care for each other?

In essense, you just don't think certain people have the capability to "swim" when adequately motivated by their own personal well-being? I implore you, what certain groups of people do you believe have not the potential (read: capability) to care for themselves directly or through voluntary collaborative endeavors?

access to health care should not be connected to the ability to pay. and right now, it isn't for the poorest. it is the lower middle class and those above the poverty level who are falling through the cracks.

we already have universal health care. however, our universal health care is the most inefficient in the first world. we need to fix that.

 

[Helix]

Yep.. need to regulate for safety though.. and consistency in dosing for medical reasons.

Also should come up with a safer alternative drug that's an "upper" and make it legal. I think if we cover both sides of the spectrum with better controls.. the need for an unsafe market will decline.

yep. i'm for a phase out of the drug war. we'll have to have a national discussion about what to do about the really dangerous stuff, like opiates.

Two very bad ideas. First.. its the effective tax you pay.. not the "tax bracket"... raising brackets has now effect if you have so many special deductions that segments of the population can avoid taxes, particularly the most connected that can afford a tax increase. the reality is that if we returned to a 1990's tax bracket it would likely hit the poor and middle class the most and hit them hard and hurt our economy.

with our level of debt and the country's immediate needs, it's only fair if everyone chips in something, IMO. not just the rich.

A national sales tax is a terrible idea, Besides being regressive and hurting business in this manner... because the tax would effect higher priced goods.. which encompass most American made goods.. it would make goods from countries like china even more competitive.

i admit that i hate the idea. however, you have to take into consideration that if employers don't have to provide health insurance for employees, that will more than offset any low percentage sales tax. our businesses have to compete against foreign businesses right now who are not saddled with that responsibility.

Medicaid for adults pretty much sucks.. its better than nothing but as a health coverage it sucks.. Medicaid for long term care is a great deal. And that's having businesses in liberal states as well as red states. In fact an irony... I would MUCH rather deal with Medicaid in a Red very conservative state than the monumental FUBAR that is in one of the liberal states I own facilities. In fact.. we do not accept Medicaid in this state.. (only for long term care facilities.. and then only for assisted living).

the problem is that you have to liquidate all assets before medicaid will pay for long term care. this can easily amount to a one hundred percent death tax paid to the health care industry. i've actually heard people express the sentiment that they hope that they die quickly so that they can leave their kids something. that bothers me a lot.

Surgeons paid less.. GP's get paid less and you get fewer doctors. Pretty simple.. already seen it to a degree. Its going to be worse in a few years. I've watched my competition decrease in the area except for large hospital systems (larger than ours) People have fewer surgeons in the area.

i work at a med school. the cost is horrendous, and there are strict limits on how many students are admitted. i would increase the supply of doctors and surgeons, and have them working fewer hours (which we should be doing anyway for safety reasons,) and pay them similarly to doctors in Europe and Canada. other first world countries don't have any problem finding good doctors.

Malpractice has to be addressed as does the other costs of being a provider.. not just tort reform.. but education, documentation costs, compliance costs etc. Those costs continue to climb while reimbursement has gone down. I am reimbursed less per patient NOW than I was 10 years ago.. my operating costs have not gone down. The reason that I have been able to continue to make it is on expansion of new business, and because I managed to have no debt that had to be serviced. Thats why I don't get new competition in the area except for extremely large chains.

agree.

The "doctors make too much" is simply a lame explanation for whats happening in the market. Its amazing to me how some folks will cry "teachers make too much",,. then get amazed that the teachers that they recruit suck or if they are good and smart.. end up going into other careers. but then the cry is "doctors make too much" but there is no thought that their could be any negative consequences of that.

its not the fault of doctors, though i would increase the supply and lower the cost of entry. the whole system has accumulated unsustainable costs for a lot of reasons. another example : it costs a billion dollars to get a new drug through phase three. this is ridiculous, and i have doubts that aspirin would even make it to market if it was discovered today.

Again.. I don't think you are going to be able to get lower prices without serious consequences. Salaries more comparable to Europe would especially have serious consequences and would mean decreased care, decreased availability of physicians in this country. There are other ways to lower costs without having to lower prices. One of the biggest issues is not on how much an individual procedure costs.. but in what is ordered and the amount its ordered. For example.. I see a patient, they have an obvious problem that needs a test ordered. They get the test... yep.. I'm right.. and they need a referral to surgery. The surgeon orders the same dang test AGAIN. Why? They will say its because of insurance.. but that's bull puckey. Its because they are in a hospital system that encourages them to order as many tests as possible as its a great money maker. The truth is.. you lower reimbursements further? My facilities would have to do that.

the cost reductions would have to be systemic and well planned.

You can say.. lower salaries.. sure.. you lowering my insurance? Lowering the cost of education? Lowering the cost of square footage? Lowering marketing costs? so on and so forth?

yeah, for a service this important and with this level of demand, i'm for pulling out all the stops.

 

[Thrilla]

I'm leaning towards a total government takeover of all medical care in the country... all medical personnel would be federal employees and all hospitals and clinics would be government owned and run.

then we can all get free healthcare.. anything we want ( even boob jobs)

and no, we don't have to raise taxes....our taxes dollars are unnecessary to fund anything.
that's the beauty of a fiat monetary system...

 

[CycloneWanderer]

access to health care should not be connected to the ability to pay. and right now, it isn't for the poorest. it is the lower middle class and those above the poverty level who are falling through the cracks.

we already have universal health care. however, our universal health care is the most inefficient in the first world. we need to fix that.

Aren't those the same people who are most hurt by the ACA in that they make enough to not have subsidies, but not enough to really be able to afford the insurance? In that regard we can both agree that our universal insurance is inefficient. I do agree with one of your posts following the quoted above in that we should really start looking at how we can make the academic gateway to being a doctor less restrictive (and less punitive in terms of cost).

 

[Born Free]

People lost plans, but did not lose coverage.

It's like bewailing the fate of someone who is laid off from one job only to land a higher paying one the next day.

I love how you liberals spin out of control. Lets try this, their plans were canceled, period. Some purchased new plans at a higher cost, and some did not purchase new coverage. When their policy was canceled they were on their own, like you say they had to go find another job, but in this case that job did not provide insurance coverage.

 

[Samhain]

Just to point out this Return on Investment. there is a problem with doing things based on return on investment. Recently, there has been a lot of consternation over the number of PSA's (screen for prostate cancer) and the number of false positives and then biopsies.. and its been stated that its a poor return on investment..

The same with mammograms...

but here is the thing.. it might be a poor return on investment when you take into account the whole population... but if its YOUR DAD that the screen picks up.. and its treated early.. and he LIVES... that's a heck of a return on investment.

I am not saying that more needs to be done to ensure that the people at risk should be screened and those without much risk probably shouldn't be screened as much. However, I think this idea that seems to be pushed.. that women don't need mammograms and guys shouldn't be getting PSA's doesn't factor in the small percentage.. which is small.. that benefits TREMENDOUSLY from such screening. Literally a matter of life and death.

Why does the US lead the world in the number of colonoscopies performed each year? Because its an easy, low-risk money maker. Its doctor's go-to, gastro-intestinal, lets look because why the **** not, maybe you just ate a bad burrito but you can't be too sure, bull**** procedure.

Does it actually find something? Sure, if you stick your head up someone's ass enough you are bound to find a growth or enlarged prostate or cancer. Is it an efficient use of medical technology? Nope.

 

[Helix]

Aren't those the same people who are most hurt by the ACA in that they make enough to not have subsidies, but not enough to really be able to afford the insurance? In that regard we can both agree that our universal insurance is inefficient. I do agree with one of your posts following the quoted above in that we should really start looking at how we can make the academic gateway to being a doctor less restrictive (and less punitive in terms of cost).

yeah, i wouldn't be surprised if there were a lot of people falling through the cracks in the ACA.

definitely support clearing the path to help more students become physicians. we need to increase the supply, and no doctor should be working 80 hour weeks. that makes about as much sense as overworking pilots or truck drivers until they are exhausted and dangerous.

 

[Linc]

As for the academic gateway, possibly in conjunction with the VA, I present a program similar to my tuition-free college education;
starting in 1971 in Illinois due to a shortage of Chemistry, Physics and Math teachers.

With a shortage of both doctors and nurses, a program to pay a certain amount of college expenses in exchange for the students doing their
internships/residency as well as at least FIVE years at regular pay in either the
VA or some other location such as the rural ones with a doctor/nurse shortage .

yeah, i wouldn't be surprised if there were a lot of people falling through the cracks in the ACA.

definitely support clearing the path to help more students become physicians. we need to increase the supply, and no doctor should be working 80 hour weeks. that makes about as much sense as overworking pilots or truck drivers until they are exhausted and dangerous.

 

[CycloneWanderer]

yeah, i wouldn't be surprised if there were a lot of people falling through the cracks in the ACA.

definitely support clearing the path to help more students become physicians. we need to increase the supply, and no doctor should be working 80 hour weeks. that makes about as much sense as overworking pilots or truck drivers until they are exhausted and dangerous.

In my opinion, this can't be overstated.

 

[American]

Ahh, singapore again

Where the govt own most of the hospital, controls the supply of medical equipment (and therefore care) and prices, forces people to save money and where the majority get their care from govt provided health care.

Europe is better right?

 

[jaeger19]

yep. i'm for a phase out of the drug war. we'll have to have a national discussion about what to do about the really dangerous stuff, like opiates

Honestly, I think if you make depressant like pot legal and regulated and a "stimulant" legal and regulated, I think you will end a lot of the other drugs out there. Pot is the gateway drug in my opinion because you have to get it through illegal channels.. and that puts most in contact with folks that aren't so great. Then its an easy stretch from .. well this is illegal.. so whats the problem with trying cocaine?

If a person can stay legal.. and get the feeling he wants.. I think a lot of the "harder" drugs will have less demand.

with our level of debt and the country's immediate needs, it's only fair if everyone chips in something, IMO. not just the rich.

AS a conservative.. I'd say there is fair.. and there is what makes fiscal sense. And right now.. taxing the poor and middle class MORE doesn't make sense in the wake of declining real wages. We are a consumer economy.. why would we want to take money out of the hands of the consumers?

admit that i hate the idea. however, you have to take into consideration that if employers don't have to provide health insurance for employees, that will more than offset any low percentage sales tax. our businesses have to compete against foreign businesses right now who are not saddled with that responsibility

Two thoughts.. and I with I had more time to develop this fully... but I think this argument that its best for corporations so they can compete is just a little screwy. Healthcare costs have been climbing, we recognize that. The liberal mantra is that this has to be stopped.. that corporations can't bear this cost... even though 1. They have been bearing this cost since 85% of americans have health insurance 2. corporations have been making record profits during this time 3. Liberals are so worried about the costs to corporations that they want to add more taxes and force corporations to pay "living wages" or at least double the minimum wage.

Second point.. you assumption that taking healthcare away from the employer is going to help more than the increase in taxes... but what do employers fight for more now? Decreasing their healthcare.. or worrying about taxes? think about it.

Third point... sales taxes really make the American company less competitive. Say I produce an American rotomolded cooler. It retails for around 200 dollars. At that price break.. the quality of my cooler wins over the cheap quality of a Chinese made cooler at 100 dollars. Then you slap a sales tax on it... say 10% to make life easy.

Now my cooler goes up in price by 20 dollars.. while the Chinese cooler only goes up in price by 10. Sales taxes HURTS American businesses.

the problem is that you have to liquidate all assets before medicaid will pay for long term care. this can easily amount to a one hundred percent death tax paid to the health care industry. i've actually heard people express the sentiment that they hope that they die quickly so that they can leave their kids something. that bothers me a lot.

Honestly, the people that have money to really leave their kids.. have avenues like trusts and gifting etc to divest themselves of these assets and or protect them before they get where they need Medicaid. The reality is that most people go on Medicaid pretty quick in long term care.. because the vast majority don't have tremendous assets.

i work at a med school. the cost is horrendous, and there are strict limits on how many students are admitted. i would increase the supply of doctors and surgeons, and have them working fewer hours (which we should be doing anyway for safety reasons,) and pay them similarly to doctors in Europe and Canada. other first world countries don't have any problem finding good doctors.

No offense but what you propose will increase costs not decrease them. Most European countries decrease the number of surgeons and Canada.. and that's because more surgeons.. more inefficiency. Surgeons make their money by time.. so if you decrease the number of hours they work.. or decrease supply (with competition) so their is less volume.. they have to make more per patient. That is why we have more choice in this country.. and less wait times etc.. but higher costs. UHC countries reduce the number of physicians so as to decrease the overhead, and decrease costs.
By the way.. most of these countries are also having a hard time getting doctors. Why do you think there are so many foreign trained doctors in the US? Part of that's the pay.

In addition.. I don't think you realize the effect on the economy when you decrease physician reimbursement.

the cost reductions would have to be systemic and well planned.

Like implementation of the ACA? I think there is an irony there. the ACA is not the big bad monster that its portrayed.. but you can see the trouble with its implementation. Now think what problems you would have with a single payer.. Medicaid and especially VA come to mind. To me.. this is an indicator that instead of a single payer.. we simply need to address the 10 percent now of americans that don't have health insurance... rather than focusing on changing the 90% that do.. toward an unknown system.

yeah, for a service this important and with this level of demand, i'm for pulling out all the stops.

How would you do this? Do you want to gut our economy?

 

[vasuderatorrent]

Actually that's not true... before the exception was made for these policies.. there were people that did lose coverage.. they had their policies cancelled because they were not in compliance.. and the new policies cost significantly more.... Thats losing coverage.

Then people have been losing coverage for decades. When I worked at a bigger company the Blue Cross Blue Shield Rep would come EVERY YEAR and tell people how they were getting screwed over more than the previous year. (Wouldn't you love that job?) Now that the Affordable Care Act has become law the Blue Cross Blue Shield Rep will still have to come by and tell them that they will be paying more and/or receiving less coverage just like they have done EVERY YEAR in the past. The only difference is that there is a big campaign against "Obamacare" that makes it easier for the Blue Cross Blue Shield Rep. Now that person has a perfect scapegoat. (Hint: This is the best year to be that person who calmly tells you how you are getting screwed over.)