The Goat Pen

the last thing we needed was another government run insurance program. medicare and the VA suck the taxpayer dry while failing to give most ofg the consumers quality health care.

part of the US problem is the consumer--too many people go through too many ttreatments when the condition they have warrants a lot less expenditures. anybody with metastatic lung cancer should just kiss theri ass goodbye instead of letting oncology do costly radiation/chemotherapy that might extend their life a few weeks.
throw in the fact we have one of the more obese populations with mutliple diabetics/ mutiple smokers/multiple people with CAD that all are aging with less and less of a younger population to make up for the increased expenditures.

we spend 1/2 our medical budget on people in the last 6 months of life. do we really make a diffence on somebodys last 6 months of life by running every test in the book?

the problem is figuring out who is in there last 6 mos of life and not wasting assets on them.., if they want to go for extended medical expenditures it should come out of their own pocket not the governement

crashcourse wrote:the last thing we needed was another government run insurance program. medicare and the VA suck the taxpayer dry while failing to give most ofg the consumers quality health care.

part of the US problem is the consumer--too many people go through too many ttreatments when the condition they have warrants a lot less expenditures. anybody with metastatic lung cancer should just kiss theri ass goodbye instead of letting oncology do costly radiation/chemotherapy that might extend their life a few weeks.
throw in the fact we have one of the more obese populations with mutliple diabetics/ mutiple smokers/multiple people with CAD that all are aging with less and less of a younger population to make up for the increased expenditures.

we spend 1/2 our medical budget on people in the last 6 months of life. do we really make a diffence on somebodys last 6 months of life by running every test in the book?

the problem is figuring out who is in there last 6 mos of life and not wasting assets on them.., if they want to go for extended medical expenditures it should come out of their own pocket not the governement

as one of the wealthiest countries in the world, we aren't going to take a pragmatic approach to determining end of life for someone, especially by putting a price on it tied to health care. If I am 85 years old and get cancer - well OK, I've put in my time, I can probably deal with just going out with as much peace and dignity as possible, but if you're 45, 50, 65? You're not going to be "oh well its been a great ride" kind of person if there are medical procedures or medicines that extend your life, even with lower quality.

I do agree it got to the point that people with HMO's didn't think twice about going to the doctor - but if I'm paying $200 - $500 a month (me and my company combined) and I'm hitting them up for a price negotiated office visit of $70 with a $25 co-pay every 6 months, and maybe 6 additional times for the remainder of my family - how much of an impact are we really having on the insurance company bottom line.

The big hit is the major health issue - the $22K child birth, the $150K heart attack - and a $5K deductible isn't going to make one bit of damn difference to either side in that situation.

If you think health care costs are bad because of people hitting the doctor up over every little thing, or tied to lifestyle like obesity - then imagine what they are going to be when people put off seeing a doctor because they have a $5K deductible and the flu turns into pnuemonia, or obesity turns into type II diabetes, unchecked blood pressure turns into stroke, lack of immunization (I'm sure is covered but with a mindset of everything going against the deductible people are going to treat the general practitioner like most people treat a dentist now) turns into a outbreak.....

let's at least forgo the deductible for people that maintain a healthy lifestyle

"part of the US problem is the consumer--too many people go through too many ttreatments when the condition they have warrants a lot less expenditures. anybody with metastatic lung cancer should just kiss theri ass goodbye instead of letting oncology do costly radiation/chemotherapy that might extend their life a few weeks."

I agree with that in theory, but when it happens to you or someone close to you, it's a different story. Obviously I have had to deal with this recently, and even though you know there's really nothing to be done, it's hard to tell somebody "well, you're not going to make it until the end of this year, that's for certain, so you might as well just die now." Again, in theory, that's probably the way to go. Hell, it was considered a high virtue in Roman times to kill yourself as a matter of honor in situations far less dire than that. But again, when it's you or a loved one, it's hard to let go. That's one reason I think they try to make hospice seem so attractive (and really, it is) - when you go on hospice, they are in total control of your care. You don't call the doctor or go to the ER, you call them first no matter what and they come hold your hand and give you some more morphine and talk you down. They are really there to ease you into accepting that you are fixin to die and to try and accept it with as much dignity and as little pain as possible. Saves medicare a ton b/c all these hopeless cases aren't rushing to the doctor or the hospital for every ailment that comes with end of life scenarios, esp. when there's nothing to be done anyway...

eCat wrote: That's not tea party idealism. There is no free ride in capitalism.

Ask a veteran how well a national health care plan can be run by the government - and they are supposed to be our nations top priority in regards to health care.

Tell that to the assholes who are making more money each year and not raising wages. Or the dickheads who do everything they can to avoid paying their share of taxes.

You can hedge all you want about how this current setup sucks or how a national system would suck, but the bottom line is that unless some of these fuckwads pocketing major bucks right now are willing or made to give some of it up, the whole thing is going to continue to suck for you, me and everyone else other than the cocksuckers who get the free gov't care now.

Saint wrote:

eCat wrote: That's not tea party idealism. There is no free ride in capitalism.

Ask a veteran how well a national health care plan can be run by the government - and they are supposed to be our nations top priority in regards to health care.

Tell that to the assholes who are making more money each year and not raising wages. Or the dickheads who do everything they can to avoid paying their share of taxes.

You can hedge all you want about how this current setup sucks or how a national system would suck, but the bottom line is that unless some of these fuckwads pocketing major bucks right now are willing or made to give some of it up, the whole thing is going to continue to suck for you, me and everyone else other than the cocksuckers who get the free gov't care now.

putting your trust in a politician to choose you over them however is not the answer

So I read all of those posts and most of the things you list as facts just aren't the case. First, the fact is health care costs inflation is less than it was 5 years ago, significantly less. So your premise in the beginning that because you pay more in co-pay, that can't be true doesn't hold water. Much of what is going on is companies taking the opportunity to do something they've wanted to do for a longtime, shift more cost to the employee, not because they are mandated, not because the ACA requires it but because they can (and blame something else).

This isn't the 1st time that this has occurred. This happened in California when the state passed a law about car insurance, many of them increased their rates way above necessary and blamed the law. Wasn't true at all. Neither is it the case here.

Here are the biggest requirements for employers: have a minimum level of coverage. Most companies (and I suspect your own), already have this but many are raising rates anyway. The biggest problem is that most areas are dominated by one insurance company. They can do what they want as a result. It isn't the ACA requiring them to raise rates, they are doing it anyway and suckering you guys into believing that it's required to get rid of flexibility that they have.

Here the main rule insurance companies want to get rid of: The ACA required that insurance companies spend 80% of their revenue on patient care. This is big. Insurance companies (each of the top 5 who said their profit was only 1.5% for each of the 5 previous years) don't like this rule at all. Insurance is a racket. They treat the healthiest patients when until they reach retirement and then pass them off to medicare/medicaid or state plans when 80% of health care costs occur. They are supposed to be independent, but they share actuarial tables. They basically reinsure in a way that they are socialize their losses but capitalize their profits. (BCBS of North Carolina at one point had a billion dollars in profit as a nonprofit and that was when health care inflation rate was 14 to 18% per year).

all I know is I'm fucked post ACA, not pre

we can talk about why and point fingers but you can't tell me or a *huge* percentage of Americans their health care is better or cheaper post ACA.

Given what America was told about it, especially if you point out there was a precendent in place about mandates and insurance companies, then I have no sympathy for its architects in its colossal failure.

Affordable Care Act

The designers learned well from the Republicans who gave us the Patriot Act.

By the way, my brother is one of those primary care doctors. The issue for them isn't the ACA. Medicare and medicaid payments have not increased for a number of years despite health care inflation. Also, their has been a shift where insurance companies are moving to a group payment plans, preferring to pay physicians through hospitals. This is leading towards hospitals hiring physicians as employees and other physicians banding together. Different plans are now firing physicians. 500 Yale physicians were let go last year. Guess what, not related to the ACA.

We are headed back to a sorta HMO organization or PPO's. Again, it's being blamed on the ACA, but actually is unrelated.

eCat wrote:all I know is I'm fucked post ACA, not pre

we can talk about why and point fingers but you can't tell me or a *huge* percentage of Americans their health care is better or cheaper post ACA.

Given what America was told about it, especially if you point out there was a precendent in place about mandates and insurance companies, then I have no sympathy for its architects in its colossal failure.

Affordable Care Act

The designers learned well from the Republicans who gave us the Patriot Act.

yeah, I can. A huge percentage of Americans have health care that is the same as it was pre-ACA. As for the architects, don't care. But know why something is not working if you believe it isn't working. Otherwise, the mechanic will get you to replace then engine when you just need a tune-up

of course by a group that is against it anyway, but the reality is that this is not a surprise

Surge In Marijuana Ills Causes Cries For Stricter Control

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Owlman wrote:

eCat wrote:all I know is I'm fucked post ACA, not pre

we can talk about why and point fingers but you can't tell me or a *huge* percentage of Americans their health care is better or cheaper post ACA.

Given what America was told about it, especially if you point out there was a precendent in place about mandates and insurance companies, then I have no sympathy for its architects in its colossal failure.

Affordable Care Act

The designers learned well from the Republicans who gave us the Patriot Act.

yeah, I can. A huge percentage of Americans have health care that is the same as it was pre-ACA. As for the architects, don't care. But know why something is not working if you believe it isn't working. Otherwise, the mechanic will get you to replace then engine when you just need a tune-up

well first I think your confidence in your facts is misplaced, second , while I don't think I'm on the cutting edge of people screwed by the implementation of the ACA, over the course of the next 2 years, there is going to be a growing number of people in the same position as me. What you may define as the same certainly isn't taking into account sizeable cost increases and high deductibles - which was - in the form of an HSA - an outlier to most other than single 20 year olds 3 years ago.

This is one I'm not budging on Spacer, even with you coming across as knowledgeable and informed. My sampling pool is simply too large to give you any credit here. There are too many references from unbiased sources - I'm not going to Alex Jones or Blaze or Fox News to get this information.

Former HMO/PPO participants are being pushed into an HSA model (with or without the benefit of pre-tax dollars set aside for spending) to cover the incidental costs of health care and only have support for major medical issues.

That's not the health care we had before the ACA and its not the health care anyone other than someone who had no healthcare as an option envisioned as being preferred, or I'd venture , acceptable post ACA.

Clearly the biggest concern in my eyes is how many people will forgo health care using some cost/benefit analysis in an effort to save money as opposed to getting well thru care due to this ongoing deductible model - because spending $5K cash on top of $200-$300 a month for insurance per year is a big hit to a family making $40k to $75K a year. How many kids will suffer because parents have to face that decision? Tomorrow morning I'm having a $1500 procedure that would have cost me $50 2 years ago. Its not mandatory, its cautionary, so I am not one of those people choosing to put off health care in an effort to save money. I will make the same decisions for anyone in my family. But other parents may not, acting with the same thought processes as those who do not have insurance - because essentially the ACA has put them in the same boat - paying out of your pocket for typical health ailments people encounter.

And unfortunately while I do know the law was written to prevent insurance from greatly jacking up cost to have a higher % of income or disparity on revenue to patient care spending, that puts alot of faith in companies you admit are inherently evil to not cook the books and play complex wall street games/loopholes.

my confidence in my facts comes from the fact that I've been teaching it for 5 years both pros and cons and the ABA health law association has been looking at health care costs and changes for the last 11 years. I know that the ACA was first proposed by Republicans and presented by Sen Chaffee in 1994 as a way to increase competition into the health care costs and in opposition to Hillarycare. This republican plan was then adopted by Romney and brought to Massachusetts.

That's why I know that changes in physicians is not based on the ACA since this trend started before 2008. I know that health care inflation in the early 2000's was 14 to 18% per year during a time when national inflation was less than 3%, and that was before baby boomers retired. We know for a fact that costs are going to steadily increase in health care over the next 20 years with the retirement of baby boomers. We know that thses costs are not accounted for, neither by the ACA, not by anything we have out there (one of my major complaints about the ACA). We know that since they didn't do a govt option but essentially just a govt regulation, you still have the majority of areas dominated by a monopoly, just one health care company. We know that under a 1940's law, McCarron-Ferguson, designed to help small insurance companies by sharing actuarial tables, that insurance companies are comparing rates that other companies cannot do.

If Owlman was an employer, he would understand what is happening. Yes, you could keep the old plan, but your employer would have to pay 33% more. That's what BC/BS came back to us as our increase last year. I have been a partner for 18 years and, before this, the most premiums have increased in a year is 18%. Now, we are eating the difference because employees are hard to come by in our industry, but industries like BRM's law firm where labor supply is higher than demand, they will pass the cost to employees. So, yeah, some employees will suffer some won't.

The idea that you can give more coverage without raising the cost or lower the quality goes against basic physics.

Also, these other countries that have nationalized healthcare have significantly more restrictions on malpractice litigation. Are Owlman and his cohorts in the ABA willing to support such restrictions in this country?

actually, both my brother and my roommate are employers. I understand it very well. Both are happy with the ACA.

Yes, you could keep the old plan, but your employer would have to pay 33% more. That's what BC/BS came back to us as our increase last year.

Right. Yet you blame the ACA for this. Why not BC/BS? I already pointed out nonprofit BC/BS of North Carolina petitioning to go for profit so they could distribute a billion dollars they could no longer distribute as a non-profit (that is instead of decreasing rates) Or blame the lack of competition in the area among health care providers. That's much more likely to be the case.

" It isn't the ACA requiring them to raise rates, they are doing it anyway and suckering you guys into believing that it's required to get rid of flexibility that they have."

I think it's undoubtedly true that somebody is getting suckered, but I think the real suckers are the people who think there's some difference in being suckered by the government or suckered by big business, as if there was some difference b/w the two...

Owlman wrote:of course by a group that is against it anyway, but the reality is that this is not a surprise

Surge In Marijuana Ills Causes Cries For Stricter Control

https://www.yahoo.com/health/surge-in-m ... 09887.html

From the first sentence in that article: "The number of children treated annually for accidental pot consumption in Colorado has reached double-digits".

Double digits? As in 10?? So 10 kids in the state of Colorado got stoned, and that's some kind of problem?

"my confidence in my facts comes from the fact that I've been teaching it for 5 years both pros and cons"

So tell us some of the cons (a perfect word, given the topic of this discussion)...

Owlman wrote:actually, both my brother and my roommate are employers. I understand it very well. Both are happy with the ACA.

Yes, you could keep the old plan, but your employer would have to pay 33% more. That's what BC/BS came back to us as our increase last year.

Right. Yet you blame the ACA for this. Why not BC/BS? I already pointed out nonprofit BC/BS of North Carolina petitioning to go for profit so they could distribute a billion dollars they could no longer distribute as a non-profit (that is instead of decreasing rates) Or blame the lack of competition in the area among health care providers. That's much more likely to be the case.

Blame BC/BS? They are just trying to make the same margin as before the ACA. They aren't, so the fact that they are raising premiums and have less profit margins than before proves to us that costs have increased under the ACA. Stop misleading the public that healthcare costs have gone down or haven't increased as much as previous. You guys know this, but were hoping you could force insurance companies to eat the increase and the public would not feel it. Well, a capitalist system doesn't work that way.

Again, will the ABA be willing to restrict malpractice suits like in the other countries that have national healthcare?

Some of them I already mentioned:

It really didn't address the fact that most areas have an essential monopoly. So while it was designed not for the poor but for increasing competition in health care companies for small businesses, it didn't for large companies. Second, it didn't address the elephant in our country, namely the retirement of baby boomers and the pressure that will put on medicare. Those expenses will skyrocket. It's being ignored by both parties essentially. The taxes on some of the health care providers has been problematic, not really collected evenly and probably should be dropped. It leaves a gap in coverage in those states that have a very low coverage of medicaid.

For example: the poverty rate in Louisiana is 11,400 to receive Medicaid. This means to get access to the exhanges, you need to at least make 11,400 per year. But if you only make $10,000, you can't get access to the exchanges nor in Louisiana do you qualify for medicaid. You only make $10,000 per year, but you are too rich for medicaid (qualifications controlled by the state).

I don't know if you consider this a con, the one thing that puts pressure on rates for everyone else is that the difference that the insurance company can charge between the elderly and the young is now 7 to 1, not 15 to one.

Blame BC/BS? They are just trying to make the same margin as before the ACA

margins??? They are a non-profit. Plus, most insurance companies have anti-trust protection. Insurance companies have the greatest business model in the country. They mostly insure healthy and the govt primarily takes care of the elderly. They share costs and rate information that no other industry (other than baseball) is allowed to do.

On the same day in Jan, 2010, the 3 largest insurance providers in the country "independently" decided to drop children coverage. The statistical odds of them coming to the same decision at the same time is astronomical.