Author Topic: Dismantling Obamacare Brick by Brick.  (Read 5828 times)

Firethorn

  • friend
  • Senior Member
  • ***
  • Posts: 5,789
  • Where'd my explosive space modulator go?
Re: Dismantling Obamacare Brick by Brick.
« Reply #25 on: October 17, 2017, 06:51:11 PM »
If only we could apply that to government.

Uh?  In what aspect do we NOT?  The government gets a cost+ amount of your income for "administration" stuff.  It signs out cost+ contracts all the time.

And, as I just pointed out, this sucks as a system.

Quote
In the systems I have worked at, the typical co-pay (depending on the insurance plan) is $ 15-20.  If you don't have insurance and you are paying cash, you will likely be paying $ 150-225, depending on the specialty and complexity of the visit.  Usually around 70% of that charge goes to overhead, and the provider gets the remainder.

The system I was looking at was a regular GP visit, with a $40 copay.  For paying cash, shopping around a bit to get the best deal(which you don't do when insurance is paying), especially providers that have jettisoned ALL insurance dealings.

Then consider - 70% of the charge going to overhead.  $150 * .3 = $45 going to the doctor.

I'm not saying that overhead can be eliminated, but 70%, really?

MechAg94

  • friend
  • Senior Member
  • ***
  • Posts: 33,622
Re: Dismantling Obamacare Brick by Brick.
« Reply #26 on: October 17, 2017, 11:35:45 PM »
Uh?  In what aspect do we NOT?  The government gets a cost+ amount of your income for "administration" stuff.  It signs out cost+ contracts all the time.

And, as I just pointed out, this sucks as a system.

The system I was looking at was a regular GP visit, with a $40 copay.  For paying cash, shopping around a bit to get the best deal(which you don't do when insurance is paying), especially providers that have jettisoned ALL insurance dealings.

Then consider - 70% of the charge going to overhead.  $150 * .3 = $45 going to the doctor.

I'm not saying that overhead can be eliminated, but 70%, really?
70% for overhead is probably what the govt is doing with our taxes though that might be optimistic.

The overhead is why I think going to basically a cash for services straight free market system would be cheaper for everyone, doctors and patients.  I doubt it would ever happen.  There is always an outlier or other excuse.  In trying to "cover" everyone, we end up preventing people from getting basic health care. 
“It is much more important to kill bad bills than to pass good ones.”  ― Calvin Coolidge

RevDisk

  • friend
  • Senior Member
  • ***
  • Posts: 12,633
    • RevDisk.net
Re: Dismantling Obamacare Brick by Brick.
« Reply #27 on: October 18, 2017, 09:04:08 AM »
70% for overhead is probably what the govt is doing with our taxes though that might be optimistic.

The overhead is why I think going to basically a cash for services straight free market system would be cheaper for everyone, doctors and patients.  I doubt it would ever happen.  There is always an outlier or other excuse.  In trying to "cover" everyone, we end up preventing people from getting basic health care. 

Chronic or serious illness is the "outlier or other excuse". These are quite common, statistically speaking. Car accidents, heart attacks, etc.

Which could be resolved with catastrophic health insurance coverage, but that would violate the 'cash for services straight free market system' thing mentioned.
"Rev, your picture is in my King James Bible, where Paul talks about "inventors of evil."  Yes, I know you'll take that as a compliment."  - Fistful, possibly highest compliment I've ever received.

Jamisjockey

  • Booze-fueled paragon of pointless cruelty and wanton sadism
  • friend
  • Senior Member
  • ***
  • Posts: 26,580
  • Your mom sends me care packages
Re: Dismantling Obamacare Brick by Brick.
« Reply #28 on: October 18, 2017, 09:07:52 AM »
Chronic or serious illness is the "outlier or other excuse". These are quite common, statistically speaking. Car accidents, heart attacks, etc.

Which could be resolved with catastrophic health insurance coverage, but that would violate the 'cash for services straight free market system' thing mentioned.

Not if government butted out.  The free market would figure out the best balance.
JD

 The price of a lottery ticket seems to be the maximum most folks are willing to risk toward the dream of becoming a one-percenter. “Robert Hollis”

MillCreek

  • Skippy The Wonder Dog
  • friend
  • Senior Member
  • ***
  • Posts: 19,964
  • APS Risk Manager
Re: Dismantling Obamacare Brick by Brick.
« Reply #29 on: October 18, 2017, 09:16:51 AM »
Uh?  In what aspect do we NOT?  The government gets a cost+ amount of your income for "administration" stuff.  It signs out cost+ contracts all the time.

And, as I just pointed out, this sucks as a system.

The system I was looking at was a regular GP visit, with a $40 copay.  For paying cash, shopping around a bit to get the best deal(which you don't do when insurance is paying), especially providers that have jettisoned ALL insurance dealings.

Then consider - 70% of the charge going to overhead.  $150 * .3 = $45 going to the doctor.

I'm not saying that overhead can be eliminated, but 70%, really?

Overhead really depends on your specialty, location and practice setting.  The national average is around 60% or so, as per the MGMA.  The more staff and the more expensive the location, the higher the overhead.  Overhead typically includes the fixed costs such as rent, staff salaries and benefits, taxes, insurance, medical supplies/equipment and the like.   It is entirely feasible, and happens every darn day, that we lose money on patient visits because Medicare/Medicaid/private insurance does not cover the fixed costs of the overhead to see that patient.  Especially in primary care, we may end up making about $ 30 or less in 'profit' for a typical office visit paid by many of the insurance plans.  This is why we now expect the typical primary care provider to see 20-25 patients per day.  Volume is the only way to survive.  The 'good' thing about the ACA is that at least the patients have some degree of insurance so we can get some degree of reimbursement, as opposed to writing it all off to bad debt.  See all the especially rural hospitals who have shut down entirely or had to close the ER because of this.  Not enough actual revenue coming in to pay the bills.
_____________
Regards,
MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

makattak

  • Dark Lord of the Cis
  • friend
  • Senior Member
  • ***
  • Posts: 13,022
Re: Dismantling Obamacare Brick by Brick.
« Reply #30 on: October 18, 2017, 09:26:06 AM »
Overhead really depends on your specialty, location and practice setting.  The national average is around 60% or so, as per the MGMA.  The more staff and the more expensive the location, the higher the overhead.  Overhead typically includes the fixed costs such as rent, staff salaries and benefits, taxes, insurance, medical supplies/equipment and the like.   It is entirely feasible, and happens every darn day, that we lose money on patient visits because Medicare/Medicaid/private insurance does not cover the fixed costs of the overhead to see that patient.  Especially in primary care, we may end up making about $ 30 or less in 'profit' for a typical office visit paid by many of the insurance plans.  This is why we now expect the typical primary care provider to see 20-25 patients per day.  Volume is the only way to survive.

Hmm... interesting.

It is starting to sound like house calls by doctors might be far more cost effective. Less of the "go to the doctor and get sick from the sick people at the doctor" as well.

I wonder if making 10 house calls per day would be provide significantly more profit than 20 per day in an office.
I wish the Ring had never come to me. I wish none of this had happened.

So do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil. Bilbo was meant to find the Ring. In which case, you also were meant to have it. And that is an encouraging thought

MillCreek

  • Skippy The Wonder Dog
  • friend
  • Senior Member
  • ***
  • Posts: 19,964
  • APS Risk Manager
Re: Dismantling Obamacare Brick by Brick.
« Reply #31 on: October 18, 2017, 10:06:03 AM »
http://www.latimes.com/business/technology/la-me-doctor-house-calls-20160320-story.html

Here is an interesting story about house calls.  You could make money at it if you charged a standard office visit fee but accepted cash only at the time of service and were in a busy area with a steady stream of visits.  No insurance and no billing hassles.  You can have a lot of unpaid downtime however, with travel to/from the patients and times when there are no patients to see.
_____________
Regards,
MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

RevDisk

  • friend
  • Senior Member
  • ***
  • Posts: 12,633
    • RevDisk.net
Re: Dismantling Obamacare Brick by Brick.
« Reply #32 on: October 18, 2017, 10:04:44 PM »

Essentially there is no simple solution to healthcare. Socialized healthcare comes with bureaucracy, long wait times, etc. Free market healthcare doesn't handle chronic or ueber expensive stuff well. American healthcare grabs the worst of both worlds, and subsidizes the entire world's pharmacological development. Oddly, virtually no one thanks us for developing life saving cheap drugs.
"Rev, your picture is in my King James Bible, where Paul talks about "inventors of evil."  Yes, I know you'll take that as a compliment."  - Fistful, possibly highest compliment I've ever received.

Hawkmoon

  • friend
  • Senior Member
  • ***
  • Posts: 27,199
Re: Dismantling Obamacare Brick by Brick.
« Reply #33 on: October 18, 2017, 11:25:51 PM »
Perhaps of interest, I saw my cardiologist today. I had to go to a different location, and deal with a completely different staff and office setup. It's a multi-doctor practice that was formerly associated with a large-ish hospital in another city. Now the doctors from my doc's practice have joined into an even larger group practice that's affiliated with the larger-ish hospital in the nearby city. I asked him why the change.

His answer was that the other hospital "fired" them. When I first saw him, it was a private practice with no affiliation. Just a few months after I first became their patient, the practice was acquired by the hospital in the other city. Apparently, the doctors wasted too much time doctoring, and that hospital didn't think they were producing enough profit. So they cut them loose.

I guess by rolling into a larger group practice they can continue to practice decent doctoring and realize efficiencies of scale by having more doctors share the staff. Dunno -- time will tell.
- - - - - - - - - - - - -
100% Politically Incorrect by Design

Perd Hapley

  • Superstar of the Internet
  • friend
  • Senior Member
  • ***
  • Posts: 61,334
  • My prepositions are on/in
Re: Dismantling Obamacare Brick by Brick.
« Reply #34 on: October 19, 2017, 12:41:16 AM »
A popular complaint of the left is that Trump is "sabotaging Obamacare." I hope they keep saying that. Yeah, keep spreading the word that Trump is following through on a major campaign promise. Enjoy your 8 years.
"Doggies are angel babies!" -- my wife

Firethorn

  • friend
  • Senior Member
  • ***
  • Posts: 5,789
  • Where'd my explosive space modulator go?
Re: Dismantling Obamacare Brick by Brick.
« Reply #35 on: October 19, 2017, 04:36:26 AM »
A popular complaint of the left is that Trump is "sabotaging Obamacare." I hope they keep saying that. Yeah, keep spreading the word that Trump is following through on a major campaign promise. Enjoy your 8 years.

I'm not sure that would work out the way you're thinking.  If people lose their healthcare because of it, they'll be pissed.

Quote from: RevDisk
Essentially there is no simple solution to healthcare. Socialized healthcare comes with bureaucracy, long wait times, etc. Free market healthcare doesn't handle chronic or ueber expensive stuff well. American healthcare grabs the worst of both worlds, and subsidizes the entire world's pharmacological development. Oddly, virtually no one thanks us for developing life saving cheap drugs.

I agree with you 100% on the worst of both worlds.  Note, long wait times are not actually guaranteed - a lot of european countries have waiting times that average out to the same as the USA.  You know, an x-ray might be slower, but sonograms faster, type stuff.

The US has effectively single payer coverage for two of the most expensive conditions out there - Dialysis and Transplants.  I propose something along these lines:
1. Universal HSP eligibility
2.  Most people pay for most of their healthcare via the HSP.
3.  Insurance covers the range between, oh, $6k and $1M.  The $6k can be increased if the HSP is suitably funded.
4.  Uncle Sam picks up past $1M, because how many people get that much healthcare and aren't dying or disabled?  This provides stability to the insurance companies.

Perd Hapley

  • Superstar of the Internet
  • friend
  • Senior Member
  • ***
  • Posts: 61,334
  • My prepositions are on/in
Re: Dismantling Obamacare Brick by Brick.
« Reply #36 on: October 19, 2017, 07:12:01 AM »
I'm not sure that would work out the way you're thinking.  If people lose their healthcare because of it, they'll be pissed.


That's not what I meant. He said he'd repeal Obamacare. "Sabotaging Obamacare" sounds a lot like repealing it.
"Doggies are angel babies!" -- my wife

MillCreek

  • Skippy The Wonder Dog
  • friend
  • Senior Member
  • ***
  • Posts: 19,964
  • APS Risk Manager
Re: Dismantling Obamacare Brick by Brick.
« Reply #37 on: October 19, 2017, 08:41:00 AM »
Perhaps of interest, I saw my cardiologist today. I had to go to a different location, and deal with a completely different staff and office setup. It's a multi-doctor practice that was formerly associated with a large-ish hospital in another city. Now the doctors from my doc's practice have joined into an even larger group practice that's affiliated with the larger-ish hospital in the nearby city. I asked him why the change.

His answer was that the other hospital "fired" them. When I first saw him, it was a private practice with no affiliation. Just a few months after I first became their patient, the practice was acquired by the hospital in the other city. Apparently, the doctors wasted too much time doctoring, and that hospital didn't think they were producing enough profit. So they cut them loose.

I guess by rolling into a larger group practice they can continue to practice decent doctoring and realize efficiencies of scale by having more doctors share the staff. Dunno -- time will tell.

My guess is that the cardiology group did not meet expectations for patients admitted to, and procedures performed at, the hospital that owned them.  So from that standpoint, the group was not producing a profit for the hospital.
_____________
Regards,
MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

makattak

  • Dark Lord of the Cis
  • friend
  • Senior Member
  • ***
  • Posts: 13,022
Re: Dismantling Obamacare Brick by Brick.
« Reply #38 on: October 19, 2017, 10:37:28 AM »

That's not what I meant. He said he'd repeal Obamacare. "Sabotaging Obamacare" sounds a lot like repealing it.

BUT BUT BUT BUT... HE MIGHT BE BLAMED FOR OBAMACARE FAILING!@!!!!@!@

<wrings hangs> <wipes cold sweat off of brow>

/spineless GOP crapweasels off
I wish the Ring had never come to me. I wish none of this had happened.

So do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil. Bilbo was meant to find the Ring. In which case, you also were meant to have it. And that is an encouraging thought

Pb

  • friend
  • Senior Member
  • ***
  • Posts: 4,887
Re: Dismantling Obamacare Brick by Brick.
« Reply #39 on: October 19, 2017, 11:48:38 AM »
The most reasonable health care system I have read about is Singapore's system.  It combines a mandatory heath savings account contribution (6.5–9.0%) for citizens with gov subsidies for hospital care based on income.  The largest subsidy available for lower income folks is 80%- so everyone must pay at least of 20% of their bill in cash, with richer people paying a lot more.

The mandatory HSA can be used to pay for private insurance or for paying health care bills.

I have no idea how this system would work in the USA.

https://en.wikipedia.org/wiki/Healthcare_in_Singapore

JN01

  • friend
  • Senior Member
  • ***
  • Posts: 883
Re: Dismantling Obamacare Brick by Brick.
« Reply #40 on: October 19, 2017, 04:30:16 PM »
Uh?  In what aspect do we NOT?  The government gets a cost+ amount of your income for "administration" stuff.  It signs out cost+ contracts all the time.



I guess I wasn't clear.  What I meant was,  make it so there's a maximum percentage insurance companies  government can use for administration and profit on ANY program or service.  Government is horrible at getting the best bang for our bucks with duplication of administrative services, fraud, waste, abuse, affirmative action bidding, pork barrel projects, etc.


Scout26

  • I'm a leaf on the wind.
  • friend
  • Senior Member
  • ***
  • Posts: 25,997
  • I spent a week in that town one night....
Re: Dismantling Obamacare Brick by Brick.
« Reply #41 on: October 19, 2017, 04:42:03 PM »
I'm not sure that would work out the way you're thinking.  If people lose their healthcare because of it, they'll be pissed.


It's not "losing Healthcare", it they'll be pissed if they have to pay for their own.


Insurance (was) just that.  It was to cover you if something catastrophic happened.  You break your arm or leg or get a serious illness.  Not "I have the sniffles, someone else pay for my doctor/office visit."  I said on many occasions, I remember watching my mother write a check for $25 or $50 or some such amount after dragging me to the doctor because that cough wouldn't go away or a fever wouldn't come down.  That came out of pocket.  When I broke my arm(s) and leg(s), they took me to the ER and that was covered by insurance. 

People don't understand what insurance is.   

Allstate doesn't cover you taking your car in for an oil change.  State Farm doesn't cover needing new tires.  USAA doesn't pay when you need to replace your brakes.  But all pay (if you have insurance) to get your car repaired AFTER an accident, if you had their insurance BEFORE the accident.
Some days even my lucky rocketship underpants won't help.


Bring me my Broadsword and a clear understanding.
Get up to the roundhouse on the cliff-top standing.
Take women and children and bed them down.
Bless with a hard heart those that stand with me.
Bless the women and children who firm our hands.
Put our backs to the north wind.
Hold fast by the river.
Sweet memories to drive us on,
for the motherland.

JN01

  • friend
  • Senior Member
  • ***
  • Posts: 883
Re: Dismantling Obamacare Brick by Brick.
« Reply #42 on: October 19, 2017, 04:43:56 PM »
American healthcare grabs the worst of both worlds, and subsidizes the entire world's pharmacological development. Oddly, virtually no one thanks us for developing life saving cheap drugs.

That is a huge part of the problem.  It sucks that we American consumers are the ones stuck paying the lion's share of the R&D costs.

Firethorn

  • friend
  • Senior Member
  • ***
  • Posts: 5,789
  • Where'd my explosive space modulator go?
Re: Dismantling Obamacare Brick by Brick.
« Reply #43 on: October 19, 2017, 06:06:13 PM »
That's not what I meant. He said he'd repeal Obamacare. "Sabotaging Obamacare" sounds a lot like repealing it.

I think most who cared enough about healthcare for it to be a point wanted "repeal and replace".  I have very little skin in the game and I want it replaced more than repealed.  Hell, I'd settle for some laws just fixing the major problems.

The republicans haven't come up with a viable replacement yet, and I think that is why it hasn't been successfully repealed.

Meanwhile, people have to live in the system, so it's like throwing sand in the engine of your only car because you wanted a better car.  Making the existing car worse, without providing the new one, isn't helping the person.

Quote
I guess I wasn't clear.  What I meant was,  make it so there's a maximum percentage insurance companies  government can use for administration and profit on ANY program or service.  Government is horrible at getting the best bang for our bucks with duplication of administrative services, fraud, waste, abuse, affirmative action bidding, pork barrel projects, etc.

I just got done telling you that that was a bad idea because it simply encourages larger spending to match the desired overhead(and profit), didn't I?

I'd prefer to just actually empower the OMB to fight fraud, waste, and abuse.

Quote from: Amy Schumer
It's not "losing Healthcare", it they'll be pissed if they have to pay for their own.

At our costs, why wouldn't they be pissed?  It's cheaper to fly to the Bahamas and take a vacation for a couple weeks to get a hip replacement than it is to get it done at home, and that's including the flights and expense of the vacation!

And in many cases, with our increased costs, it becomes a case of if you are lower income, you can't afford it period.  As in the recommended treatment exceeds your income entirely.  Should we let such people die from lack of treatment?  Become disabled?  In continuous pain?  Etc...

In many cases, their medical condition amounts to a moderate disability that limits their ability to work(not prevents, limits), and being marked as disabled and going on medicaid is difficult and can take years. 

Quote
Insurance (was) just that.

As a note, I agree with you.  I only call it "insurance" because that is what people recognize.  Often I'll call them "healthcare plans".  Because they're not insurance.

Quote
Allstate doesn't cover you taking your car in for an oil change.  State Farm doesn't cover needing new tires.  USAA doesn't pay when you need to replace your brakes.  But all pay (if you have insurance) to get your car repaired AFTER an accident, if you had their insurance BEFORE the accident.

A better analogy might be windshield replacements.  Some insurance companies pay for them because it is a "Safety issue", some don't.  Most wave the deductible and pay for having small cracks repaired completely.

The idea is that paying for the preventive service is cheaper than paying for the treatment later.

And it doesn't help that the insurance companies have arranged to be the "cheaper" method of getting various forms of healthcare, so doing it alone will often get you higher prices even if you are paying cash.

There are also problems.  If it worked more like car insurance, my father wouldn't have to maintain coverage during his cancer treatment - the insurance he had when it was discovered would have to pay for all treatment for that cancer. 

If the insurance companies want to have their cake about pre-existing conditions, they should have to eat all of it - that means that if you had insurance when the condition was discovered/developed, then that insurance has to pay for it.

Perd Hapley

  • Superstar of the Internet
  • friend
  • Senior Member
  • ***
  • Posts: 61,334
  • My prepositions are on/in
Re: Dismantling Obamacare Brick by Brick.
« Reply #44 on: October 19, 2017, 07:43:00 PM »
I think most who cared enough about healthcare for it to be a point wanted "repeal and replace".  I have very little skin in the game and I want it replaced more than repealed.  Hell, I'd settle for some laws just fixing the major problems.

The republicans haven't come up with a viable replacement yet, and I think that is why it hasn't been successfully repealed.

Meanwhile, people have to live in the system, so it's like throwing sand in the engine of your only car because you wanted a better car.  Making the existing car worse, without providing the new one, isn't helping the person.

You're talking about policy. I was talking about the way his opponents are framing it. Two very different issues.

They're saying he's bringing down Obamacare. He was elected to bring down Obamacare. When you're not looking at the actual policies (and plenty don't), "sabotaging Obamacare" sounds good to a lot of people. Again, I'm just talking about the sound of the words, not the policy, or its effects.
« Last Edit: October 19, 2017, 08:54:51 PM by fistful »
"Doggies are angel babies!" -- my wife

Scout26

  • I'm a leaf on the wind.
  • friend
  • Senior Member
  • ***
  • Posts: 25,997
  • I spent a week in that town one night....
Re: Dismantling Obamacare Brick by Brick.
« Reply #45 on: October 19, 2017, 08:17:48 PM »

At our costs, why wouldn't they be pissed?  It's cheaper to fly to the Bahamas and take a vacation for a couple weeks to get a hip replacement than it is to get it done at home, and that's including the flights and expense of the vacation!

And in many cases, with our increased costs, it becomes a case of if you are lower income, you can't afford it period.  As in the recommended treatment exceeds your income entirely.  Should we let such people die from lack of treatment?  Become disabled?  In continuous pain?  Etc...

In many cases, their medical condition amounts to a moderate disability that limits their ability to work(not prevents, limits), and being marked as disabled and going on medicaid is difficult and can take years. 


A new hip is covered by insurance, as it should be.  And for something like that you could and should be able to shop around (unless it's an Emergency, then you take what you can get.) 

And for the truly poor (not the Obamacare 400% of poverty level "poor")*, in the past the Mutual Aid Societies, Charitable Groups, Hospitals, and Doctors all helped to cover the truly poor.  I see no reason why they can't do that now. 


As a note, I agree with you.  I only call it "insurance" because that is what people recognize.  Often I'll call them "healthcare plans".  Because they're not insurance.

A better analogy might be windshield replacements.  Some insurance companies pay for them because it is a "Safety issue", some don't.  Most wave the deductible and pay for having small cracks repaired completely.

The idea is that paying for the preventive service is cheaper than paying for the treatment later.

And it doesn't help that the insurance companies have arranged to be the "cheaper" method of getting various forms of healthcare, so doing it alone will often get you higher prices even if you are paying cash.

There are also problems.  If it worked more like car insurance, my father wouldn't have to maintain coverage during his cancer treatment - the insurance he had when it was discovered would have to pay for all treatment for that cancer. 

If the insurance companies want to have their cake about pre-existing conditions, they should have to eat all of it - that means that if you had insurance when the condition was discovered/developed, then that insurance has to pay for it.

We need to call things what they truly are.  "Healthcare" is what you and your doctors and other professionals do to make you well again.   "Insurance" is to transfer risk, a thing providing protection against a possible eventuality.   "Welfare" is getting someone else to pay for your problem(s).

If you father only needed one cancer treatment, then I'd agree with you.  But since that car keeps crashing into a tree several times a week or so, then you need insurance for each one of those.  (I know, BTDTGTTS.)   The insurance will pay for that, but what about something else going wrong ??   If he had a heart attack, but had stopped paying for the insurance, then you are fine with that not being covered ??

And look at the deductibles/max out of pocket for O-care.  It's designed to NOT be used by the people paying for it, but TO be used that people that aren't.   Seriously, if you deductible is $10,000, you going avoid going to the doctor/hospital as best you can, but if your deductible is NOTHING, then you're going to Doctor or ER every chance you get.   Since it's FREE !!!





*- don't even get me started on a lot of the folks that are "Poor" under Obamacare, yet have brand new tattoos, piercings, the latest iPhones, and nicer, new cars then I drive.   All the while "chilling" in their Section 8 housing, watching the latest flatscreen TV,  waiting for their EBT card to recharge with more food stamp and welfare money.     :mad: :mad: :mad: :mad: :mad: :mad: :mad:
Some days even my lucky rocketship underpants won't help.


Bring me my Broadsword and a clear understanding.
Get up to the roundhouse on the cliff-top standing.
Take women and children and bed them down.
Bless with a hard heart those that stand with me.
Bless the women and children who firm our hands.
Put our backs to the north wind.
Hold fast by the river.
Sweet memories to drive us on,
for the motherland.

MillCreek

  • Skippy The Wonder Dog
  • friend
  • Senior Member
  • ***
  • Posts: 19,964
  • APS Risk Manager
Re: Dismantling Obamacare Brick by Brick.
« Reply #46 on: October 20, 2017, 01:55:51 PM »
http://news.trust.org/item/20171020050722-gq4hu

The nursing shortage will get worse as the baby boomers retire and there are not enough slots in the nursing schools due to lack of faculty.  This may well lead to hospitals closing wards, closing to new admits or cancelling surgeries.  The answer is not necessarily as easy as 'raise wages' when the hospital revenue is dropping.
_____________
Regards,
MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

Scout26

  • I'm a leaf on the wind.
  • friend
  • Senior Member
  • ***
  • Posts: 25,997
  • I spent a week in that town one night....
Re: Dismantling Obamacare Brick by Brick.
« Reply #47 on: October 20, 2017, 03:21:55 PM »
I think most who cared enough about healthcare for it to be a point wanted "repeal and replace".  I have very little skin in the game and I want it replaced more than repealed.  Hell, I'd settle for some laws just fixing the major problems.


You haven't been paying attention.  Every attempt, ever, to fix a problem, by the .gov passing a law, has created more problems then they have solved.  The Law of Unintended Consequences....
Some days even my lucky rocketship underpants won't help.


Bring me my Broadsword and a clear understanding.
Get up to the roundhouse on the cliff-top standing.
Take women and children and bed them down.
Bless with a hard heart those that stand with me.
Bless the women and children who firm our hands.
Put our backs to the north wind.
Hold fast by the river.
Sweet memories to drive us on,
for the motherland.

Firethorn

  • friend
  • Senior Member
  • ***
  • Posts: 5,789
  • Where'd my explosive space modulator go?
Re: Dismantling Obamacare Brick by Brick.
« Reply #48 on: October 20, 2017, 09:32:31 PM »
Quote
You haven't been paying attention.  Every attempt, ever, to fix a problem, by the .gov passing a law, has created more problems then they have solved.  The Law of Unintended Consequences....

Are you being sarcastic here?  You provide no proof that this is the case.

A new hip is covered by insurance, as it should be.  And for something like that you could and should be able to shop around (unless it's an Emergency, then you take what you can get.) 

Why?  Isn't a new hip normally routine maintenance due to aging?

But I agree on shopping around except for when they do studies and hospitals aren't able to give quotes within an order of magnitude of what they expect the final bill to be. 

Quote
And for the truly poor (not the Obamacare 400% of poverty level "poor")*, in the past the Mutual Aid Societies, Charitable Groups, Hospitals, and Doctors all helped to cover the truly poor.  I see no reason why they can't do that now.

400% is where the subsidies end.  If you're a family of 4 making $90k, you're not getting much of a subsidy.  That said, I'd consider changing that 'tuning', more than a knock on the program.

Quote
We need to call things what they truly are.  "Healthcare" is what you and your doctors and other professionals do to make you well again.   "Insurance" is to transfer risk, a thing providing protection against a possible eventuality.   "Welfare" is getting someone else to pay for your problem(s).

That's why I used "healthcare plan".  It isn't insurance, and it isn't healthcare.  It's a plan for getting healthcare.  It's not an ideal term.  I'd welcome a better one, I just can't think of one at the moment.

Quote
If you father only needed one cancer treatment, then I'd agree with you.  But since that car keeps crashing into a tree several times a week or so, then you need insurance for each one of those.  (I know, BTDTGTTS.)   The insurance will pay for that, but what about something else going wrong ??   If he had a heart attack, but had stopped paying for the insurance, then you are fine with that not being covered ??

I wouldn't be "fine" with it, he is my father, after all, but I'd be more mad at Dad than the insurance companies.

Quote
And look at the deductibles/max out of pocket for O-care.  It's designed to NOT be used by the people paying for it, but TO be used that people that aren't.   Seriously, if you deductible is $10,000, you going avoid going to the doctor/hospital as best you can, but if your deductible is NOTHING, then you're going to Doctor or ER every chance you get.   Since it's FREE !!!

Have you actually studied Obamacare?  Because zero deductible isn't a thing in those plans.  What do you mean by "not used by people paying for it, used by those who aren't"?  Because they all end up in the same plans, just with varying amounts of the premium covered by the government.

And even in countries with no deductibles, they don't find that Doctor/ER visits become too common.  Visiting the doctor is a pain for most people, and a marginally high deductible won't deter the hypochondriacs anyways, and those with better things to do will go elsewhere anyways.

Quote
*- don't even get me started on a lot of the folks that are "Poor" under Obamacare, yet have brand new tattoos, piercings, the latest iPhones, and nicer, new cars then I drive.   All the while "chilling" in their Section 8 housing, watching the latest flatscreen TV,  waiting for their EBT card to recharge with more food stamp and welfare money.

I think you have issues in that the people you are assuming are "poor" are actually employed and doing other things.  Either that or they're committing fraud.

KD5NRH

  • friends
  • Senior Member
  • ***
  • Posts: 10,926
  • I'm too sexy for you people.
Re: Dismantling Obamacare Brick by Brick.
« Reply #49 on: October 20, 2017, 11:56:07 PM »
Why?  Isn't a new hip normally routine maintenance due to aging?

A fair number of joint replacements are due to abuse in the form of obesity.  You can't exceed the weight rating by a significant margin and expect it to last as long as if used properly.  (Though I'm fairly certain these aren't included in the ~20% of American healthcare spending for obesity related issues.)

Had a friend who needed a knee replacement, but the doc told her it wouldn't last if she didn't get and stay well under 300lbs.  So she got a wheelchair instead.