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Author Topic: Affordable Care Act: Thoughts on the Law with 2014 Almost Here  (Read 2318 times)

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Offline RubySlippersTopic starter

Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« on: February 26, 2013, 02:51:51 PM »
I was thinking with the ACA aka Obamacare almost here and a repeal or major changes unlikely to happen for years what are peoples thoughts about it? From your perspective or as an outsider if not an American.

I am in Florida and the governor made a deal with HHS and it still needs to go into law by the Legislature acting on the Medicaid Expansion among the measures are everyone goes into an HMO, these must spend 85% of health care and there are oversight provisions in the law plus primary care providers will get more money.

One thing I noticed as a professed idler, lounger or slacker (pick your version) is that there is one clear point its an expansion only based one ones income there are now no other factors.  In simpler terms one can decide not to work, work to earn a lower income than you could or reduce hourse to get Medicaid if your earning over 133% of the poverty line. I can go into the social worker that handles that, tell them here is my income and proof and I choose not to work more that is my income its enough or if you don't work and your parents support you bring in a letter of support and say I don't want to work. In either case they cannot refuse to give it to you and there is no law demanding one work or work as much as you can to make more money. And since in my state its an HMO there are no out of pocket costs for me its for me 100% free. Seems to me kind of ripe for abuse.

On the employer front the IRS won't seem to make it easy to just cut hours to avoid the penalty they have rules in place to curb abuses but what if they say to an employee who is working 40 hours. We will be offering part-time workers only more money say they earn $10 an hour the part-timers get $12 an hour if they work under 30 hours say 29 hours or less. Also we are dropping insurance and paying the penalty if you stay on but part-timers who choose to work less we will offer to help pay for the exchange say the half the premiums. So you can decide to reduce your hours signing this form or not. I will note the law and provisions will make it hard to have the compnay drop them down but not if they willingly choose to work less hours this would be legal its just incentives to encourage employees to work less hours. If everyone does that there would be no tax penalties if I read the law right.

Overall seems to need work not that I mind for me its a sweet deal.

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #1 on: February 26, 2013, 03:27:20 PM »
I agree that the law as it's written is far from perfect.  I think it's a good first (and tiny) step in the right direction, as the law is essentially a huge subsidy to the health insurance companies in the country.  I would have prefered an idea that Vermont Senator Bernie Sanders put forward that was ignored by the mainstream media, which is have essentially Medicare part E, with the E standing for everyone.   Despite the rhetoric, medicare is fairly efficient, though there is always room for improvement just like in any government program.   Of course, expanding to a nationalized health care (like those evil socialist countries in Europe do that enjoy better health, longer average life spans and much happier quality of life, those heathens) would require expanding the tax base on the upper class so that there's no cap on the amount of income taxed for Medicare.  Currently that cap is at I believe $150,000.   Meaning any amount of money you earn above that, the IRS does not withhold FICA taxes (which also includes Social Security but that's an entirely different can of worms).

That being said, you asked about what we have rather than what I would like to see the country provide.   I live in Kentucky, which currently has a Democratic governor and House of Representatives with a tiny Republician-majority Senate.  The governor has said that he would decide this year whether to accept or deny the expansion of Medicare, but almost everyone believes that he will go along with it.  And if he does, then that means I will fall under the cut-off limit to qualify which I am happy to hear.   

I have no insurance, because I am considered part-time despite working 36 hours a week.  And since I entered the work force fifteen years ago, I have never had insurance provided for me through my job.   I looked into buying private insurance, but because I have high blood pressure as a pre-existing condition, my monthly premiums were all well over $130.  To an 18-year old kid flipping burgers at McDonald's making minimum wage (at that time it was $5.15/hour), that was entirely out of reach.   Now granted the new law does prohibit insurance companies from denying coverage based on pre-existing conditions, but it doesn't do anything about keeping the cost down.

I was disappointed with the end result, and how it's being trumpted in the media as this impressive overhaul of our health system.  It's as impressive an overhaul in my opinion as the law requiring everyone to have auto insurance before they drive was an impressive overhaul to our transporation system.

Offline Darius

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #2 on: February 27, 2013, 07:00:48 PM »
The Time article on medical costs is very good. One of the strengths that Medicare has that I wish was in the ACA was the ability to control the costs of medical providers.  Its long but worth a read



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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #3 on: February 27, 2013, 07:36:27 PM »
The Time article on medical costs is very good. One of the strengths that Medicare has that I wish was in the ACA was the ability to control the costs of medical providers.  Its long but worth a read



Bitter Pill

I just read that when it came out. It was a hefty read but it was enlightening.

Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #4 on: February 28, 2013, 12:34:19 AM »
The Time article on medical costs is very good. One of the strengths that Medicare has that I wish was in the ACA was the ability to control the costs of medical providers.  Its long but worth a read



Bitter Pill

Haven't finished reading it myself but so far it's proving interesting, if incredibly depressing... You'd think people working to make it in the health sector would be more benevolent.

Offline Pumpkin Seeds

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #5 on: February 28, 2013, 02:38:38 AM »
I think people underestimate the amount of work those of us in the health sector do.

As for my problem with the bill, my main concern revolves around patient satisfaction surveys and press gainey being used to dictate payment.

Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #6 on: February 28, 2013, 03:26:21 AM »
I think people underestimate the amount of work those of us in the health sector do.

To clarify, I meant the people charging such ridiculous markups (something I find difficult to justify), not the entire health industry and everyone in it. I've seen the conditions some work in so I definitely don't underestimate the work they do.

Offline Pumpkin Seeds

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #7 on: February 28, 2013, 03:35:09 AM »
Sorry if I was clip there.  I often see people making an assumption that as someone in the healthcare field I make a massive amount of money, but simply put we do not.  The money does not go to the actual people at the bedside. 

Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #8 on: February 28, 2013, 04:21:17 AM »
No worries, I should have been more specific from the start. I was just kind of blown away by the article. It makes it seem so helpless to effect any change. I've heard of some who argue for regulating prices but I've yet to see such a course work, the bloat normally stays while the actual workforce is cut down. I've also heard the idea of handing the hospitals over to government control but that normally causes a rapid decay in service, either through corruption or mismanagement.

Offline RubySlippersTopic starter

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #9 on: February 28, 2013, 08:34:32 AM »
No worries, I should have been more specific from the start. I was just kind of blown away by the article. It makes it seem so helpless to effect any change. I've heard of some who argue for regulating prices but I've yet to see such a course work, the bloat normally stays while the actual workforce is cut down. I've also heard the idea of handing the hospitals over to government control but that normally causes a rapid decay in service, either through corruption or mismanagement.

And there is no corruption and mismanagement now lets see $7.00 for a basic alcohol swab on a bill seems to me why can't they be honest make the hospital charge for services what it actually costs and these other items what they are on paper supposed to be. Its also odd medical care is the only industry where prices and costs of operation are not generally out in the open you get a haircut you know the price up front, you by a gallon of gasoline you can get a good idea the costs to produce it and such but not going to the hospital for a procedure - is that fair. And it rarely makes sense one hospital might charge $50,000 and another $30,000 for the same procedure and its worse if you have a procedure here that costs $100,000 you can fly to India to a tourist hospital and get the same procedure for perhaps $15,000. And in India the hospital will give you a flat rate you pay complications happen they must under contract fix it and you get a base time in say ten days for a coronary bypass graft with tons of extras. Here not as good a time in the hospital and I get its a higher standard of living and all but still seems odd to me overall the cost differences.

Like I said for ME the Medicaid Expansion in Florida as planned is a sweet deal and its good for other voluntary or not poor people under 133% of the Federal poverty line but it seems to me not well designed.



Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #10 on: February 28, 2013, 09:25:45 AM »
RubySlippers, I didn't mean to imply that there's no corruption in the private sector; my comment (as well as those before it) actually implies the total opposite... I was just saying that the entire situation feels hopeless. It's almost as if everyone is trying to pick between two rotten apples as opposed to one rotten and one fresh. Sorry for the confusion, I'm clearly not portraying my points properly.

Offline RubySlippersTopic starter

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #11 on: February 28, 2013, 12:25:22 PM »
Well this is more about the impact of the law on each of you seems two of us benefit sadly on the backs of a lot of other people, see again for me its if the HMO plan goes through 100% free to use Medicaid under state rules as they are now. Likely these demanded by HHS also under the basic Medicaid rules for the state. And since its only based on income no other factors they cannot refuse me in fact anyone who would choose to not work could get it as much as a working low income worker.

I was wondering what the impact is on other US people on the site.

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #12 on: February 28, 2013, 01:07:05 PM »
It's not 100% free to use. It comes from taxpayer income (which I'm not convinced you pay, Ruby) and taking some of the funding from other places like higher education (about which you give exactly no fucks). So...

I'm sorry, I guess I missed the point where you explain that you're honestly seeking an answer rather than just gloating about your 'sweet deal' kind of like you've done in the past. Over and over. A lot. The bottom line is that the ACA is a compromise that, while I suppose it's better than nothing, is a shitty deal for the US people. It is not a sweet deal by any stretch of the imagination.

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #13 on: February 28, 2013, 02:01:21 PM »
No worries, I should have been more specific from the start. I was just kind of blown away by the article. It makes it seem so helpless to effect any change. I've heard of some who argue for regulating prices but I've yet to see such a course work, the bloat normally stays while the actual workforce is cut down. I've also heard the idea of handing the hospitals over to government control but that normally causes a rapid decay in service, either through corruption or mismanagement.


I've seen this meme a lot. Maybe it's just my outsider status on this one, but it always brings two questions to mind:


1. Why are "let them run amok" and "the government runs everything" the only two options? I come from a system where hospitals are private entities, but are regulated to the hilt, and it's pretty damn solid.


2. What is with the (apparently American, IME) belief that government involvement inevitably leads to incompetence, malice, and waste? As it stands right now, US hospitals are being run by people who aren't doctors, have no idea what patients actually need, and give zero fucks as long as the money continues to roll in. The administrative overhead alone in this system is ten times that of a typical single-payer publicly-funded system. (This is before we get into the pure-waste item known as "profit" in accounting circles.) You've already got guaranteed incompetence, malice, and waste; isn't an alternative where these things are possible but by no means guaranteed worth a shot?

Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #14 on: February 28, 2013, 03:33:16 PM »
Ephiral,

1) It is really all dependent on the government which is doing the regulating... Let's be honest, out of all the countries in the world, itís hardly the majority which can lay claim to a trustworthy government. I'm glad that it works where you come from but I can confidently say that your locale is likely one of the few exceptions. Itíd be nice to hear some of the regulations put in place by your government as it could lend something to ponder on for the current debate. Maybe even a solution.

2) There are a number of Americans (I think) on this very forum which are pro-government. There are plenty of non-Americans around the world which hate their own governments. I'm surprised that your country has absolutely no anti-government groups... It would be the first country I've heard of.

My own opinions come from a trend which Iíve noticed when it comes to government-controlled versus privately-owned entities. Iíve found that unless specific attempts are made to avoid it they're normally both controlled by common administrators rather than the field's professionals, so thereís generally a bit of confusion no matter who is in charge (nothing a consultant canít fixÖ with a heavy cost). Iíve also noticed that while a privately-owned company might be a touch far too driven, a government-controlled one is usually hardly driven at allÖ Neither option provides for an ideal situation.

And then thereís the middle-groundÖ If government strictly regulates cost prices, thereís the fairly good chance that the company will make cuts to balance the loss. This has a tendency to hurt the actual workforce more than the overpaid admin.

Quote
You've already got guaranteed incompetence, malice, and waste; isn't an alternative where these things are possible but by no means guaranteed worth a shot?

Is it worth a shot? MaybeÖ It could either show some success or it could cause a decline in service and equipment as well as a loss of experts, leaving quite a bit of restoration work to do. Not to mention the population has to consider if they can even afford to take the risk.

In the end it can be exceptionally difficult at times to tell the likely success of an act until it has passed. Even the experts and analysts tend to be shocked by the results, on more than a few occasions. This is why itís nice to see such healthy debate before or even after a government/population takes the plunge, no matter how ďmemeĒ-like some might consider another sideís argument.
« Last Edit: February 28, 2013, 03:48:26 PM by Scribbles »

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #15 on: February 28, 2013, 04:49:19 PM »
Ephiral,

1) It is really all dependent on the government which is doing the regulating... Let's be honest, out of all the countries in the world, itís hardly the majority which can lay claim to a trustworthy government. I'm glad that it works where you come from but I can confidently say that your locale is likely one of the few exceptions. Itíd be nice to hear some of the regulations put in place by your government as it could lend something to ponder on for the current debate. Maybe even a solution.

I trust my government to take care of the interests of large businesses and its own members, and screw everybody else. But they know that screwing with universal heath care is political suicide, so making sure it's healthy and functional becomes their interest. I flatly reject your claim that my health-care experience is exceptional; cross-referencing countries with universal health care with life expectancy by country (Registration but no paywall) reveals an interesting trend - the overwhelming majority of countries with UHC have at least as much life expectancy as the US, and a cursory look reveals absolutely no countries that beat the US but do not have UHC. Meanwhile, US health expenditures are the second-highest in the world. The US seems to be the exception here; its citizens are paying more than most countries with UHC, and in many cases getting worse care.

As for my own country's regulations on hospitals: That falls under provincial law, and is more difficult to find than I have time for at the moment, I'm afraid.

2) There are a number of Americans (I think) on this very forum which are pro-government. There are plenty of non-Americans around the world which hate their own governments. I'm surprised that your country has absolutely no anti-government groups... It would be the first country I've heard of.

"A number of", yes, but - and this might simply be my experience; the plural of anecdote is not data - it seems like the knee-jerk reaction among Americans is to assume that their government will massively screw up anything it touches. I have absolutely zero love for my government - I regard it as poisonous to my country. But I expect it to execute its agenda competently, even if I don't agree with that agenda.

My own opinions come from a trend which Iíve noticed when it comes to government-controlled versus privately-owned entities. Iíve found that unless specific attempts are made to avoid it they're normally both controlled by common administrators rather than the field's professionals, so thereís generally a bit of confusion no matter who is in charge (nothing a consultant canít fixÖ with a heavy cost). Iíve also noticed that while a privately-owned company might be a touch far too driven, a government-controlled one is usually hardly driven at allÖ Neither option provides for an ideal situation.

What criteria do you judge effectiveness or "drive" by? Going by simple efficiency (quality of care and dollars spent per patient treated)... well, in the field of health care, the data is in, and public systems are vastly superior.

And then thereís the middle-groundÖ If government strictly regulates cost prices, thereís the fairly good chance that the company will make cuts to balance the loss. This has a tendency to hurt the actual workforce more than the overpaid admin.

Why is this the only middle ground? Why not start by regulating salaries - or administrative overhead as a whole? Or mandate that "non-profit" actually means "we do not make a profit"?

Is it worth a shot? MaybeÖ It could either show some success or it could cause a decline in service and equipment as well as a loss of experts, leaving quite a bit of restoration work to do. Not to mention the population has to consider if they can even afford to take the risk.

Treating these possibilities as even remotely close to equal is disingenuous. There's plenty of data that clearly shows it will improve things; I'd like to see even two substantial and credible pieces that say it will cause harm.

In the end it can be exceptionally difficult at times to tell the likely success of an act until it has passed. Even the experts and analysts tend to be shocked by the results, on more than a few occasions. This is why itís nice to see such healthy debate before or even after a government/population takes the plunge, no matter how ďmemeĒ-like some might consider another sideís argument.

That's because, to be frank, experts in a field that is not statistics tend to make extremely poor statisticians and probability analysts - just like most people. If we look at the actual data on what happened when this was tried, over and over and over and over again the numbers say the same thing. At this point, it would take overwhelming evidence to balance out everything sitting on the pro side.

For the record, the "meme" comment was not intended to be derisive; I use the term in its original sense.

Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #16 on: February 28, 2013, 07:12:33 PM »
I trust my government to take care of the interests of large businesses and its own members, and screw everybody else. But they know that screwing with universal heath care is political suicide, so making sure it's healthy and functional becomes their interest. I flatly reject your claim that my health-care experience is exceptional; cross-referencing countries with universal health care with life expectancy by country (Registration but no paywall) reveals an interesting trend - the overwhelming majority of countries with UHC have at least as much life expectancy as the US, and a cursory look reveals absolutely no countries that beat the US but do not have UHC. Meanwhile, US health expenditures are the second-highest in the world. The US seems to be the exception here; its citizens are paying more than most countries with UHC, and in many cases getting worse care.

It might sound silly but Iím very paranoid about where I registerÖ Iíll just take your word for it. The fact that it took me some time to find any failures of UHC to counter your points speaks volumes.

Unless, of course, youíre willing to take FOX as a totally unbiased and completely legitimate source of news. Then I suddenly have a surplus of reasons why a UHC is bad news.

Quote
As for my own country's regulations on hospitals: That falls under provincial law, and is more difficult to find than I have time for at the moment, I'm afraid.

I understand.

Quote
"A number of", yes, but - and this might simply be my experience; the plural of anecdote is not data - it seems like the knee-jerk reaction among Americans is to assume that their government will massively screw up anything it touches.

I doubt this will go anywhere considering that weíre both debating from experienceÖ

Quote
What criteria do you judge effectiveness or "drive" by? Going by simple efficiency (quality of care and dollars spent per patient treated)... well, in the field of health care, the data is in, and public systems are vastly superior.

By drive, I was simply referring to the motivation required to push an administrator to succeed. For example, you believe that administrators will be motivated by their own political interests. Drive/Motivation is essential for at least some success.

Quote
Why is this the only middle ground? Why not start by regulating salaries - or administrative overhead as a whole? Or mandate that "non-profit" actually means "we do not make a profit"?

Thereís never only one middle-ground. Sorry if I implied as much. Naturally thereíll be an assortment which lean either toward greater government or private control. Regulated costs is simply the one Iíve heard of the most.

Quote
Treating these possibilities as even remotely close to equal is disingenuous.


Not from my perspective but this was because I was trying to lump developing and developed countries into the same basket. I figured the situations would be similar but I was obviously wrong.

Quote
I disagree, There's plenty of data that clearly shows it will improve things; I'd like to see even two substantial and credible pieces that say it will cause harm.

Iím shocked to say that I canít provide any, at least not in the developed world. The two main culprits that Iíve been made aware of over the years were Russia and Cuba and yet a little in-depth research shows that most of what Iíve been told was either an over-exaggeration or outright lie. Cubaís health-care is apparently praised the world over, with the only problem being that it benefits foreigners more than its own people: www.global-politics.co.uk Ė link to article

Russiaís own UHC failed horrifically but from what Iíve read this was due more to the effect communism had as a whole as well as other external factors (radiation, industry, fall of the Soviet Union, etc) rather than the UHC itself. Unfortunately, the best article I could find doesnít go beyond the year two thousand but from what Iíve read, Russia is moving away from its current system. Itís considered a developing country however so it really doesnít add much to the discussion. www.countrystudies.us - link to article

There is an interesting titbit I found while digging through articles. This is just a hunch for now, one which Iíll look up more thoroughly when I have time, but it seems that the USís private system might provide better care than other countries. So the difference might lie in the fact that a UHS provides more, if less specialized, care while the USís current system provides less but highly specialized care. Of course, providing for a bigger group trumps providing for individuals at exorbitant prices.

Quote
For the record, the "meme" comment was not intended to be derisive; I use the term in its original sense.

I'll take your word for it. I looked it up and was instantly put-off by the definition I found...
« Last Edit: February 28, 2013, 07:26:28 PM by Scribbles »

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #17 on: February 28, 2013, 11:04:38 PM »
It might sound silly but Iím very paranoid about where I registerÖ Iíll just take your word for it. The fact that it took me some time to find any failures of UHC to counter your points speaks volumes.

It's the Lancet - one of, if not the medical journal of record. You're probably safe. As for failures: When checking my lists, Mongolia jumped out at me. I suspect that has something to do with a lack of resources or infrastructure, though.

Unless, of course, youíre willing to take FOX as a totally unbiased and completely legitimate source of news. Then I suddenly have a surplus of reasons why a UHC is bad news.

Hahahahahahano. I'm sorry, but no news source that fought a court battle for its right to outright lie has the slightest shred of credibility with me.

I understand.

Did some more digging. Regulations aren't subject to the same sort of compulsory publication as law, but I do have an example of provincial health care law, and it does provide some insight: Items specifically noted as requiring legal regulation include not just costs of uninsured services, but staffing requirements, quality of care, and related factors. I won't lie - funding cuts do hit nurses hardest (often in the form of excessive hours), but nobody's pulling down seven figures in a hospital.

I doubt this will go anywhere considering that weíre both debating from experienceÖ
I'll concede the point; it's far more likely that I'm suffering from confirmation bias than that a huge number of people have the same odd fault in thinking.

By drive, I was simply referring to the motivation required to push an administrator to succeed. For example, you believe that administrators will be motivated by their own political interests. Drive/Motivation is essential for at least some success.

Mmm. I honestly don't care why the job gets done - be it from personal drive, or a desire for promotion out of a crappy job, or what have you. What I care about is the effects where the rubber meets the road: How does a change affect actual patients?

Thereís never only one middle-ground. Sorry if I implied as much. Naturally thereíll be an assortment which lean either toward greater government or private control. Regulated costs is simply the one Iíve heard of the most.

There's a very clever collection of well-paid organizations and people whose job it is to suggest the worst possible implementation as loudly as possible, and then say that since that won't work the whole thing is a wash. (See also: Fox news.)
 

Not from my perspective but this was because I was trying to lump developing and developed countries into the same basket. I figured the situations would be similar but I was obviously wrong.
Developing countries are different, yes. It's difficult to implement universal anything without the money and infrastructure to do it.

Iím shocked to say that I canít provide any, at least not in the developed world. The two main culprits that Iíve been made aware of over the years were Russia and Cuba and yet a little in-depth research shows that most of what Iíve been told was either an over-exaggeration or outright lie. Cubaís health-care is apparently praised the world over, with the only problem being that it benefits foreigners more than its own people: www.global-politics.co.uk Ė link to article

Russiaís own UHC failed horrifically but from what Iíve read this was due more to the effect communism had as a whole as well as other external factors (radiation, industry, fall of the Soviet Union, etc) rather than the UHC itself. Unfortunately, the best article I could find doesnít go beyond the year two thousand but from what Iíve read, Russia is moving away from its current system. Itís considered a developing country however so it really doesnít add much to the discussion. www.countrystudies.us - link to article

I must say, it's very rare to see someone actually check the facts, conclude that they were mistaken, and change their mind. You have my deep and abiding respect. As for Russia... I haven't looked into it in depth, but there's endemic corruption issues and serious infrastructure problems, so this doesn't surprise me overmuch. The fact that they're considered developing does, though.

There is an interesting titbit I found while digging through articles. This is just a hunch for now, one which Iíll look up more thoroughly when I have time, but it seems that the USís private system might provide better care than other countries. So the difference might lie in the fact that a UHS provides more, if less specialized, care while the USís current system provides less but highly specialized care. Of course, providing for a bigger group trumps providing for individuals at exorbitant prices.

Speaking for my country, we've got roughly the same level of specialization. Where the US pulls way, way ahead is in specialized-treatment capacity. You have, for example, a huge number of CT machines. The problem is, while this looks good on paper, it's actually masking another hefty form of inefficiency - there is far more specialist capacity in the US than is needed or ever used, including people coming to the US from other countries for care. Machines are sitting empty and silent, and the half-million dollars or so that each one cost is basically money that was set on fire instead of helping patients.

I'll take your word for it. I looked it up and was instantly put-off by the definition I found...

The actual, original meaning of the term was, basically, an idea that seems to self-propagate in a manner not dissimilar to a biological virus.
« Last Edit: March 01, 2013, 11:05:36 AM by Ephiral »

Offline Vekseid

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #18 on: March 01, 2013, 06:24:19 AM »
It's not 100% free to use. It comes from taxpayer income (which I'm not convinced you pay, Ruby) and taking some of the funding from other places like higher education (about which you give exactly no fucks). So...

I'm sorry, I guess I missed the point where you explain that you're honestly seeking an answer rather than just gloating about your 'sweet deal' kind of like you've done in the past. Over and over. A lot. The bottom line is that the ACA is a compromise that, while I suppose it's better than nothing, is a shitty deal for the US people. It is not a sweet deal by any stretch of the imagination.

I just wrote a $720 check for a 2-mile ambulance ride. I went to pay a $950 hospital bill which I found to be more than reasonable, and noticed there was another one for over $10k for the ER trip and stay.

And this isn't the price insurers pay. It isn't the price Medicare pays. It's simply the price that hospitals try to charge to cover nonpayment, underpayment, overtesting, etc. On top of all this 'for profit non-profit' bullshit.

And like Pumpkin said... little of it goes to doctors and less to nurses.

It's not like traditional insurance is an option for me. For $12k, I can get two months of insurance. The war on the self-employed is going strong in this country.

Do you think this situation is even remotely defensible, or would you rather I have not had care?

Offline Scribbles

Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #19 on: March 01, 2013, 08:56:20 AM »
Did some more digging. Regulations aren't substitute to the same sort of compulsory publication as law, but I do have an example of provincial health care law, and it does provide some insight: Items specifically noted as requiring legal regulation include not just costs of uninsured services, but staffing requirements, quality of care, and related factors. I won't lie - funding cuts do hit nurses hardest (often in the form of excessive hours), but nobody's pulling down seven figures in a hospital.

Thanks for digging that up, I can see what you mean by strict regulation. It looks as if they go so far as to require hospital improvements or additions to be pre-approved and that the board is appointed by the government - I take it that the hospitals are fully state-owned.

Quote
Mmm. I honestly don't care why the job gets done - be it from personal drive, or a desire for promotion out of a crappy job, or what have you. What I care about is the effects where the rubber meets the road: How does a change affect actual patients?

----

Developing countries are different, yes. It's difficult to implement universal anything without the money and infrastructure to do it.

These two are actually related, if you take my previous thoughts on the matter. One of the major hurdles in some developing countries isnít actually resources or infrastructure, oddly enough, but rather an apparent indifference held by leaders for their citizens. There just isnít any motivation (positive or negative) to compel them to do their jobs, properly.

Quote
I must say, it's very rare to see someone actually check the facts, conclude that they were mistaken, and change their mind. You have my deep and abiding respect.

Aww, thanks, the feeling is mutual!

Quote
As for Russia... I haven't looked into it in depth, but there's endemic corruption issues and serious infrastructure problems, so this doesn't surprise me overmuch. The fact that they're considered developing does, though.

I was caught off guard by that as wellÖ

I thought this might be an interesting read, if a bit dated (2000). I havenít had the time to wade through the actual documentation yet but I found the statistics at the bottom interesting enough.

http://www.who.int/whr/2000/en/whr00_en.pdf

I hope itís alright that I cut a few chunks out of the conversation. I just didnít see anything more I could add to those other points beside maybe a nod. Thanks for the discussion Ephiral, it was an eye-opener.

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #20 on: March 01, 2013, 09:23:05 AM »
I just wrote a $720 check for a 2-mile ambulance ride. I went to pay a $950 hospital bill which I found to be more than reasonable, and noticed there was another one for over $10k for the ER trip and stay.

And this isn't the price insurers pay. It isn't the price Medicare pays. It's simply the price that hospitals try to charge to cover nonpayment, underpayment, overtesting, etc. On top of all this 'for profit non-profit' bullshit.

And like Pumpkin said... little of it goes to doctors and less to nurses.

It's not like traditional insurance is an option for me. For $12k, I can get two months of insurance. The war on the self-employed is going strong in this country.

Do you think this situation is even remotely defensible, or would you rather I have not had care?

The system as it is - even as it's going to be - still needs a lot of work before we get a true UHC.  There's still a big difference between the attitude of 'I'm working as much as I can, or I am unable to work.  I need help and I still can't afford it.' and 'I don't want to work.'

Regulating prices (like Reich and Sanders have both suggested over the past year) in the vein of expanding Medicare/Medicaid coverage would go a long way in helping the self-employed or those whose employers are offering the bare minimum.  Right now, the 'health care plan' that Mr. Oniya's company is offering - assuming we only chose to enroll him and the little Oni - would take out about $150 per month.  During that one month, if either of them had a doctor's visit, we would have to pay the doctor up-front, and then apply for a $50 reimbursement.

It would do us more good to take the money and stuff it in a bank account.

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #21 on: March 01, 2013, 11:13:10 AM »
I just wrote a $720 check for a 2-mile ambulance ride. I went to pay a $950 hospital bill which I found to be more than reasonable, and noticed there was another one for over $10k for the ER trip and stay.

And this isn't the price insurers pay. It isn't the price Medicare pays. It's simply the price that hospitals try to charge to cover nonpayment, underpayment, overtesting, etc. On top of all this 'for profit non-profit' bullshit.

And like Pumpkin said... little of it goes to doctors and less to nurses.

It's not like traditional insurance is an option for me. For $12k, I can get two months of insurance. The war on the self-employed is going strong in this country.

Do you think this situation is even remotely defensible, or would you rather I have not had care?

I'm not sure how "ACA is better than nothing but nowhere near what we need" translates to defending current health care costs?

Offline Ephiral

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #22 on: March 01, 2013, 11:52:23 AM »
Thanks for digging that up, I can see what you mean by strict regulation. It looks as if they go so far as to require hospital improvements or additions to be pre-approved and that the board is appointed by the government - I take it that the hospitals are fully state-owned.

I learned something here. I had always thought they were Crown corporations - entities owned by the government but privately run - but it turns out that they're actually owned and operated by private non-profit entities. The relationship strikes me as akin to a contractor - the government is pretty much their sole customer, so that customer gets to dictate a lot of the contractor's practices in order to insure that their money is well-spent. I've seen similar relationships in my time in the call-center industry.

These two are actually related, if you take my previous thoughts on the matter. One of the major hurdles in some developing countries isnít actually resources or infrastructure, oddly enough, but rather an apparent indifference held by leaders for their citizens. There just isnít any motivation (positive or negative) to compel them to do their jobs, properly

I know this isn't the way the vernacular works, so not faulting you here, but I think it would be useful to draw a distinction between "developing" and "undeveloped" here. What you're describing, I'd file under "undeveloped".

I thought this might be an interesting read, if a bit dated (2000). I havenít had the time to wade through the actual documentation yet but I found the statistics at the bottom interesting enough.

http://www.who.int/whr/2000/en/whr00_en.pdf

I hope itís alright that I cut a few chunks out of the conversation. I just didnít see anything more I could add to those other points beside maybe a nod. Thanks for the discussion Ephiral, it was an eye-opener.

Damn it, this is exactly the report I could've used in my second post. And yeah, it's got some pretty revealing bits. I don't mind you trimming the fat at all - I'm pretty horrible at it, myself. And you're quite welcome. I really enjoyed this.
« Last Edit: March 01, 2013, 11:56:01 AM by Ephiral »

Offline Valthazar

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #23 on: March 23, 2013, 11:31:59 AM »
I realize I am a bit of a late entrant to this conversation, but I figured I would add my two cents.  Like many others here have stated, while ACA is a step in the right direction, the wording of the law may actually end up hurting more Americans, than helping.

For example, the ACA defines a "full-time" employee entitled to health benefits as anyone working over 30 hours a week.  "For purposes of section 4980H, a ďfull-time employeeĒ is an employee who is employed on average at least 30 hours per week." [[ Source ]]

As a business owner, this would either prompt me to keep more of my employees in part-time positions, or it would cause me to reduce the number of employees.  Just some food for thought.

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Re: Affordable Care Act: Thoughts on the Law with 2014 Almost Here
« Reply #24 on: March 23, 2013, 12:25:23 PM »
And this is a change from preexisting trends?