The Cellar - Obama Care vs Republicans

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- - Obama Care vs Republicans (http://cellar.org/showthread.php?t=29404)

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Words matter

LIAR

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Originally Posted by BigV (Post 882915)

they don't have a built in motivation to make the costs less, until they were compelled/cajoled into competing directly. competition has a long and well established track record of simultaneously allowing profits for effective companies and lowering prices for consumers where they have a choice.

Unless they collude to fix prices so the all get fat.
But they wouldn't do that, would they. :rolleyes:

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Originally Posted by xoxoxoBruce (Post 882964)

Unless they collude to fix prices so the all get fat.
But they wouldn't do that, would they. :rolleyes:

point well taken . however, what you describe is *not* competition anymore, it's collusion.

The entire health insurance business, I think, started in Texas with Blue Cross/Blue Shield.
back in the 1930's as hospitalization and physician insurance, respectively, for teachers.

The plan coverages were, and still are, based on "usual and customary" fees;
but "reasonable" has been added now that BC/BS licensees process Medicare for the feds.

I don't think competition between physicians was a mechanism, and probably still is not.
It was/is insurance to assure payments to the benefit of hospitals and physicians.

Probably the only path to holding down health care costs is now thru Medicare/Medicaid limits,
and I hope the policies dictated within the Obamacare exchanges will eventually do that.

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they don't have a built in motivation to make the costs less

They still don't - they do have a motivation to keep them all about the same - more or less.

To be fair, the same could be said of any industry. That's why price-fixing and collusion among competitors is illegal. That's not to say it doesn't happen, but at least now there is a *potential* element of competition in the healthcare marketplace.

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Originally Posted by Lamplighter (Post 883026)

<snip>Probably the only path to holding down health care costs is now thru Medicare/Medicaid limits,
and I hope the policies dictated within the Obamacare exchanges will eventually do that.

This is a very LONG posting, but it seems to be an authoritative summary of the cost-reducing effects of Obamacare.
It includes implications of the initial web-site problems. I have sniped out most of that.

Washington Post
David Cutler
November 8, 2013
The health-care law’s success story: Slowing down medical costs

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The anger over the botched rollout of the Affordable Care Act’s federal health insurance exchange
— and over the conflicting explanations about whether people can keep their coverage —
has been bipartisan and well-deserved.<snip>

The law has two overarching goals: Cover almost everyone, and slow the growth of medical care costs.
The goals are equally important. Too little coverage, and premiums in the exchanges will be unaffordable;
too rapid a cost increase, and the federal government will not be able to afford the subsidies.

Since 2010, the average rate of health-care cost increases has been less than half the average in the prior 40 years.
The first wave of the cost slowdown emerged just after the recession
and was attributed to the economic hangover. Three years later,
the economy is growing, and costs show no sign of rising. Something deeper is at work.

The Affordable Care Act is a key to the underlying change.
Starting in 2010, the ACA lowered the annual increases that Medicare
pays to hospitals, home health agencies and private insurance plans.
Together, these account for 5 percent of the post-2010 cost slowdown.
Medicare payment changes always provoke fears — in this case,
that private plans would flee the program and that the quality of care in hospitals would suffer.
Neither of these fears has materialized, however.
Enrollment in private plans is up since the ACA changes.

The law also emphasized that payments should be based on the value, not the volume, of medical care.
In a value-based system, compensation is made for the patient as a whole, not for specific services provided.
As a result, eliminating services that are not needed is financially rewarded.
The reaction to this change has been rapid:

Hospital readmissions, which used to bring in substantial dollars, are now penalized.
Unsurprisingly, the readmission rate in Medicare is down 10 percent since 2011.
Similarly, hospital-acquired infections used to bring in additional dollars, but now they do not.
One program to cut infections, encompassing only 333 hospitals, saved more than $9 billion.
Both of these changes improve patient health even as they reduce spending.

Cost savings induced by the ACA are particularly beneficial
because they could increase quality while they lower spending.
The reduction in technology development means lower costs
but also fewer ways to treat sick people.
People with high deductibles use fewer valuable services as well as fewer less-valuable ones.
Only by eliminating unnecessary care can we ensure that everyone benefits from saving money in health care.

Governors and legislators in red states are almost universally opposed to the ACA.
But these states are still seeing cost savings from the law — and they are participating in other ways.

For those who want to blame Obama for anything and everything that affects them personally,
they should put the blame where it belongs, on the GOP and the GOP Governors
who are fighting tooth and nail to defeat the A.C.A. law for their own political purposes.

So there, I said it

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Originally Posted by Clodfobble (Post 883058)

That's not to say it doesn't happen, but at least now there is a *potential* element of competition in the healthcare marketplace.

We went through similar problems with automobile insurance in the 1960 and 70s. The solution was to change how insurance was conducted - at state levels. That included requiring auto insurance. Also was not fair - according to naysayers. But it solved skyrocketing costs. Permitted the free market to work properly.

Health insurance is being restructured to solve a similar problem. But increasing costs are not limited to how health insurance was implemented. If our extremists want to advance America, then we are already moving on to other parts of the problem - ie hospital billing. That could not be solved without Obamacare. It is now possible to fix reasons for skyrocketing hospital bills.

Unfortunately naysayers want to maintain a bad system rather than address problems. Unfortunately a discussion of how to solve hospital billing is impossible - because many have been told and therefore believe we want America to fail. So many want a defective status quo; have and refuse to offer any solutions.

So many critics. So few want to address or even discuss reasons for radically increasing hospital costs.

Clod - I know and agree to a point.

Lamp - sorry to say that your post is nothing more than one team pointing the finger at the other. I think there is plenty of blame to go around. The R's are being asshats in some respects, but the law itself was written very poorly, none of them read it and when you only have one tool (writing laws) the old "when all you have is a hammer, everything looks like a nail" comes to mind. This law was nothing more than an attack on one industry while completely missing the other cost drivers which are Big Pharma, Medical equipment manufacturers, hospitals and providers.

What industry did it attack? Insurance?

I wish.

It defined some minimum standards for insurance, but added the mandate. Insurance providers were on board. Now they are blaming the ACA for whatever their customers don't like, whether or not the ACA is actually to blame, but they aren't victims here.

edit- "Attacking the problem from limited direction" perhaps, but not attacking the industry.

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This law was nothing more than an attack on one industry
while completely missing the other cost drivers which are Big Pharma,
Medical equipment manufacturers, hospitals and providers.

Classic, just which "one industry" are you saying is being attacked ?

I doubt you can make the argument that the "health insurance" industry is being attacked.
They (the insurers) are just being given some minimum requirements.
They will still be setting the extent of their coverages, the limits, and the co-pays.
They still are setting the prices as they do now; but subsidies and tax credits
and %-of-income limits will be available to those who may need them, their clients.
So how is the insurance industry being attacked ?

OTOH, it is exactly the hospitals and providers who are being limited in their inflation of costs.
If they don't want to live with the M/M reimbursements, that is their choice.
Unfortunately, their first choice is to pass the difference on to you, the patient.
Eventually, hospitals and providers will come around,
exactly through the mechanisms described in the above article.

Big Pharma is the result of GW Bush and Republican's writing Part D
as forbidding the government from negotiating the cost of proprietary drugs.
So, you end up with "preventative immunizations" like Shingles being
set at Tier 3 (patient pay) at a cost of $200-$400, instead of being free.
Change M/M Part D, and you'll see some major cost reductions.

As I and others are saying, put the blame where it belongs
... on your GOP Governor, and the national leadership of the GOP .

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Eventually, hospitals and providers will come around,

sure they will

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Big Pharma is the result of GW Bush and Republican's

Of course its the other teams fault.

As I and others are saying, put the blame where it belongs ....
on the other team. sigh...

More Than 1M Californians Having Insurance Cancelled Due To ACA

"More than 1 million cancellation notices have been sent to Californians as the Affordable Care Act begins allowing individuals to buy insurance through exchanges, Jones said. The federal law requires policies to offer minimum levels of coverage, forcing companies to terminate many existing plans. But Jones said that under the law, insurers have another year to do so."

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But Jones said that under the law, insurers have another year to do so."

From here

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The policies had been set to expire on Dec. 31
but will be extended until Feb. 28 for those who choose to re-enroll.
Notices informing customers of the extension will be sent out this week

This might be a "Ya' see, Timmy... " moment.

Doesn't that really sound more as tho the policies were going to expire anyway ?
And then the corporation made it's own decision to re-market inferior policies while they still had time.

And then, coincidentally, Anthem Blue Cross also screwed up notices
"due to a computer glitch" and failed to notify some 104K policy holders

Of course, we should never be suspicious of corporate decisions, or their computers.

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The federal law requires policies to offer minimum levels of coverage, forcing companies to terminate many existing plans.

...And offer new plans that do meet the guidelines of ~~basic human decency~~ the law. That's like saying the minimum wage "forced" employers to fire all their $2-per-hour workers. Of course the old plans have to go. That was the whole point.