Originally Posted by Marx & Lennon

It's easy. Procedures and "stuff" (drugs, medical devices, etc) can be counted. Why do you think that everything is coded? It's not for medical reasons, that's for sure.

Yeah, it makes hospital bills hard, but not impossible to sort out. However... sometimes a screwup is so blatant that it can't be overlooked. One of my parents' friends received HIS hospital bill and found a procedure code with a procedure called "PAP smear" on HIS bill. Of course he called the errant hospital to have said charge removed since HE doesn't have the relevant body part for said procedure.

In this regard, I think finding extra charges is , umm easier as there are fewer body parts for procedure codes to promulgate.
For future reference I've enumerated proper body parts as per schedule below.

100.902 colonoscopy. Well, I think I can dress up in a turban and get one of those free at the nearest airport. Hospital not required. Or I can whisper, "I'm a mule" to get a more thorough exam, including prostate exam at airports. Of course, I'd demand the TSA give my hydrocodone/Valium or medicinal weed before undergoing said procedures for stress relief.
201.13 Prostate digital exam. Sort of above, TSA approved procedure or hospital code.
666.00 Hospital food. Food from hell, 'nuff said.
1313.13 Room and board. Catch all which should be broken down into why the hell it costs $20,000. I think it would be more cost effective to just put me up in the nearest Hotel 6, have the requisite medical equipment taxied over to my room, and nurses taxied over when they need to give me a shot or take my blood pressure.
2020.20 $20.00 aspirin pill. Dumb. I have no issue with paying $20.00 a pill. Give me a Valium or dope me up with a morphine pill and I won't bitch. Hospital stays are not fun, so make them fun with "better living through chemistry". There are so many pills that are worth $20.00 a hit. I'll accept Lortabs, Amphetamine, ketamine, white crosses, yellow jackets, a joint, black mollies, etc.

That's all guys need wrt body part stuff. All we have to do is bitch abound generic, all encompassing stuff like "room and board" and demand exactly what that covers. I can have the other crap like cholesterol/heart stuff/skin exams to the primary care part.

Now if we go under the knife, I'll demand to know which drug was used to put me under and if it costs too much demand that some other cheaper drug could have been used. Pentothal is cheap and I guess Propopol is as well.

Originally Posted by The Rani

Now yer talkin'!
I thank you, playdude, and my friend the surfboarding neurosurgeon with the second home in Costa Rica also thanks you.

You're dating a neurosurgeion and he only took you surfing in Costa Rica???!!!

Hopefully this is still early in the relationship and he's just holding back.

Originally Posted by Deb C

Totally different story for primary docs. As you most likely know, not every doctor makes a ton of money.

To help with reading composition, please go back and note the reference was to "the cancer/heart/kidney specialist."

Psss, the mediocre ones make a ton of money and take their GFs to Costa Rica; the really good ones make bucku tons of money and buy entire islands for their GFs.

It's not Dr Marcus Welby GP that drives up medical care costs (and many GPs don't even have GFs 20-25 years younger!), but they sure don't drive around in 10 year old cars either (unless someone uses the term "classic" in describing it).

But I agree its not just the doctors, not even mostly the doctors. It's a combination of technology and the expectations of miracle technologies as a God-given right all immersed in a quasi free-market profit-making systems where one of the parties is much less concerned about what is paid because they don't want to be sick or don't want to die, and the actual costs are spread out to many others. It's not only much more complicated than just pointing fingers at the doctors, the insurers, the drug makers or what have you, it also doesn't go away under a single payer regime - that just changes who makes the hard decisions. I would prefer single payer but I would go into it with eyes wide open and not expecting miracles. I don't do magic pony lands.

Obamacare has made my brother Mark very busy. (He works for Blue Cross/Blue Shield in Albuquerque). He was the one who mentioned the risk pool in New Mexico. The goal in to insure those who are otherwise uninsurable. Think low income. If Obamacare ends up being undermined, we should consider a Plan B.

This morning, at the end of graveyard shift, there was some story (television news) about Democratic congress-critters defecting, turning against Obamacare.

Originally Posted by TimWalker

This morning, at the end of graveyard shift, there was some story (television news) about Democratic congress-critters defecting, turning against Obamacare.

Not going to happen. Anyone who thinks it will has no understanding of how Congress actually works. It's just Kabuki Theater for the sheeple.

One possible scenario that would be particularly fun is if Reid does bring the House's Upton bill to the floor. Little doubt it will be substituted with the the Landrieu bill if that would happen. If that happens it will be the Senate GOP filibustering a legislative fix and that will enrage the t-baggers while making the GOP look like they've stumbled their way back in the clown car to everyone else. What would be really cool is if enough Rand Paul types would x-over to the Dems to override the GOP filibuster and send it back to the House. If that happens, the fireworks are gonna be pretty as the GOP's heads explode.

To understand why, one needs to understand that any "fix" that is broader/longer than what Obama offered will completely bankrupt the insurers in about 2 years. The insurers know it. Obama knows it. Most of the Dems with half-a-brain know it. Most GOP Congressional critters don't because they lack the prerequisite half-a-brain, and their base is pretty much brainless.

Destroying the insurers will go far beyond impacting just those covered by Obamacare[ it will impact the majority of people that get their insurance through their employers. We will be on the path to single payer.

The insurers are not going to let this happen and they'll be pretty clear about where their 10s of millions of dollars in campaign funds will go and will not go. The GOP is not so far gone intellectually to let this just happened so they won't, but it sure will help split their party because the baggers are going to go ape shit crazy over not only what looks like a betrayal but absolute stupidity of the GOP. It could be what causes the party's split.

The GOP's best hope is Reid just lets the House bill die in the Senate by not bringing it up. That would allow the GOP to keep pushing their memes of the website failure and the cancellations. They need to make that 'stick' as much as they can now because its power is going to be continually eroded from here on out as millions get signed up on the health exchanges, most with very good news on the costs, and millions more get signed up for Medicaid. By this time next year, only the faithful are going to feel those memes have any power left in them.

Between now and January (when millions will be signed up), the House only is planning 15 days of being in session. That makes a good chance they don't have time to really F themselves. On the other hand, we are talking about the clown car. Fingers crossed.

PW,

Out of mild curiosity, if Barack Obama wasn't willing to stand up to political pressure on the cancelled policies this year, why will next year be any different?

Originally Posted by The Rani

Yes:

http://www.nydailynews.com/news/nati...icle-1.1518836

And from Obama himself (same article):

Does anyone know WTF an "administrative fix" is? Something like an "executive order?"
Someone needs to remind this guy that he's not a dictator.

Oh wait, someone already has:

The one clear thing that has come out of the 'Obamafix' is the massive ignorance of the difference between legislation and regulation. I suggest spending some time on the Federal Code of Regulation and a few weeks reading of daily Federal Register Notices to get some inkling of the broad lattitude the Executive Branch has in interpreting legislation and implementing it.

Now, if you're talking about operational reality of the poor insurers not being able to un-cancel the cancelled policies, I have some practical advice for them and some more philosophical one. Practically, I suggest the re-hire all those people they let go that use to do the investigations to determine if claimants with cancer, heart attacks and other high-cost illnesses didn't actually have pre-conditions that the insurer could use to not only kick them off their policies but take them to court to recover any reimbursements. These people were ruthlessly good at what they did; un-cancelling cancelled polices should be a piece of cake (and maybe one or two less levels of hell when they pass to the underworld). Philosophically, that's even easier - who gives a flying F about the insurers?

Politically, the ObamaFix has done what it was supposed to do - muddy the waters as to 'fault' for the cancellations and to buy time for the website fix. When the website is running and signing up 10s of thousands in December, followed by thousands of stories of people getting coverage for the first time on January 1, it will not only make all the Kabuki Theater this Fall seem like stupid hysteria, but also a great Christmas story! Only the faithful and nihilists will think this is meaningful by the time of the 2014 elections.

Originally Posted by playwrite

Not going to happen. Anyone who thinks it will has no understanding of how Congress actually works. It's just Kabuki Theater for the sheeple.

Right, no congress-critter would ever bail out of supporting an increasingly unpopular bill.

Where do you come up with this stuff, and do you realize you're the only one you're insulting here?

Originally Posted by JordanGoodspeed

PW,

Out of mild curiosity, if Barack Obama wasn't willing to stand up to political pressure on the cancelled policies this year, why will next year be any different?

Who cares?

It's only a political issue because of the power of the meme of Obama being wrong about people being able to keep their old policies. Some of the power of that has been mitigated by the ObamaFix muddling up who's at fault - admittedly a small shift toward the insurers, certainly not enough to get the GOP to back off or for their sheeple to stop screaming, but enough to give some backbone to the Dems. That power is also only good this time around; it will not be an issue for the 2015 policies. However, the big thing is the numbers. Millions more are going to get Medicaid or insurance for the first time. Millions more are going to be very happy with the price they pay and the insurance they will get. Of the ones left, their stories are going to get muddy up between those who truly lost good insurance and have to pay more now and those too stupid/ideological to grab a better deal. Moreover, it will be increasingly reported that any repeal or major tinkering with the ACA will result in much, much greater cancellations and in a return to the wild markets for individual policies we had prior to the ACA.

So bottom line: the political power of this is highly limited and has probable already hit its peak; old news by this Christmas.

It's actual impact on policy and program is even less consequential. About 5% of the market is getting cancellations. Of those, about 1/4 are the highly prized young "invincible." Many of these young folks are going to have incomes far below the 400% FPL and will be eligible for subsidies. Many will pay nothing to get real insurance and we know that overall 2/3 of the young (both those who had and did not have insurance) will pay less than $100/month. That ratio will probable hold for those with cancelled insurance. That means the group with cancelled insurance and are young with high incomes that will keep their old insurance is extremely small relative to all the other young cohorts. People, smart people, are conflating the issue of cancellations and the issue of risk pools having enough youth. It doesn't make any sense to conflate them in reality; it just helps sell newspapers and GOP candidates - but, as noted above, even that is going to prove limited.

At a party today everyone was laughing about how overblown the whole "Oooooh Obamacare is so messed up!" It's typical hype.

And nobody with an income of less than $11K is paying anything for health care.

Originally Posted by annla899

At a party today everyone was laughing about how overblown the whole "Oooooh Obamacare is so messed up!" It's typical hype.

How many people at the party are actually affected by it and dealing with it? Are these professors with top 10% salaries, generous benefits, and students living off loans and parental employer plans?

I don't really see the humor in the hours I've spent on hold, or trying to use a dysfunctional website. Buuut I'm glad my frustration can amuse you - I guess that goes under the "benefits" column.

On a slightly related note, I keep wondering how much longer upper middle class (and up) professional's are going to stay within the present progressive coalition. It always amazes how the party affiliations actually line up by race, class, and all that other happy horseshit.

I suppose one could take the opportunity to insert some disparaging comment about those Republican knuckledraggers at this point, and depending on how it was worded I might even agree with it to some degree, but let's be honest: If the Republican party were to collapse tomorrow, permanently, THAT's where the new faultline would emerge.

The results of this turning should be interesting.

Originally Posted by JohnMc82

Right, no congress-critter would ever bail out of supporting an increasingly unpopular bill.

Where do you come up with this stuff, and do you realize you're the only one you're insulting here?

You want to make a bet?

If they pass any Obamacare fix legislation by the end of this year, I'll apologize and leave the forum for a year.

If they don't, then you apologize and leave the forum for the year.

Got the gonads or are you just a mouth that spews horseshit?

Originally Posted by The Rani

I literally can't read his posts any more. It's not worth the glucose that it takes to move my eyes back and forth across the screen.
Having checked out the website myself and looked at the rates, I don't see how anyone actually believes that anyone with an annual income of less than $11K is going to shell out $2K year in health insurance premiums. It's just not gonna happen. (Which I'm sure is why state legislators knew that refusing to expand Medicaid would effectively destroy ACA.)

I don't think there's a state in the Union where someone making 11k per year isn't eligible for Medicaid even before any ACA expansion of the program. Why in the world would you think they have to shell out any money for premiums???

You're in the medical field and have this level of ignorance; imagine the general population. Democracy and willful ignorance by the many eventually doesn't work.

Originally Posted by playwrite

I don't think there's a state in the Union where someone making 11k per year isn't eligible for Medicaid even before any ACA expansion of the program. Why in the world would you think they have to shell out any money for premiums???

Considering the US poverty level is around $11,900 (except for Alaska and Hawaii where it's higher), yes, even a single person on that income is eligible for Medicaid.

Originally Posted by JohnMc82

How many people at the party are actually affected by it and dealing with it? Are these professors with top 10% salaries, generous benefits, and students living off loans and parental employer plans?

I don't really see the humor in the hours I've spent on hold, or trying to use a dysfunctional website. Buuut I'm glad my frustration can amuse you - I guess that goes under the "benefits" column.

http://talkingpointsmemo.com/edblog/...ser-speaks-out

An Obamacare "Loser" Speaks Out ... About Not Being an Entitled Douche

Since it’s been estimated that about 3% of the US population will end up “losers” under Obamacare, I thought I’d write in and give you my perspective as a 3-percenter. However, I suspect that I belong to a smaller subset of the 3%, that being people who find it appallingly self-indulgent and shamefully self-pitying to think of ourselves as losers.

Having insurance, even crappy insurance, in the individual market means we are almost by definition, healthy and relatively young. If we were not, we wouldn’t be able to get coverage of any kind in the non-group market. If our ACA-compliant replacement policy costs us more, it’s likely because we’re too affluent to qualify for subsidies.

It takes a remarkable degree of self-absorption and sense of self-entitlement to be healthy, young(ish) and affluent—and yet consider oneself a “loser.” It’s a label I reject out of shame (no matter how much the lazy, superficial MSM want to fixate on me and my “plight”) NOT because there’s anything shameful about being a loser; the shame is in thinking oneself a loser when one is actually fortunate.

I live in Louisiana where 400,000 working poor people will continue to go without health care because one man, Gov. Bobby Jindal, decided letting them have Medicaid wouldn’t be good for his future ambitions. Those 400,000 are the losers. And while my healthcare.gov application has been stuck for a month now at the “View Eligibility Results” stage, where instead of my results I see a blank screen when I click the button, I know I will get better health insurance than the bare-bones individual policy I have now, even if I end up having to pick up the phone, or heaven forbid, send in paper. I will pay significantly more, but after years of being one serious illness from financial ruin, I will finally have security. And not only that; every time I pay my new premium, I am paying into a system that makes it possible for my fellow Americans who have not been as lucky as me—people who really have been losers pre-ACA—to finally get affordable health care.

I was fortunate before Obamacare, and now I am an Obamacare winner. Now if the media would just help more of the public understand how lucky us 3-percenters actually are, perhaps the public would start to recoil at the absurdity of the outrage being whipped up on our behalf, and we could start focusing on how to help the real losers: the working poor in refusenik states.

There are 500,000 people, men, women and children, in North Carolina that will be denied Medicaid coverage in North Carolina because of the GOP a-holes there that will not accept the ACA expansion. You got a long line of pity to stand in, John, before we get to someone who is probable been pretty healthy and too affluent to get an ACA subsidy - why, I just might run out of tears for you.

Originally Posted by The Rani

I didn't "get it" myself til I looked at the website.
I'd bet none of the laughers have tried it, either. I don't know what kind of dumb fuck (cough, Obama) thinks that setting it up that way and blaming Republican state legislatures for the fallout is anything short of immoral.

This is an example of the conflation of issues that the Right relies on to shape its sheeple. The website has NOTHING to do with states accepting or not the Medicaid extension, deary.

It's difficult to know when someone is just saying these dumb F things to influence the sheeple or if indeed they are the sheeple.

Originally Posted by JordanGoodspeed

On a slightly related note, I keep wondering how much longer upper middle class (and up) professional's are going to stay within the present progressive coalition. It always amazes how the party affiliations actually line up by race, class, and all that other happy horseshit.

I suppose one could take the opportunity to insert some disparaging comment about those Republican knuckledraggers at this point, and depending on how it was worded I might even agree with it to some degree, but let's be honest: If the Republican party were to collapse tomorrow, permanently, THAT's where the new faultline would emerge.

The results of this turning should be interesting.

Completely depended on whether or not the upper middle class professional stays willfully ignorant of facts and logic. We already have example of that here.

Originally Posted by The Rani

Hey here's some good news. Lots of helpful tips in this article how to successfully defraud the government and get some free subsidies:
Obamacare Will Lift Tax Fraud To A Whole New Level

Your source is a moron. He is confusing the limits of the IRS to collect the penalty (except if one is ever owed a tax refund) with their ability to go after tax fraud OR insurance fraud which is what it would be if one intentionally misrepresents their financial status to collect a subsidy. Something that one would live with for life since their is no statue of limitations for defrauding the government. Generally, working people who make 400% of the FPL are not likely to risk it all to save a couple hundred bucks a month on health insurance. Not to say this will not happen, there obviously are very very dumb people in the world; but you would think they would save their risk taking for some actual cash rather than for cheaper insurance.

Originally Posted by playwrite

Completely depended on whether or not the upper middle class professional stays willfully ignorant of facts and logic. We already have example of that here.

I would be fascinated to hear your opinion on this. I'm not sure if we're talking about the same thing, but please elaborate.

Originally Posted by playwrite

http://talkingpointsmemo.com/edblog/...ser-speaks-out

There are 500,000 people, men, women and children, in North Carolina that will be denied Medicaid coverage in North Carolina because of the GOP a-holes there that will not accept the ACA expansion. You got a long line of pity to stand in, John, before we get to someone who is probable been pretty healthy and too affluent to get an ACA subsidy - why, I just might run out of tears for you.

Do you think putting the entire Democratic party campaign strategy on the line of a piece of crap legislation with a 40% approval rating has anything to do with the Tea Party victory in NC? It's only going to get worse, and regurgitating the latest talking points isn't going to fix that.

The Dems are playing checkers with the retarded kid at school... and losing. If you're not pissed, maybe you don't understand.

Originally Posted by playwrite

There are 500,000 people, men, women and children, in North Carolina that will be denied Medicaid coverage in North Carolina because of the GOP a-holes there that will not accept the ACA expansion. You got a long line of pity to stand in, John, before we get to someone who is probable been pretty healthy and too affluent to get an ACA subsidy - why, I just might run out of tears for you.

Instead of obsessing over your uncanny ability to repeat the party's latest spin, maybe I should have focused on shedding some light on the random accusations that constitute the unique sliver of original content that is your typical post.

If I hadn't gotten married earlier this year, I would not indeed be eligible for subsidies. Given a complete lack of competition, the only provider in my county has decided to set premiums at roughly 8% of the median income, or in other words, what Congress arbitrarily decided someone with a median income could afford, before they receive any actual medical services.

As a married couple, we will be eligible for subsidies - if and only if - we both sign up for a plan on the exchange. To do this, my wife will need to drop her non-profit plan run by the very school-owned hospital that provides the services (for both of our plans, actually). Of course, that's just theoretical because right now I can't get a proper application on the exchange. My first attempt dropped her halfway through the process, and the second attempt created a second copy of me, and wants to bill me for three plans. Making changes to those applications is "currently not available," but I've probably already committed federal wiretap fraud in trying to make a second attempt so I'm hesitant to spend more hours writing up a third.

In all, this will result in a 150% increase in the amount we spend on insurance, and we will end up with significantly worse plans. Does it make me feel better that I might be able to get the government to pay some or all of that increase? Not in the slightest.

Now your other claim... that I'm healthy... well thank you, but it has nothing to do with the medical system except perhaps that I stopped trusting & seeing doctors, and started taking responsibility for researching my own health. See, I've been through the for-profit system as a chronically ill patient. I even got the VIP treatment via my dad's federal employee "platinum plan." Do you know what I looked like to those doctors? A blank fucking check. Every specialist you can name failed to diagnose a relatively common disease with a free cure. Go figure. They did manage to prescribe a lot of useless and dangerous drugs & surgeries to mask the symptoms until the side-effects kicked in... but the "benefit" of that excessive spending isn't a fate I'd wish on my worst enemy.

John, is the school-run plan you have now getting cancelled? I assume you can just stay with that.

I imagine the subsidies will help some people. There seem to be problems for others. It would be so much simpler if we would just have Medicare for all, and raise the medicare tax to pay for it. I imagine that's hard because the conservatives have successfully raised the specter of socialism; plus the insurance companies have such power over politicians.

Originally Posted by Eric the Green

John, is the school-run plan you have now getting cancelled? I assume you can just stay with that.

I imagine the subsidies will help some people. There seem to be problems for others. It would be so much simpler if we would just have Medicare for all, and raise the medicare tax to pay for it. I imagine that's hard because the conservatives have successfully raised the specter of socialism; plus the insurance companies have such power over politicians.

The school run plan will still be there, but a) I'm not eligible because I'm not a student or employee b) the plan isn't registered on the exchange and is not eligible for any subsidies and c) next year's prices won't be available until after Jan. 1, while we are required to make exchange purchases before Dec. 15 to avoid an interruption in coverage.

If the school plan "only" goes up 20% like insurance tended to do before the ACA, it will end up being a 75% increase in our collective insurance premium, and a marginal reduction in my plan's benefits in all scenarios. It's more than likely that I will choose to drop the non-profit plan due to the perverse incentives created by this poorly written law, and that will result in a 150% increase in premiums being paid by us and on our behalf. (as well as huge new overhead income for the private, for-profit insurer who has monopolized our town's allotment of federal "generosity")

Still though, I can't afford to get sick if that means missing work and spending hours in a waiting room with a dozen other sick people to pay some doctor $100 for fifteen minutes of consideration. That's the status quo before the ACA increases demand for doctors' services without increasing supply.

The conservatives have not "succeeded" in anything. The GOP's approval rating and relevance are in the dumpster.

The problem is that "liberals" have not succeeded in anything except being rejected by the corporate-center Democrats. The public option was much more popular than the current ACA, but Reid & Baucus decided to use the Republicans' old healthcare proposal as a starting point in negotiations. It doesn't take a degree in political economy to realize the GOP is going to take that as a concession of weakness and demand even more.

Democrats coulda/shoulda/woulda rode the millie wave and pushed hard to the left on this issue. There was too much at stake not to, and now this defeat is of their own doing, and this has not been caused by any particular victory from the right. It's basically the last reason the right has any life left in it - all of the usual limo-liberal suspects are coming out to mock the concerns of the "misguided" poor people they're trying to help - and they do so in such a way as to prove they are wholly ignorant of exactly what those concerns are. Their hearts might be in the right place, but their heads are in a totally different social class and economic world than the one they're trying to help. You can't afford healthcare? Let them enroll in platinum plans at a small discount! Cake too, please. [while the quote and Antoinette attribution may be apocryphal, there is truth in the saying still]

A rational universal healthcare system based on economic and healthcare success demonstrated in two dozen countries around the world could have been Obama's silver bullet for reversing the Reagan trend, but the party would rather follow their corporate sponsors than lead in a new direction. Opportunity cost is still a cost, and that cost is incalculable in terms of political capital, American's health outcomes, bank accounts, as well as our workers' competitiveness in the global economy for decades to come.